The overall goal of this procedure is to diagnose breast cancer-related lymphedema and evaluate the therapeutic effect of resistive exercise by using ultrasonography to measure the thickness of subcutaneous tissue. Begin by laying the patient's arm in a supine position with both arms on the bed. Use a pen to mark the midpoint of the wrist crease, the midpoint of the medial and lateral epicondyles at the level of the elbow, in the bicipital groove.
Then connect these points using a ruler. Next, mark the first target area 10 centimeters proximal to the elbow point along the line between the elbow and bicipital groove. In the second target area, 10 centimeters distal to the elbow point along the line between the elbow and the wrist.
Then, switch on the ultrasound system. Enter the 2-D mode of the soft tissue via the keyboard. Set the depth to five centimeters and choose the 14L5 linear array transducer.
Apply sufficient gel to the ultrasound transducer and place it perpendicularly to the upper limb ventral axis. The short axis view to capture the image where the thickness of the gel is at least one centimeter and the soft tissue contours are not distorted. Next, select the calibrator and the software via the keyboard of the ultrasounds system to draw a line between the muscle and the subcutaneous tissue.
Then, measure the thickness of the muscle, defined at the distance between the highest point on the boundary of the bone to the highest point on the boundary portion of the fascia. Finally, measure the thickness of the subcutaneous tissue, defined as the distance from the skin to the fascia. After measuring the upper limb muscle and subcutaneous tissue thickness at baseline, give the patient a 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 forth week, and 25 times each during the fifth through eighth weeks. Inform the subject to return at four and eight 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. According to the tape measurement, arm circumference did not significantly change in the PRE group after four weeks of exercise. However, both proximal and distal arm circumferences showed a significant reduction after eight weeks.
As measured by ultrasonography in the PRE group, the thickness of muscle in the distal part showed a significant increase at four weeks and eight weeks. and the proximal part demonstrated a significant increase in thickness at eight weeks. Lastly, in the PRE group, the thickness of subcutaneous tissue in the affected upper limb significantly decreased after eight weeks.
No significant difference in these parameters was observed in the control group.
