• The Korean Journal of Pain
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• v.35 no.3
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• pp.280-290
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• 2022

Background: This study aimed to determine the impact of complex decongestive therapy applications on upper extremity function in breast cancer patients who developed adhesive capsulitis after lymphedema. Methods: Thirty patients who developed adhesive capsulitis due to lymphedema were divided into two groups as study (n = 15) and control (n = 15) groups. Both groups received 20 minutes of exercise five days a week for three weeks using a Biodex isokinetic dynamometer, as well as a hot pack and TENS (Transcutaneous Electrical Nerve Stimulation) treatment to the shoulder joint. The study group received 45 minutes of intensive decongestive therapy along with the adhesive capsulitis treatment. The visual analogue scale was used to assess pain, circumference, and volumetric measurements were used to assess edema, and the Arm, Shoulder, and Hand Problems Questionnaire (DASH: Disabilities of the Arm, Shoulder, and Hand) was used to assess upper extremity functionality. The shoulder range of motion was evaluated. Results: Both groups had improvements in pain (P < 0.001), shoulder joint range of motion (P < 0.001), and upper extremity functionality (P < 0.001) after the treatment. There was a significant decrease in circumference and volumetric measurements in the study group (P < 0.001). However, no differences were seen in measurements in the control group. Conclusions: The results showed that complex decongestive therapy was beneficial in reducing lymphedema in breast cancer patients who acquired adhesive capsulitis due to lymphedema. Consequently, the authors believe that supplementing conventional physiotherapy with complex decongestive therapy will benefit patients.

• The Journal of Korean Physical Therapy
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• v.21 no.4
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• pp.103-109
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• 2009

Purpose: Cases of male external genitalia lymphedema are relatively uncommon in the clinical physical therapy field. Of more than two thousand clinical cases treated by the author in the lymphedema treatment center, only 4~5 cases of male external genitalia lymphedema were encountered. The present case report presents the experience and treatment results of male external genitalia lymphedema from urological cancer. Method: This case was a 47-year-old man, who was treated with complex decongestive physical therapy consisting of manual lymph drainage, compression bandage (including the external genitalia), remedial exercise, skin care. Result: The results were relatively good. The clinical experience would suggest that early treatment and education can reduce the external genitalia lymphedema. However, the treatment efficacy remains limited. Therefore, early treatment is vital for more successful outcomes. Conclusion: The relief of symptoms and a decrease in male external genitalia lymphedema may be the best result from long-term conservative management.

• Journal of the Korean Society of Physical Medicine
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• v.6 no.1
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• pp.31-38
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• 2011

Purpose : The purpose of this study was to examine the effect of upper extremity exercise and Bandage on the edema and range of motion. Complex decongestive physiotherapy was one of the latest methods to deal with the limitation of range of motion and the edema that were the prime problems of patients with lymphedema. Methods : Twenty patients undergone mastectomy were participated in this study voluntarily. They had lymphedema on upper extremity and partial limitation of range of motion. The subjects had been treated with upper extremity home exercise and complex decongestive physiotherapy with Bandage for 4 weeks. The measure of these patients with upper extremity edema was included: the volume, arm circumfenence and range of motion. These were measured two times: before the treatment, after 4 weeks of the treatment. Results : The upper extremity edema of patients treated home exercise group and complex decongestive physiotherapy group with Bandage was definitely decreased (p<0.05). Moreover, the upper volume of those who were the same condition also significantly shrank and patients' arm circumferences of upper arm breathtakingly diminished as well (p<0.05). But home exercise group patients' arm circumferences of forearm was not remarkable(p>0.05). However, patients' range of motion who were treated with upper extremity exercise were evidently increased when compared to that of the before treatment (p<0.05). Conclusion : Complex decongestive physiotherapy and bandage performed by physical therapist increased the ROM of upper arm and reduced the edema in patients with lymphedema.

