Research Paper E-ISSN NO : 2455-295X | VOLUME : 4 | ISSUE : 8 | AUGUST 2018

TO STUDY THE EFFECTIVENESS OF PNEUMATIC COMPRESSION

THERAPY ON UPPER LIMB EDEMA, SHOULDER FUNCTION IN POST
RADICAL MASTECTOMY INDIVIDUALS.

DR. C.PRASAD 1 | DR. K.MADHAVI 2 | DR. ASHAJOTHI 3

1 MPT (CT) PG STUDENT, COLLEGE OF PHYSIOTHERAPY, SVIMS, COLLEGE OF PHYSIOTHERAPY, SRI VENKATESWARA
INSTITUTE OF MEDICAL SCIENCES (SVIMS) UNIVERSITY, TIRUPATI – 517 507 (AP), INDIA.
2 MPT (CARDIO THORACIC), PH.D., FIAP, PROFESSOR, HOD, PRINCIPAL, COLLEGE OF PHYSIOTHERAPY, SVIMS, COLLEGE OF

PHYSIOTHERAPY, SRI VENKATESWARA INSTITUTE OF MEDICAL SCIENCES (SVIMS) UNIVERSITY, TIRUPATI – 517 507 (AP),
INDIA.
3 MPT (CT), CLINICAL STAFF, COLLEGE OF PHYSIOTHERAPY, SVIMS, COLLEGE OF PHYSIOTHERAPY, SRI VENKATESWARA

INSTITUTE OF MEDICAL SCIENCES (SVIMS) UNIVERSITY, TIRUPATI – 517 507 (AP), INDIA.
ABSTRACT
Introduction
Breast cancer has been the most common form of cancer in women, but its incidence has decreased with increasing diagnosis and treatment options
in the last few years However, illness-induced functional impairment still constitutes a problem. Patients with breast cancer undergo surgical
treatment (mastectomy) accompanied by axillary node dissection, radiotherapy, and chemotherapy. These treatments impair lymphatic drainage of
the affected upper limb, and place patients at risk for secondary upper limb edema, which has been reported at rates ranging from 10.0% to 49.0%.
Breast cancer patients develop some complications because of both the nature of the cancer itself and the treatment of the cancer, including
cosmetic, psychological, and physical problems, such as dysfunction of the shoulder and upper limb edema. Post-operative breast cancer are
commonly referred to physiotherapy for treatment of reduced shoulder complex function . There is a growing evidence that strengthening or
resistive exercises, enhances strength, improves quality of life and reduces incidence of upper limb edema. Exercises is an important component of
the cancer rehabilitation continuum. Manual lymphatic drainage is a massage technique that is performed from distal to proximal directions .
Pneumatic compression therapy, which involves gradual pressure gradients on the lymph vessels, helps to drain the lymph flow. Apart from
strengthening exercises, lymphatic techniques as are essential to soothe the total motion.
AIM OF THE STUDY
To study the effectiveness of pneumatic compression therapy on upper limb edema shoulder function in post radical mastectomy individuals.
NEED OF THE STUDY
Many of the studies have done on Faradism under pressure and manual lymphatic drainage on upper limb edema but there is dearth of the studies
on efficacy of pneumatic compression therapy on upper limb edema, shoulder function in post radical mastectomy individual.
OBJECTIVES
 To find out the effectiveness of pneumatic compression therapy on upper limb edema through Pneumatic compression unit in units, in post
radical mastectomy individuals.
 To find out the effectiveness of pneumatic compression therapy on shoulder function through DASH scale in units, in post radical
mastectomy individuals.
METHODOLOGY
Patients who had a history of unilateral upper limb edema for at least 1year. Upper limb edema more than 2 inches compared to normal limb, were
taken up to the study.
All the patients who are eligible for this study were included in the study. 25individuals were taken up for the study they received a pneumatic
compression therapy for 60mm of Hg pressure for 30 minutes. Manual lymphatic drainage for 10minutes, upper limb stretching’s for 10 minutes,
shoulder mobility exercises for 10 minutes, under therapist supervision. Patients were treated 5times per week for 3weeks a total of 15 sessions.
After the therapy the patients were instructed to continue the exercises. Pre and post therapeutic values of upper limb oedema and DASH were
measured.
RESULTS
The pre and post experimental mean value, t-test and p-value of all the outcomes that is upper limb edema, DASH are significant at (0.05) in the
group.
CONCLUSION
The study concluded that pneumatic compression therapy, manual lymphatic drainage, stretching‘s, shoulder mobility exercises showed a significant
improvement in alleviating upper limb edema, DASH.

