Lymphedema Ultrasonography: A Technique to Measure the Change in Thickness of an Affected Tissue

Most cancer patients suffer from lymphedema post treatment. A condition of localized fluid retention and tissue swelling. The lymphedema reduces with progressive resistance exercises, PRE, which can be elucidated by ultrasonography measuring affected tissue thickness. First, make the lymphedema patient wear a compression stocking on an affected part, such as the arm and hold a half kilogram dumbbell.

Instruct her to perform PRE, such as dumbbell fly, triceps extension, and biceps curl for a specified time duration with the required number of repeats. After therapy, lay the patient in a supine position with arms on the side. Using a pen, connect the midpoint of the wrist crease, the midpoint between the medial and lateral epicondyles at the elbow, level and the bicipital groove.

Now, mark two target areas on the upper arm and forearm. Next, apply sufficient gel to an ultrasound transducer and place it perpendicularly on the marked area. Capture the image and measure the thickness of the subcutaneous tissue and the muscle.

Compare the image with the control patient unaffected with lymphedema. The lymphedema usually reduces and the muscle thickness increases with PRE. In the following protocol, we will perform ultrasonography to determine the effect of progressive resistance exercises on breast cancer related lymphedema.

After measuring the upper limb muscle and subcutaneous tissue thickness at baseline, give the patient a 0.5 kilogram dumbbell and have him or her put on a compression stocking. Ask the patient to perform the progressive resistant exercises or PRE in the following order, dumbbell fly, tricep extension, one arm bent over row, bicep curls, dumbbell side raise, and lifting the arms forward.

Next, instruct the patient to complete the six exercises twice a day according to the following schedule. Five times each during the first week, 10 times each during the second week, 15 times each during the third week, 20 times each during the fourth week, and 25 times each during the fifth through eighth weeks.

Inform the subject to return at 4 and 8 weeks later to measure the thickness of the subcutaneous tissue and muscle of the upper limb again. Finally, after all measurements are collected, analyze the data by comparing the difference between both arms using a paired t-test. Compare the changes in subcutaneous tissue and muscle thickness using a repeated measures ANOVA.