Response of Post-Mastectomy Lymphedema to Extracorporeal Shockwave Therapy

Abstract

Introduction: Post-mastectomy lymphedema is a chronic, debilitating disorder that is frequently misdiagnosed, treated too late or not treated at all, Lymphedema (LE) is an abnormal accumulation of protein-rich fluid in the interstitium leading to limb swelling, chronic inflammation and reactive fibrosis of the affected tissues resulting from damage to lymphatic circulation following surgery, chemotherapy and/or radiation therapy. The aim was to investigate the effect of shockwave therapy on the post-mastectomy lymphedema. Subjects and methods: Sixty female patients underwent modified radical mastectomy surgery or lumpectomy, chemotherapy and radiotherapy associated with unilateral lymphedema (stage 2, 3), into two equal groups; their ages ranged from 30-50 years. The study group received shockwave therapy 2 times/week for 6 weeks plus traditional physical therapy program (manual lymphatic drainage, circulatory exercises with elevation, shoulder ROM exercises and pneumatic compression therapy) 3times /week /6weeks. Control group received traditional physical therapy program (manual lymphatic drainage, circulatory exercises with elevation, shoulder ROM exercises and pneumatic compression therapy) 3times /week /6weeks. Evaluation procedures were carried out to measure the upper limb volume measurement, ROM of shoulder flexion, abduction and external rotation. Results: Post treatment results showed that there was a significant improvement difference in shoulder ROM and upper limb volume in both groups in favor of the study group.

Low-Energy Extracorporeal Shockwave Therapy as a Therapeutic Option for Patients with a Secondary Late-Stage Fibro-Lymphedema After Breast Cancer Therapy: A Pilot Study

“…Therefore we tried to provide an alternative noninvasive method for treating the residual LE. The mean value of pre-treatment total volume of the upper limb in our patient group was 3086.4 mL, this was more important compared with 2332.9 mL in the study of Bae and Kim, 21 and only 1219.33 mL in the study of El-Shazly et al 24 They even excluded subjects with a total arm circumference difference of 8 cm. No absolute values of affected arm volume are reported by Mahran and Thabet, 22 Cebicci et al 23 or Abdelhalim and Samhan.…”

“…In the pilot study of Cebicci et al 23 265.9 mL reduction was reported after 4 weeks of ESWT, this result was maintained after 6 months. El-Shazly et al 24…”

“…These studies demonstrated good results on self-reported outcome by visual analog scale (VAS) and/or shoulder mobility, reduction of volume, and/or circumference of the arm (Table 2). [21][22][23][24][25] The hypothesis of our study was that ESWT can play a role in reducing the complaints associated with upper limb longstanding fibro-LE (stage III), also after lymphatic surgery.…”

The effect of the combined use of complex decongestive therapy with electrotherapy modalities for the treatment of breast cancer-related lymphedema: a randomized clinical trial

“…Effective treatment of lymphedema in patients with breast cancer is of great importance and can enhance their quality of life [14,15]. Several studies have reported more improvement following combined techniques [16][17][18][19]. Koo et al reported a more significant improvement after combination of heperbaric oxygen therapy with CDT in patients with BCRL [17].…”

Common conservative treatments for lymphoedema post breast cancer: A focus article

“…107 apy (ESWT) was also found to be effective for 108 lymphoedema volume reduction both post treatment 109[40,41] and at 6 month follow-up[41].110 6. Self-treatment including weight loss 111 Life-long self-management is necessary to con-112 trol lymphoedema and is essential for achieving 113 and maintaining successful treatment, as the dam-114…”