KEYWORDS: Breast Cancer, Pneumatic Compression Therapy, Manual Lymphatic Drainage, Disability Of Arm Shoulder Hand.
this signals resulting uncontrolled growth and
INTRODUCTION
proliferation2.
Cancer is a disease in which a group of abnormal cell grow
Breast cancer has ranked number one cancer among
uncontrollably by disregarding the normal rules of cell
Indian females with age adjusted rate as high as 25.8 per
division .Cancer cells develop a degree of autonomy, from
100,000 women and mortality 12.7 per 100,000 women.

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Research Paper E-ISSN NO : 2455-295X | VOLUME : 4 | ISSUE : 8 | AUGUST 2018
Data reports from various latest national cancer registries
were compared for incidence, mortality rates. The age
adjusted incidence rate of carcinoma of the breast was
found as high as 41 per 100,000 women for Delhi, followed
by Chennai (37.9), Bangalore (34.4) and
Thiruvananthapuram District (33.7). A statistically
significant increase in age adjusted rate over time
(1982–2014) in all the PBCRs namely Bangalore (annual
percentage change: 2.84%), Barshi (1.87%), Bhopal
(2.00%), Chennai (2.44%), Delhi (1.44%) and Mumbai
(1.42%) was observed. Mortality-to-incidence ratio was
found to be as high as 66 in rural registries whereas as low
as 8 in urban registries. Besides this young age has been
found as a major risk factor for breast cancer in Indian
women. Breast cancer projection for India during time
periods 2020 suggests the number to go as high as
1797900. Better health awareness and availability of
breast cancer screening programmes and treatment
facilities would cause a favorable and positive clinical
picture in the country.1
Breast cancer is a family of diseases where cell in the
breast tissue grow and divide without normal control .This
growth of cells forms a mass or lump called a tumor
Tumors are either benign or malignant. Breast cancers are
mainly two types that is invasive and non-invasive breast
cancer. Getting older, a history of breast cancer, Estrogen
exposure, Obesity, Height, Alcohol consumption, Radiation
exposure, Hormone replacement therapy are some
risk factors that can impact woman’s likelihood of
developing breast cancer2.
Patients with breast cancer will have a lump or thickening
in or near the breast or in the underarm area, change in
the size or shape of the breast, dimpling or puckering in
the skin of the breast, new nipple retraction, discharge
(fluid) from the nipple, possibly bloody, Scaly, red or
swollen skin on the breast, nipple or areola (the dark area
of skin at the center of the breast), skin that may have
ridges or pitting so that it looks like the skin of an orange.
Breast cancer is usually diagnosed by breast examination,
breast ultrasound, biopsy of nodule detection by
mammogram or by palpation2.
Management of breast cancer is mainly surgical procedure
that is, lumpectomy (removal of the lump only), or
mastectomy( surgical removal of the entire breast) is
performed followed by radiation therapy involves using
high-energy X-rays or gamma rays that target a tumor or
post surgery tumor site is used. Chemotherapy is the use of
anti-cancer drugs to treat cancerous cells2.
Post operatively breast cancer patients present with more
complications like infection, fat necrosis, and severe
musculoskeletal problems such as soft tissue necrosis and
mild to moderate musculoskeletal pain, restricted
shoulder movements swollen arm are more common13.
Faradism under pressure is the option to treat lymphatic
edema in post-radical mastectomy individuals, along with
manual lymphatic drainage, shoulder mobility, and
stretching exercises. Pneumatic compression therapy is an
INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL
advanced instrument which is available to alleviate
edema. Very few studies were done on the effectiveness of
pneumatic compression therapy on upper limb edema in
