Different Dosages of Extracorporeal Shock Wave Therapy in Post Mastectomy Lymphedema

Abstract

Background: Secondary edema of the upper limbs is a debilitating and sometimes fatal condition that impacts the quality of life of patients. The purpose of this study is to determine the optimal number of impulses of extracorporeal shock wave therapy (ESWT) to reduce lymphedema in secondary upper extremity lymphedema, as well as its pain levels, QoL, and skin thickness relative to fibrosis.

Methods: Forty-five female patients, ranging in age from 35 to 65, were evaluated for upper extremity lymphedema (Foldi classification: stage 2, 3). Each of the three groups consisted of fifteen patienta.

Material and Methods: With a total of fifteen participants, group A underwent full decongestive therapy (CDT) while receiving ESWT with 2000 impulses at a treatment frequency of four Hz and an energy flux density (EFD) equivalent to two to three bars. The 15 participants in Study Group B underwent ESWT with 500 impulses at a frequency of 4 hertz and an EFD equivalent to 2-3 bar working pressure with CDT. Control Group C (n=15) got only CDT. The treatment was administered twice weekly for eight consecutive weeks. Pre- and post-study assessments included round measurement by tape of the following locations: hand, wrist joint, fifteen centimeters from wrist joint, elbow joint, seventeen centimeters from elbow joint, and the end of the arm close to the axillary fold; volumetric evaluations of water displacement; ultrasonographic measurements of skin thickness; as well as the lymphedema life impact scale (LLIS) for QOL.

Results: a significant difference was found among three groups post-treatment (p<0.05) in all outcome measures, however ESWT with 2000 impulse demonstrated superior outcome measures compared to lower dose.

Conclusion: this study provides novel insights by being the first to examine the effects of different impulse dosages of ESWT in patients with stage 2 and 3 post-mastectomy lymphedema. The results indicates that ESWT may play a promising role in reducing lymphedema and improving patient outcomes, particularly when applied with methodological rigor and supported by multiple evaluation tools.