RU2737357C1 - Method for restorative treatment of postoperative complications in mammary gland - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, particularly to a method for restorative treatment of complications after mammary gland surgery, and can be used for prevention and treatment in oncology, surgery, and physiotherapy. That is followed by therapeutic exercises. Therapy is followed by sinusoidal modulated currents. That is followed by electrostatic massage and intermittent pneumatic compression with interruption between procedures for 40–60 minutes. Sinusoidal modulated currents are exposed to a cervico-thoracic spinal region and a subscapular region with a modulation frequency of 100–150 Hz and a modulation depth of 25–50 %. Current force is brought to sensation of vibration for 4–6 minutes daily once a day in number of 7–10 procedures. Electrostatic massage is performed by means of manual applicator of upper extremity on side of operation by successive exposure to frequency of 100 Hz for 5 minutes, frequency of 14–18 Hz for 5 minutes and frequency of 850 Hz for 4 minutes on area of hand, inner and outer surface of forearm, arms with transition to the forearm and subscapular region by motions in the form of circular, rectilinear and spiral, once day for 14 minutes in amount of 7–10 procedures, by acting low-frequency oscillations on the superficial muscles and nerve endings of the skin, and high-frequency ones to deep-lying ones. Intermittent pneumatic compression is performed at pressure of 40–60 mm Hg, compression of 40 s, decompression of 20 s for 40 minutes, daily in amount of 8–10 procedures.EFFECT: method provides higher therapeutic effect and reduced length of treatment.1 cl, 10 tbl, 5 ex

Description

The technical field to which the invention relates

The invention relates to medicine, in particular, to a method for the rehabilitation treatment of complications after breast surgery and can be used for prevention and treatment in oncology, surgery, physiotherapy.

State of the art

A known method and device for phototherapy of edema of the extremities by uniform irradiation of the pathology area from all sides by using separate light beams with a spectral band of no more than 20 them in the range of 620-670 nm and no more than 60 nm in the range of 820-950 nm, while the irradiation is carried out both continuous and pulsed or modulated irradiation, and the duration and frequency of the proposed method of phototherapy are set. The device is made in the form of a hollow semi-detachable cylinder, on the inner surface of which radiation sources are evenly located, providing the necessary parameters of phototherapy (see US Pat. RU No. 2196622 IPC A61N 5/06, publ. 20.01.2003, bull. No. 2).

The disadvantage of this method is the low quality and effectiveness of therapy for patients.

There is a known method for the treatment of postmastectomy syndrome, which consists in the fact that before the operation, the condition of the cervical and upper thoracic spine, joints and muscles of the shoulder girdle is diagnosed, functional disorders of the spinal motion segments (PDS), joints, the presence of blockade of the 1st rib , spasmodic and atonic muscles (CM and AM), which are eliminated using manual therapy techniques, after which physical therapy exercises are carried out aimed at relaxing the SM and increasing the tone of the AM, after the operation, they re-diagnose the disorders identified before the operation, and also additionally establish the presence the syndrome of the upper aperture of the chest and its nature, treatment is carried out in stages, at the first stage, against the background of drug therapy using manual therapy techniques, re-identified violations are eliminated, as well as violations of the PDS associated with the corresponding syndrome, at the second stage, a targeted stizometric relaxation of spasmodic muscles and ischemic compression of points of the head and neurolymphatic points, topically corresponding to regional disorders of blood and lymph circulation of atonic muscles; at the third stage, physiotherapy and massage are carried out, at the fourth stage, exercises of targeted therapeutic gymnastics are carried out aimed at relaxing spasmodic or increasing the tone of atonic muscles and restoring the function of the upper limb (see US Pat. RU No. 2218142 IPC A61H 1/00, publ. 10.12 .2003, bul. No. 34).

The disadvantage of this method is the low therapeutic and prophylactic effectiveness and long terms of expensive treatment.

There is a method of rehabilitation of patients after surgery for breast cancer with one-stage plastics, including the effect of a magnetic laser on the area of surgery, while from 5-8 days after the operation, infrared laser radiation with a constant magnetic field, the intensity of magnetic induction in the range of 20-50 mT, the repetition rate of pulsed laser radiation of the infrared spectrum within 80 Hz, with a power of 0.5-1.0 W throughout the postoperative area with a defocused beam for 0.5-2 minutes, including the axillary region, the course includes 5-8 procedures depending on from the type of postoperative complication, and 10-30 days after the operation, a sinusoidal magnetic field with an intensity of 10-20 mT is applied to the shoulder and breast area for 5 minutes with a course of 10-12 procedures carried out daily (see US Pat. RU No. 2334531 IPC A61N 5/067, A61N 2/04 publ. 09/27/2008, bull. No. 27).

