Upper limb sensory evaluations and ultrasonographic skin measurements in breast cancer–related lymphedema receiving complex decongestive physiotherapy

Abstract

Purpose The aims of this study were to investigate if/how the presence of lymphedema affects the sensation of the upper limb and to assess whether complex decongestive physiotherapy (CDP) has a favorable impact on sensory testing. Methods A total of 27 patients with unilateral stage 2 breast cancer–related lymphedema (BCRL) were included in the study. Bilateral circumferential measurements were taken with a tape measure at different levels. Based on these measurements, limb volumes were determined by summing segment volumes derived from the truncated cone formula. Circumferential measurements and ultrasonographic evaluations (epidermis, dermis, and subcutaneous fat thicknesses) were performed at 10 cm distal to the elbow crease. The Semmes–Weinstein monofilament (SWM), static and moving two-point discrimination, pressure pain threshold (PPT), and tactile localization tests were also applied at the same site. After an initial evaluation, all patients underwent CDP phase 1 program. All the evaluations were repeated at the end of the treatment period. Results Before CDP, affected sides had significantly higher values than the unaffected sides in terms of SWM ( p < 0.001), static ( p = 0.002) and moving ( p = 0.011) two-point discrimination, PPT ( p = 0.001), and tactile localization ( p < 0.001) values. After CDP, SWM ( p = 0.002), static ( p = 0.009) and moving ( p = 0.024) two-point discrimination, PPT ( p = 0.014), and tactile localization ( p < 0.001) values decreased significantly on the affected sides. Conclusion BCRL seems to reduce light touch, static and moving two-point discrimination, PPT, and tactile localization sensations, whereas CDP seems to improve these sensory perceptions in women with BCRL. Ultrasonographic measurements also appear to be promising for prompt and convenient follow-up in the management of BCRL. Trial registration Clinical Trial Registration Number: NCT04296929 (date of registration: March 5, 2020)

Sensory signs and symptoms in women with self-reported breast cancer–related lymphedema: a case–control study close up

“…However, a trend towards higher thresholds (i.e., poorer acuity) in women with objective and subjective BCRL compared to the control group was noted. To our knowledge, perceptual acuity using the two-point discrimination test has only been previously explored in a small sample of women with BCRL [42]. This study showed similar results with a decreased sensory perception at the affected side compared to the non-affected side [42].…”

“…To our knowledge, perceptual acuity using the two-point discrimination test has only been previously explored in a small sample of women with BCRL [42]. This study showed similar results with a decreased sensory perception at the affected side compared to the non-affected side [42]. A negative body image, including these altered perceptions, after breast cancer have been described extensively [20,43].…”

Development of a core outcome set for breast cancer-related lymphedema: a Delphi study

“…Measuring pain during other phases may be associated with differentiation between BCRL and other causes of pain [ 28 ], considering BCRL tends to be described as achy and heavy, but not necessarily ‘painful’[ 29 ]. It is evident that BCS with BCRL experience sensory changes, including reduced light touch, static and moving two-point discrimination, pressure pain threshold, and tactile localization sensations, which can improve with complete decongestive therapy [ 30 ]. For consistency, the study management and advisory groups advise to consider measuring pain and sensation for all phases.…”

Bibliometric analysis of breast cancer-related lymphedema research trends over the last 2 decades

“…CDT comprises four integral steps, encompassing skin care, freehand lymphatic drainage, compression bandaging, and functional exercise ( 39 – 41 ). A multitude of scholarly investigations has been dedicated to the study of CDT, evaluating its efficacy through various means.Some studies have focused on assessing the effectiveness of CDT using ultrasound ( 42 , 43 ) or BIS ( 44 ) to gauge its impact on edema reduction. Additionally, comprehensive evaluations of CDT’s effects on pain, quality of life, mood, and fatigue in BCRL patients have been conducted ( 45 , 46 ).…”