post radical mastectomy individuals. Hence the aim of the
study is to find out the effectiveness of pneumatic
compression therapy on post-radical mastectomy
individual.
MATERIALS AND METHODOLOGY
The said study was ethically approved by college of
physiotherapy ,SVIMS University, Tirupati. Study was
averse events are collected at each visit or voluntary
reported by contacting the investigator. (code:16080146).
Materials used were pneumatic compression therapy
used to treat the upper limb lymph edema in post surgical
radical mastectomy individuals, inch tape to measure the
edema by recording the circumference of the upper limb at
the level of mid arm, elbow and forearm in inches.
STUDY DESIGN: The study is Quasi experimental study.
STUDY PERIOD: October, 2017 – February, 2018
STUDY CENTER
The study was conducted in oncology ward, SVIMS
university,-Tirupati , Andhra Pradesh.
INDIVIDUALS
One year duration of post surgical radical mastectomy
patients were referred by oncologist to physiotherapy
department were taken up from the study.
SAMPLING METHOD: Purposive sampling method was
used.
SAMPLE SIZE: Only 25 samples were collected.
INCLUSION CRITERIA
 Gender – female
 Age- 40 to 60 years
 Upper limb lymph edema more than 2 inches
compared to normal limb
 Unilateral mastectomy with axillary lymph node
dissection(ALND)
 Minimum 1 year after surgery
 DM, HTN without any co-morbidities
EXCLUSIVE CRITERIA
 Bilateral mastectomy
 PA shoulder
 Cervical spondylitis
 Previous rib , shoulder fractures
 Age below 40 years
 Any cardiac problems
 Any kidney problems
OUTCOME MEASURES
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Research Paper E-ISSN NO : 2455-295X | VOLUME : 4 | ISSUE : 8 | AUGUST 2018
 Edema measured with inch tape in inches edema, DASH were analyzed using the paired t-test.
 Shoulder functions were assessed using DASH HYPOTHESIS
scale in units
Alternative hypothesis:
METHODOLOGY Pneumatic compression therapy may have impact on
Twenty five individuals with upper limb edema followed upper limb edema, DASH in post surgical mastectomy
by total radical mastectomy, who me inclusive criteria individuals.
were taken and the study was performed at SVIMS
Null hypothesis:
surgical oncology ward. All the participants were informed
about the study and their written informed consent was Pneumatic compression therapy may neither have
obtained. impact on upper limb edema, DASH in post surgical
mastectomy individual.
Demographic Data of the individuals gender, age, type of
surgery, side, date of surgery, upper limb edema (Inch Table 1: Mean, SD, t-test values of upper limb
tape) shoulder function (DASH score), were recorded. All edema, DASH score of post-radical
the individuals received pneumatic compression
Parameters N Mean SD Df t-value p-value
therapy with 60mmHg pressure for 30 minutes, manual MID ARM PRE13.3± 1.43
lymphatic drainage were given for 10 minutes, upper limb 25 84 10.69139 0.05
Lymphedema POST9.98± 1.24
stretching’s for 10 minutes, shoulder mobility exercises for
10 minutes for one hour per day, five days a week for three ELBOW PRE11.86 ±1.03
25 76.5 10.69139 0.05
weeks for total fifteen sessions. Under the supervision. Lymphedema POST8.8 ± 1.13
After the therapy the patient were instructed to continue FORE ARM PRE12.24 ±1.41
the shoulder mobility exercises at home .Handouts of 25 88.5 9.578068 0.05
Lymphedema POST8.7± 1.27
shoulder mobility exercises were given to patient and
PRE53.72 ±4.44
explained the pattern of doing the exercises. Assess the DASH% 25 504 24.40695 0.05
individuals initially and 15 day after the completing the POST33.56±4.09
therapy.
The result shows that the pre and post mean values of
pain, shoulder ROM, upper limb edema , DASH and are
significant at p=0.05.
Graph: Cumulation of pre and post mean values of
upper limb edema of arm, elbow, forearm, DASH of
post radical mastectomy individuals.