The disadvantage of this method is the lack of effectiveness and long terms of treatment.

The closest in technical essence and the achieved positive effect, and adopted by the authors as a prototype, is a method for the rehabilitation treatment of complications after surgery on the mammary gland, including the impact of sinusoidal modulated currents on the cervicothoracic spine and subscapularis, carrying out physiotherapy exercises once a day during 25-30 minutes in the amount of 10 procedures, pneumocompression massage of the upper limb on the side of the surgical intervention (see Possibilities and effectiveness of using various complexes of physical techniques in the program of rehabilitation treatment of postmastectomy syndrome / Agranovich N.V., Sivolapova M.S., Gebenov M. H., Journal of Scientific Articles Health in the 21st Century and Education, http://dx.doi.org/10.26787/nydha-2226-7425-2018-20-7-62-65).

The disadvantage of this method is the long terms of treatment.

Disclosure of invention

The objective of the present invention is to develop a method for the rehabilitation treatment of complications after surgery on the mammary gland, which has an increase in the therapeutic effect and a decrease in the duration of treatment.

The technical result that can be achieved with the help of the present invention is reduced to an increase in the therapeutic effect and a decrease in the duration of treatment.

The technical result is achieved using a method of rehabilitation treatment of complications after breast surgery, including carrying out physiotherapy exercises once a day for 25-30 minutes in the amount of 10 procedures, therapy with sinusoidally modulated currents, electrostatic massage and intermittent pneumatic compression, while sequentially performing physical therapy, then therapy with sinusoidally modulated currents, then electrostatic massage and intermittent pneumatic compression with a break between procedures for 40-60 minutes, while the effect of sinusoidal modulated currents is carried out on the cervicothoracic spine and subscapularis, with a modulation frequency of 100-150 Hz , and a modulation depth of 25-50%, while the current strength is adjusted to a moderate vibration sensation for 4-6 minutes daily, once a day in the amount of 7-10 procedures, electrostatic massage is carried out using a manual applicator of the upper limb on the side of the operation and by sequential exposure to a frequency of 100 Hz for 5 minutes, a frequency of 14-18 Hz for 5 minutes and a frequency of 850 Hz for 4 minutes on the area of the hand, the inner and outer surfaces of the forearm, shoulder with the transition to the area of the shoulder girdle and subscapularis with movements in in the form of circular, rectilinear and spiral, once a day for 14 minutes in the amount of 7-10 procedures, while the low-frequency oscillation affects the superficial muscles and nerve endings of the skin, and the high-frequency oscillation - on deep, intermittent pneumatic compression is carried out at a pressure of 40-60 mmHg Art., compression 40 seconds, decompression 20 seconds for 40 minutes, daily in the amount of 8-10 procedures.

Thus, the technical result is achieved through a therapeutic effect on the body with sinusoidal modulated currents (SMT-therapy), which are amplitude pulsations (from 10 to 150 Hz) of medium-frequency currents (5000 Hz), which have a biological effect, while SMT activates the voltage-dependent ion channels of the neurolemma and sarcolemma, leading to a change in the initial polarization of the membranes and the generation of action potentials, causing significant conduction currents in the underlying tissues, which excite nerve and muscle fibers. The stimulatory effect of SMT is enhanced by the opening of both the predominant rapidly activated and slowly activated ion channels. Conversely, it decreases with an increase in the modulation frequency and with a shorter duration of the oscillation series. The mechanism of the analgesic action of CMT is associated with the activation of the microvasculature, a decrease in venous stasis and tissue edema, especially in the perineural spaces. Improvement of blood circulation occurs mainly due to the effect directly on the sensitive and autonomic nerve fibers, as well as as a result of a reflex increase in the blood supply to muscle fibers excited by the CMT. As a result, there is an increase in venous outflow and arterial inflow, as well as lymph circulation. Also, when exposed to CMT, trophic fibers are activated, which stimulates regenerative processes and leads to the restoration of the functions of internal organs during their dystrophic changes. The use of CMT therapy in the treatment of postmastectomy syndrome consists mainly in an electroneuromistimulating effect. Electroneuromyostimulation is used in the complex treatment of postmastectomy syndrome for two reasons: firstly, in order to increase the effectiveness of pneumocompression. The rationale for this combination was a study that showed that skeletal muscles have an active intraorgan micropumping function, which provides active pumping of blood from arteries through intramuscular capillaries to veins, as well as lymph advancement.

