The authors of this article proposed a new approach to treating breast cancer-related lymphedema. By requiring a pre-operative measurement baseline to bilateral upper extremities for each patient, physical therapists were better able to predict subclinical lymphedema by surveilling the patient every 3 months post-op up to 18 months. If >3% increase in upper limb volume was present, the physical therapist fitted the patient with a Jobst ready-made, 20- to 30 mmHg compression sleeve for 4 weeks. Once limb volume reduced, the sleeve was worn only during more rigorous activities or if symptoms increased.
The study found that by requiring the pre-operative screening and conservative management, patients demonstrated significantly reduced lymph volume compared with the control. Additionally, the patients did not require the more intensive and costly decongestive therapy utilized in managing life-long lymphedema. The shift in practice toward a surveillance-style will help therapists improve early diagnosis of subclinical lymphedema levels in hopes to prevent costly and more intensive care later.
Source: Costello M, Puentedura E, Cleland J, Ciccone C. The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial. JMMT.