STATISTICAL ANALYSIS AND RESULT DISCUSSION

Statistical analysis has been carried out to analysis the
significant impact of the PCT ,MLD, ROM, stretching’s
issued to the subject by using 16.oversion for that the data
has got entered into microsoft excel sheet and tabulated
then it has subjected to statistical analysis.
The total sample are 25 taken for the study, quasi
experimental study was done. All the individuals
underwent PCT, MLD, ROM, Stretching’s for fifteen
sessions without any interruption.
The pre and post therapeutic parameters of upper limb
Pre and post mean valve of lymph edema using the inch
tape in inches is mid arm 13.3 ± 1.43 to 98± 1.24, elbow
11.86 ± 1.03 to 8.8 ±1.13 ,forearm 12.24± 1.41 to 8.7 ±
1.27 with significant at p –value 0.05. The above results
are because of the use of IPC and MLD, which works on the
principle of motion and sequential compression method.
The circumferential compression of the upper extremity
by IPC also transmits pressure to the subcutaneous tissues
and the muscle groups. Compression increases the
interstitial pressure in the extracellular space. When the
interstitial pressure is greater than the hydrostatic

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Research Paper E-ISSN NO : 2455-295X | VOLUME : 4 | ISSUE : 8 | AUGUST 2018
pressure within the vessels, third spaced fluids are forced
back into circulation. This phenomenon effectively
decreases the cross-sectional area of the lower extremity
and decreases the tensile stretch on the cutaneous tissues;
especially in patients with an edematous upper extremity.
The decreased surface tension may provide improved
transcutaneous oxygenation and clearance of metabolic
toxins.12
Many of the studies have supported that MLD. IPC helps to
drain the lymphatic flow which enhances shoulder
mobility9,8,7,3,4.
Pre and post mean valve of shoulder function using DASH
scale in units 53.72 ±4.44 to 33.56±4.09 with significant at
p –value 0.05. The above said shoulder exercises can help
to improve ADL activities and decreases the DASH score.
It is supported by Sahar Zamani et al 2017 which
concludes that shoulder dysfunction following surgery in
patients with breast cancer is common. Physiotherapy
treatment in these patients is almost different from
common cases. It should be taken into account that in
patients suffering from lymph edema, recovering the
shoulder movements and early return to normal function
is very effective in improving lymph flow and reducing
edema. Therefore,, restoring shoulder movement in these
patients improves lymph flow in addition to reducing
shoulder pain and increasing its performance.14
This is explained by effects of mobilization on joint
mobility which break the adhesions , realignment of
collagen, or fiber gliding increase by specific movements
that stress the capsular tissue. The induced rheological
changes in synovial fluid, increased exchange of fluid
between tissues and the cartilage matrix and enhanced
synovial fluid turnover are found to be affected by joints
mobilization.
It is supported by few studies proved that that
multifactorial physical therapy (i.e. stretching and
exercises) and active exercises were effective to treat
postoperative minimizes the adhesion formation following
treatment for post radical mastectomy musculoskeletal
complications when done regularly during first 180 days.
This confirms the benefit of early initiation of the
functional rehabilitation and with continuous monitoring
for at least three months after surgery10, 11, 6,12,5.
The most common physiotherapy intervention used in the
management of post-operative breast cancer patient were
shoulder stretches, glenohumeral joint range of motion
exercises, general arm care advice, and postural education
(risk factors),which improves shoulder function and
quality of life following axillary dissection in breast cancer.
SUMMARY:
In the summary the present study supports that pneumatic
compression therapy, manual lymphatic drainage,
stretching‘s, shoulder mobility exercise interventions for
the individuals with post radical mastectomy has shown
significant results.
INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL
CONCLUSION:
The present study accepts alternate hypothesis and rejects
null hypothesis. Hence, the study conclude that pneumatic
compression therapy, manual lymphatic drainage,
stretching‘s, shoulder mobility exercises has a significant
improvement in alleviating upper limb edema , shoulder
activities.
LIMITATIONS & RECOMMENDATIONS:
Scope:
The study may have lot of scope to continue the
experiment for further observation and evaluation to find
the other ways to encounter the problems of post Radical
mastectomy individuals to improve their quality of life.
Limitations:
 Small sample size (N=25).
 Duration of treatment 15session only.
 Needs to do comparative study
Recommendations:
 The further study is recommended to get large
sample size.
 The further study is recommended to study
the other outcomes also.
 The further study is recommended to study
other protocols also.
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