The optimal activation of the function of the so-called intramuscular peripheral heart is muscle electrical stimulation. Secondly, in patients with pain syndrome and limited mobility in the shoulder joint, CMT therapy eliminates the phenomena of plexitis and secondary radicular pain syndrome in osteochondrosis of the spine, thus, the therapeutic effects of CMT therapy: neuromyostimulating, analgesic, vasodilating, tropho-stimulating procedure, -therapy is performed using alternating sinusoidal currents with a frequency of 5 kHz, modulated in frequency in the range of 10-150 Hz. The depth of their amplitude modulation reaches 100%. For therapeutic effects, two modes of their generation are used. In the alternating mode, amplitude pulsations of the current are used, and in the constant mode, monopolar sinusoidal pulses are used. The amplitude of the modulating current does not exceed 50 mA. CMT therapy is carried out in separate series of current oscillations, following in a certain sequence. There are five main types of work. In order to reduce pain sensitivity and improve lymphatic drainage in the present invention, the third, fourth type of work is used. The third type of work (HIPP, carrier-frequency bursts) is a combination of current pulses modulated with a certain frequency (in the range of 10-150 Hz) with unmodulated current pulses with a frequency of 5 kHz. The duration of the current pulses is discrete within 1-6 s. This mode provides an analgesic effect.

The fourth kind of work (IVPP, intermittent frequencies) is a combination of alternating current pulses with a modulation frequency of 150 Hz and another frequency in the range of 10-150 Hz. CMT in this case have the greatest analgesic effect, which increases with a decrease in the difference between the frequency of 150 Hz and the selected modulation frequency.

The procedure is performed in conditions of maximum muscle relaxation, lying on the couch on your back. The 1st electrode with an area of 60 cm ^{2 was} placed on the cervicothoracic spine at the level of C6-T4, the 2nd electrode with an area of 60 cm ^{2 was} placed perpendicular to it, in the subscapularis. The following parameters were set on the "Amplipulse-7m" apparatus: mode 1 (variable), type of work 3 and 4, modulation frequency 100-150 Hz, modulation depth 25-50%, S1-S2 2-3 s. The current strength was adjusted to a moderate vibration sensation. Each type of work was applied for 4-6 minutes. every day once a day. The course is 7-10 procedures.

The device "Amplipulse-7 m" allows continuous operation for at least 8 hours in working conditions. The devices are powered from an alternating current network with a voltage of (220 ± 22) V, 50 Hz. Power consumption - no more than 25 VA. According to the potential risk of use, the device belongs to class 2a according to GOST R 51609-2000. In terms of safety, the device complies with GOST R 50267.0-92, class II, type BF protection.

Electrostatic massage is performed using a hand-held applicator (for example, the "Hivamat200 Evident" system), which has a therapeutic effect by applying an alternating electrostatic field with a pulse frequency of 10-200 Hz with direct contact of the applicator with the patient's tissues.

Biological action. Low-frequency oscillation (10-50 Hz) predominantly excites mechanoreceptors of the skin, subcutaneous fat, primary endings of muscle spindles and autonomic nerve conductors, which leads to expansion of muscle-type vessels, increased local blood flow and lymphatic drainage, activation of tissue trophism and decreased muscle tone. High-frequency oscillations (50-200 Hz) excite secondary endings of muscle spindles and Pacini corpuscles, adjacent to thick myelized fibers, which leads to relaxation of mainly smooth muscles of internal organs and blood vessels, peripheral blockade of the pain focus, activation of the vasomotor center, increased vascular tone, activation of the hypothalamus - the pituitary system and mobilization of the adaptive reactions of the body, providing therapeutic effects: anti-edema, tropho-stimulating, relaxing, analgesic, anti-inflammatory, anti-fibrotic.

Treatment technique. Sitting position of the patient. The nurse on the monitor of the device selects special modifications with established treatment protocols by area. Additionally, the device has a memory for 150 individual treatment programs. In the treatment of postmastectomy syndrome, in order to reduce lymphatic edema, improve neuromuscular conduction and tissue trophism, select a program for "Breast cancer" and set the following parameters: - frequency 100 Hz - 5 minutes; - frequency 14 Hz - 18 Hz - 5 minutes; - frequency 850 Hz - 4 minutes.

A nurse carries out the procedure using a 9.5 cm diameter hand applicator using a labile technique. Movements of the applicator are performed according to the rules of massage on the area of the hand, along the inner and outer surfaces of the forearm, shoulder with the transition to the area of the shoulder girdle and subscapularis of the affected side, and also use circular, rectilinear and spiral movements. Low-frequency oscillation is used to influence the superficial muscles and nerve endings of the skin, and high-frequency oscillation is applied to deep-seated ones. The duration of the procedure is 14 minutes, once a day, 7-10 procedures per course. Hivamat200 Evident is a multifunctional deep oscillation therapy system.