• Journal of the Korean Society of Physical Medicine
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• v.8 no.2
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• pp.153-161
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• 2013

PURPOSE: This study aimed to investigate the effect of complex theraputic exercise on visual analog scale of pain, shoulder' range of motion for middle-aged women with breast cancer related lymphedema. METHODS: The 14 middle-aged women involved voluntary in this study and then they were divided into two groups(n =7 per group). The complex exercise program was implemented over 4 weeks, 60 minutes per day, with 3 types of exercise for stimulation whereas the control group was performed a classical decongestive physiotherapy in a same day. For data analysis, the mean and standard deviation were estimated; 2 way repeated measures ANOVA was carried out. RESULTS: First, The level of VAS was significantly reduced on time, interaction effect in the group. Second, most factors of ROM were significantly increased on time, interaction effect whereas extension was not significantly increased. CONCLUSION: In conclusion, Our results showed that complex therapeutic exercise could improve or maintain VAS and ROM of shoulder joint for middle-aged women with breast cancer related lymphedema.

• Physical Therapy Korea
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• v.14 no.3
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• pp.1-8
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• 2007

The purpose of this study was to determine whether aromatherapy massages with manual lymph drainage (MLD) are significantly more effective than sham massages with MLD in reducing edematous limb volume in lymphedema. This study was performed on 46 patients who had developed unilateral upper or lower lymphedema. Twenty-three patients served as the experimental group and were treated with complex decongestive physiotherapy (CDP) applications including aroma massages with MLD, multi layered compression bandages, remedial exercises and skin care. Twenty-three patients in the control group were treated with CDP applications including sham massages with MLD, bandages, exercises and skin care. Patients undergo a therapy program once a day; 5 days a week for 2 weeks. Percentage excess volume (PEV) and body mass index (BMI) were recorded before and after treatment. PEV and BMI were significantly decreased before and after treatment in the experimental as well as in the control groups (p<.05). However, the percentage excess volume and BMI were not significantly improved after treatment between the two groups (p>.05). This study there suggests that aroma massages is not effective in the edema of patients with lymphedema.

• Archives of Plastic Surgery
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• v.50 no.3
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• pp.288-304
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• 2023

Background Untreated lymphedema of an extremity leads to an increase in volume. The therapy of this condition can be conservative or surgical. Methods "Lymphological liposculpture" is a two-part procedure consisting of resection and conservative follow-up treatment to achieve curative volume adjustment of the extremities in secondary lymphedema. This treatment significantly reduces the need for complex decongestive therapy (CDT). From 2005 to 2020, 3,184 patients with secondary lymphedema after breast cancer and gynecological tumors were treated in our practice and clinic. "Lymphological liposculpture" was applied to 65 patients, and the data were recorded and evaluated by means of perometry and questionnaires. Results The alignment of the sick to the healthy side was achieved in all patients. In 58.42% (n = 38), the CDT treatment could be completely stopped postoperatively; in another 33.82% (n = 22) of the patients, a permanent reduction of the CDT was achieved. In 7.69% (n = 5) patients, the postoperative CDT could not be reduced. A total of 92.30% (n = 60) of the patients described a lasting significant improvement in their quality of life. Conclusion "Lymphological liposculpture" is a standardized curative sustainable procedure for secondary lymphedema for volume adjustment of the extremities and reduction of postoperative CDT with eminent improvement of the quality of life.

• Physical Therapy Korea
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• v.6 no.3
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• pp.110-120
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• 1999

Lymphedema, regardless of etiology, is essentially incurable but different treatment approaches which serve to contain swelling exist. The objectives of treatment are to reduce swelling, restore shape, educate about the self-maintenance methods, and prevent inflammatory episodes, eg, recurrent cellulitis. The purpose of this report is to provide therapists and other medical staff with a general guideline through the example treatment procedure of two patients with lymphedema admitted to Samsung Medical Center. This study demonstrates the effects of the various treatments used and how they helped to achieve improvement in mobility and reduction in swelling of the lower limbs. The basic conservative treatments were sequential intermittent pneumatic pumps, elevation, and CDP (complex decongestive physiotherapy). The surgical procedures (Homan's operation) were carried out after maximal volume reduction through conservative programs. In these cases, we can see greater than 50% reduction in the lymphedema in those treated by conservative and surgical procedures. This presents a simple, reliable, variable method yielding satisfactory cosmetic and functional results for patients suffering from chronic both-leg lymphedema. Futhermore, I suggest that the outcomes are best when treatment is administered by a multidisciplinary team including a physiotherapist, surgeon, nurse, et al.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.3
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• pp.73-84
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• 2022

