Bae, H., & Kim, H.J. (2013). Clinical outcomes of extracorporeal shock wave therapy in patients with secondary lymphedema: A pilot study. Annals of Rehabilitation Medicine, 37, 229–234. 

To research the effect of extracorporeal shock wave therapy (ESWT) in patients who had secondary lymphedema after treatment for breast cancer

In this study, ESWT was performed four times over two weeks. Four patients received manual lymphatic massage and pneumatic compression along with ESWT, and three patients received only ESWT. The three participants did not receive massage or compression because they reported that it was not successful in the past. It does not seem that there was a follow-up after the post-treatment measurements on patients.

• N  = 7    
• MEAN AGE =  52 (SD = 9.9)
• MALES: 0%, FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Mean length of time that patients suffered lymphedema was 25.3 months (SD = 12.7). All patients had stage III lymphedema.   
• OTHER KEY SAMPLE CHARACTERISTICS: All patients had received chemotherapy and radiation. Four had received combination physical therapy.

• SITE: Single site 
• SETTING TYPE: Outpatient 
• LOCATION: Department of Rehabilitation, Ewha Womans University School of Medicine, Seoul, Korea

• PHASE OF CARE: Late effects and survivorship

• Prospective trial study

To determine lymphedema presence, a limb-to-limb difference of 2 cm or more had to exist at a single measurement site in addition to lymphatic obstruction as determined lymphoscintigraphy. The following subjective measurements were used: hardness of the skin, edema of the involved upper extremity, and sensory impairment. Each was measured using visual analog scale (VAS), with 10 points being most severe. Objective measurements used were volume of the upper extremity, thickness of the skin, and circumference of the upper extremity. Volume measurement was a direct technique was used as derived from Archimedes’ principle.

All patients experienced a reduction after four treatments of ESWT. The mean reduction volume was 188.6 ml (p = .018). Those who received physical therapy and ESWT showed a reduction rate of 39.46%, and those without physical therapy showed a rate of 34.25%. The difference was not significant. The mean decrease in circumference was 1.1 cm, with a range of 0.4–1.7 cm.The mean decrease in skin fold was 7.7 mm, with a range of 4–16 mm. The mean subjective edema was decreased significantly from 7.3 to 5.6 (p = .027). No patients experienced side effects.

ESWT appears to be effective in treating stage III secondary lymphedema in women after being treated for breast cancer. The circumference and thickness of patients' arms decreased after treatment. However, the sample size is very small and therefore is not representative of a diverse population of people.

• Small sample (< 30)

ESWT treatment may provide a noninvasive treatment alternative for patients with stage III lymphedema that has a high rate of effectiveness.