Is Complex Decongestive Physical Therapy Safe for Median Nerve at the Level of Carpal Tunnel in Breast Cancer Related Lymphedema?

F. Figen Ayhan, MD,1,2 Melek Aykut, MD,1 Hakan Genc¸, MD,1 Bas xak Mansız Kaplan, MD,1 and Atilla Soran, MD3. Lymphatic Research Biology 2018

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Is Complex Decongestive Physical Therapy Safe for Median Nerve at the Level of Carpal Tunnel in Breast Cancer Related Lymphedema?

Figen Ayhan, MD,1,2 Melek Aykut, MD,1 Hakan Genc¸, MD,1 Bas xak Mansız Kaplan, MD,1 and Atilla Soran, MD3. Lymphatic Research Biology 2018 

Background: Multilayer bandaging used in complex decongestive therapy (CDT) may increase tissue pressure resulting in nerve entrapments. The aim of this study was to discover if median nerve damage is a consequence of CDT in patients with breast cancer-related lymphedema (BCRL).

Methods and Results: Eighty-two arms of 41 patients with BCRL were included. Mean age was 56.05 (8.16) years and all stages of lymphedema were equally included. Fifteen sessions of CDT was applied to all patients. The calculated volume of extremities, the quality of life (cancer adaptation of Ferrans-Powell), neuropathic pain (NP; Douleur Neuropathique 4), and disability (quick disabilities of arm, shoulder, and hand [Q-DASH]) tests were recorded before and after therapy. Skin and subcutaneous tissue thicknesses of volar and dorsal sides and median nerve cross-sectional area (CSA) at the level of carpal tunnel were measured using ultrasonography (US), before and after therapy. Carpal tunnel syndrome (CTS; 41.37%) and polyneuropathy (10.34%) were common findings confirmed by electromyography. Neuropathic pain profile was also found in 34.14% of patients. The arm volume of affected side, quality of life, and skin and subcutaneous tissue thicknesses were improved after therapy (p<0.05). However, median nerve CSA, the NP, and Q-DASH scores were not changed after therapy.

Conclusions: Although lymphedema is a painless condition, NP and CTS should not be ignored in patients with BCRL. US is an alternative, precise, and high technological method for evaluating treatment response. CDT is an effective and safe treatment according to volumetric calculations, US measurements of tissue thicknesses and median nerve size.

Main findings

  • All patients underwent CDT, which included 30–45 minutes MLD, intermittent pneumatic compression pump, multilayer compression bandaging using Rosidal lymphedema upper extremity bandaging set, lymphedema remedial exercises, and skin care.
  • Ultrasonography included volar and dorsal skin thickness measurements at six different points at the hand (the base of thumb), the forearm, and the arm, were done before and after therapy. The six points were defined as follows: (1) hand, the thenar eminence of hand at the level of the base of the thumb; (2) forearm, 10cm distal to the elbow point along the line of the radial and ulnar styloid processes between the midpoint of the medial and lateral epicondyles; and (3) arm, 10cm proximal to the elbow point along the line of the humerus and the bicipital groove between the midpointof the medial and lateral epicondyles. All skin and subcutaneous tissue thickness measurements were performed at the volar and dorsal sides; in affected and unaffected arms; before and after therapy.
  • Electromyography included median and ulnar nerve conduction studies.
  • This research found that the phase 1 or intensive phase of CDT has no effect on the size of median nerve at the level of carpal tunnel, neuropathic pain score, and arm disability.