Background : Lymphedema is a progressive disorder characterized by the impairment of lymph flow from tissues to the blood circulation system. This occurs as a result of damage to the lymphatic system. Complex decongestive therapy (CDT) is a multimodal, conservative therapeutic approach that is used for the management of lymphedema. CDT consists of a combination of compression therapy, manual lymphatic drainage, exercise, and skin care. Purpose : This study aimed to provide a review of available physical therapy interventions as well as general care guidelines for patients with lymphedema. Methods : The recommendations and guidelines for physical therapy management, medical management, and general information were reviewed from the following sources: 1) The American Physical Therapy Association, 2) The Norton School of Lymphatic Therapy, and 3) The International Society of Lymphology. This review contains general information, including the medical management and the importance of physical therapy in lymphedema. Physical therapy management should be based on an assessment of the patients' presenting impairments, including based on inclusion or exclusion of physical therapy interventions. This review also outlines a step-by-step approach that starts with disease diagnosis and progression all the way through to rehabilitation as an outpatient. Conclusion : Depending on the patients' journey to recovery and the requirement for rehabilitation, physical therapy interventions should focus on the patients' needs including pain, appearance, physical function and general rehabilitation. We hope that this review will provide information on evidence-based physical therapy and general care to patients with lymphedema.

• Clinical Pain
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• v.20 no.1
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• pp.25-29
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• 2021

Upper limb morbidity including shoulder pain, lymphedema, adhesive capsulitis, myofascial pain syndrome, and limited range of motions (LROMs) occurs frequently in breast cancer patients. Especially restricted upper limb motion aggravated by chronic lymphedema results in functional limitation and impaired activities of daily living (ADL). However, conventional rehabilitation therapy including complex decongestive therapy and stretching exercise is insufficient for managing advanced breast cancer patients with complex upper limb morbidity. Here, we report a case of breast cancer-related chronic lymphedema in a 62-years old female with severe LROM in all joints of the affected upper extremity that caused severe disability in ADL. Significant improvements in range of motion and upper extremity function were observed after serial extracorporeal shock wave therapy (ESWT), combined with conventional rehabilitation therapy. Therefore, ESWT might be recommended for managing the extensive limited joint motion which causes functional decline in a patient of chronic lymphedema with trophic skin change.

• Physical Therapy Korea
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• v.10 no.3
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• pp.53-61
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• 2003

The purpose of this study was to determine the effects On the lymphedema patients of sponge padding and the correlation between the rate of edema reduction and downward shifting of bandages. Fifty secondary lymphedema patients with no infection, active cancer, limitation of movement, pain or drugs were randomly assigned to two groups: a sponge padding group, and a cotton padding group. Complex decongestive therapy was applied for 2 weeks. In each group the volume of the ankle, mid-calf, knee, and mid-thigh and downward shifting of bandages at the thigh was measured with measuring tape. The reduction of volume and downward shifting of bandages were analyzed by the unrelated t-test and the Pearson Correlation Test. The results were as follows: 1. In comparison between the sponge padding group and the cotton padding group, there was no significant difference in volume except in the thigh area. The edema volume was reduced significantly to $37.77{\pm}31.15%$ at the thigh with sponge padding after treatment (p<.05). 2. Bandage shifted 10.12 cm with cotton padding, but only shifted 2.85 cm when sponge padding was used. Sponge padding had an excellent effect in preventing the shifting of bandages. There was a significant difference in the amount of shifting that occurred with each type of padding (p<.05). 3. There was also a strong correlation between the reduction of edema and the shifting of bandage. These results suggest that short-stretch bandaging with sponge padding is more effective than bandaging with cotton padding. Further study on skin irritation and the comfort of sponge padding is needed to use padding materials safely and effectively.