title: Clinical outcomes of extracorporeal shock wave therapy in patients with secondary lymphedema: a pilot study.
abstract: OBJECTIVE
  To investigate the clinical effect of extracorporeal shock wave therapy (ESWT) in patients with secondary lymphedema after breast cancer treatment.
  
  
  METHODS
  In a prospective clinical trial, ESWT was performed consecutively 4 times over two weeks in 7 patients who were diagnosed with stage 3 secondary lymphedema after breast cancer treatment. Each patient was treated with four sessions of ESWT (0.056-0.068 mJ/mm(2), 2,000 impulses). The parameters were the circumference of the arm, thickness of the skin and volume of the arm. We measured these parameters with baseline values before ESWT and repeated the evaluation after each ESWT treatment. Subjective data on skin thickness, edema and sensory impairment were obtained using a visual analogue scale (VAS).
  
  
  RESULTS
  The mean volume of the affected arm after four consecutive ESWT was significantly reduced from 2,332 to 2,144 mL (p<0.05). The circumference and thickness of the skin fold of the affected arm were significantly decreased after the fourth ESWT (p<0.05). The three VAS scores were significantly improved after the fourth ESWT. Almost all patients were satisfied with this treatment and felt softer texture in their affected arm after treatment.
  
  
  CONCLUSIONS
  ESWT is an effective modality in the treatment of stage 3 lymphedema after breast cancer treatment. ESWT reduced the circumference and the thickness of arms with lymphedema and satisfied almost all patients with lymphedema. Therefore, this treatment provides clinically favorable outcome to patients with breast cancer-related lymphedema.
authors.affiliation: Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Hasuk
authors.initials: H
authors.lastname: Bae
authors.forename: Ho Jeong
authors.initials: HJ
authors.lastname: Kim
keywords: Breast neoplasms; High-energy shock waves; Lymphedema; Physiotherapy