The device can only be used in dry rooms intended for medical purposes. The device complies with the technical requirements of VDE 0750 / IEC 60601-1 and is classified as a class Pa product in accordance with the EU Medical Device Directive.

The essence of the method is as follows.

The method of restorative treatment of complications after surgery on the mammary gland includes exposure to sinusoidal modulated currents according to the following technique: the 1st electrode with an area of 60 cm 2 is placed on the cervicothoracic spine at the level of C-5 TZ, the 2nd electrode with an area of 60 cm 2 is placed in the subscapularis, mode 1 - alternating, genders 3 and 4, modulation frequency 100-150 Hz, modulation depth 25-50%, S1-S2 2-3 s, the current strength is adjusted to a moderate vibration sensation, each type of work is applied 4 -6 minutes daily, once a day, a course of 7-1e0 procedures, carrying out physiotherapy exercises once a day for 25-30 minutes in the amount of 10 procedures and intermittent pneumatic compression of the upper limb on the side of the surgical intervention, pressure 40-60 mm Hg. Art., compression 40 sec, decompression 20 sec, for 40 minutes, once a day, daily, a course of 8-10 procedures, while additionally electrostatic massage is carried out using a manual applicator of the upper limb on the side of the operation by sequential exposure to a frequency of 100 Hz within 5 minutes, with a frequency of 14-18 Hz for 5 minutes and a frequency of 85 Hz for 4 minutes on the area of the hand, the inner and outer surfaces of the forearm, shoulder with the transition to the area of the shoulder girdle and subscapularis with movements in the form of circular, rectilinear and spiral, once a day for 14 minutes in the amount of 7-10 procedures, while the low-frequency oscillation affects the superficial muscles and nerve endings of the skin, and the high-frequency oscillation affects the deep-seated ones; at the same time, physiotherapy exercises, therapy with sinusoidally modulated currents, electrostatic massage and intermittent pneumatic compression with a break between procedures 40-60 minutes.

Brief description of drawings and other materials

FIG. 1 shows a method of restorative treatment of complications after breast surgery, indices of the circumference of the affected upper limb before treatment and after the course of treatment in the study groups, table 1.

FIG. 2, too, the change in the excess volume of the affected upper limb before and after treatment in each group, table 2.

FIG. 3, also, benchmarks according to example 2, table 3.

FIG. 4, also, the range of motion in the shoulder joint according to example 2, table 4.

FIG. 5, also, benchmarks according to example 3, table 5.

FIG. 6, also, the range of motion in the shoulder joint according to example 3, table 6.

FIG. 7, too, benchmarks according to example 4, table 7.

FIG. 8, also, the range of motion in the shoulder joint according to example 4, table 8.

FIG. 9, also, benchmarks according to example 5, table 9.

FIG. 10, also, the range of motion in the shoulder joint according to example 5, table 10.

Implementation of the invention

Examples of specific implementation of the method for the rehabilitation treatment of complications after breast surgery.

Example 1. The object of the study is 105 patients after radical combined treatment for breast cancer, confirmed histologically and suffering from postmastectomy syndrome (PMES) on the side of the surgery, which was clinically manifested as lymphatic edema of the upper limb on the side of the surgery, limitation of the range of motion in shoulder joint, shoulder - scapular periatrosis, psychoemotional discomfort in the form of personal dissatisfaction, disunity, rigidity of the family system. The studied patients aged 35 to 82 years, depending on the severity of the disease, were distributed as follows: Stage I T1-N0-M0 was established in 10 people, stage II T1-2N0-1M0 - in 40, IIIT1-4N1-3M0 in 55 people , as well as disabled people of groups 2 and 3. All patients underwent radical surgical treatment and combination therapy, which included radiation, systemic chemotherapy and hormone therapy. The timing of the appearance of the first signs of PMES on average ranges from 6 months to 6 years. Before drawing up a program of restorative treatment of complications to exclude the progression of the underlying disease: recurrence or tumor metastases, all patients undergo general clinical, instrumental examination methods, and specialist consultations. The study included patients belonging to the 3rd clinical group. To assess the severity of the upper limb lymphostasis, special control methods are performed: measuring the circumference of the affected limb every 10 cm, calculating the volume of the limb using the O'Brien formula, while the excess volume is calculated as the difference in volumes between the edematous and healthy limbs, and the condition soft tissue, consistency, density, mobility and so on. The degree of PMES is assessed according to the classification based on the difference in limb circumferences and the degree of tissue changes (see Fig. 1, table 1; Fig. 2, table 2).

Four groups have been formed:

1 group: control - 41 people, receives a standard set of procedures, including physiotherapy exercises (exercise therapy), pneumocompression massage, LED photomatrix therapy;

Group 2: comparison group - 23 people, receives a set of standard procedures + therapy with sinusoidally modulated currents (CMT therapy);

Comparison group 3 - 22 people, receives a set of standard procedures + electrostatic massage of the upper limb on the side of the operation;

Group 4: comparison group -19 people - a set of standard procedures + therapy with sinusoidally modulated currents + electrostatic massage of the upper limb on the side of the operation.

Group 1: exercise therapy classes are carried out once a day for 25-30 minutes in the amount of 10 procedures, pneumocompression massage is carried out on a multisection device "PULSTARPSX" (France) for 30 minutes, daily, 8-10 procedures per course of treatment, under pressure 40-60 mm Hg, compression 40 sec, decompression 20 sec for 40 minutes, daily in the amount of 8-10 procedures, LED photomatrix therapy is carried out on the TeraFot device (Russia) daily on the area of the affected shoulder and forearm along 6 minutes on the field, daily, a course of 7-10 procedures;

Group 2: receives a set of standard procedures, including physiotherapy exercises (exercise therapy), pneumocompression massage, LED photomatrix therapy and CMT therapy, which is carried out using the Amplipulse-7 apparatus (Russia), while the effect of sinusoidal modulated currents is carried out according to the following method : The 1st electrode with an area of 60 cm ^{2 is} placed on the cervicothoracic spine at the C5-Th3 level, the 2nd electrode with an area of 60 cm ^{2 is} placed in the subscapularis, mode 1 - variable, genus 3 and 4, modulation frequency 100-150 Hz, modulation depth 25-50%, S1-S2 2-3 s, the current strength is adjusted to a moderate vibration sensation, each type of work is used for 4-6 minutes daily, once a day, the course is 7-10 procedures, for 10 minutes , daily, 8-10 procedures per course of treatment;

Group 3: receives a set of standard procedures + electrostatic massage of the upper limb on the side of the operation, while low-frequency electrostatic therapy is carried out using the device "Hivamat - 200 Evident" (Germany) according to the prescribed treatment regimen for breast cancer directly on the affected upper limb by sequential exposure with a frequency of 100 Hz for 5 minutes, a frequency of 14-18 Hz for 5 minutes and a frequency of 850 Hz for 4 minutes on the area of the hand, the inner and outer surfaces of the forearm, shoulder with the transition to the area of the shoulder girdle and subscapularis with movements in the form of circular, rectilinear and spiral, once a day for 14 minutes in the amount of 7-10 procedures, while the low-frequency oscillation affects the superficial muscles and nerve endings of the skin, and the high-frequency oscillation affects the deep ones;

Group 4: receives a set of standard procedures + CMT therapy + electrostatic massage of the upper limb on the side of the operation, according to the above procedures, while physical therapy is strictly consistently carried out, then CMT therapy, then electrostatic massage and intermittent pneumatic compression with a break between procedures 40- 60 minutes.

Control examples of testing the method of restorative treatment of complications after breast surgery on patients.

Example 2. Patient P., 56 years old, was admitted to the department with a diagnosis:

Primary: Cancer of the right breast, Art. 2A pT2N0M0, condition after surgical treatment (02/12/2016 - radical mastectomy according to Madden), after 6 courses of adjuvant polychemotherapy, in the process of 1st line hormone therapy since August 2016, class. gr. 3 (C50.9)

Complications: Postmastectomy syndrome. Secondary lymphovenous insufficiency of the right upper limb 1 tbsp. (197.2) Shoulder-scapular periarthrosis on the right. (M75.1)

Date of hospitalization: June 24, 2019 - July 5, 2019

Treatment performed: exercise therapy, LED photomatrix therapy, intermittent pneumatic compression (see Fig. 3, table 3; Fig. 4, table 4).

Example 3. Patient K., 63 years old, was admitted to the department with a diagnosis:

Primary: Cancer of the right breast, Art. 2A pT1cN1MO, condition after surgical treatment (extended modified mastectomy to the right of 03/13/2018), after 6 courses of adjuvant chemotherapy, postoperative course of radiation therapy, class. gr. 3 (C50.4)

Complications: Postmastectomy syndrome. Secondary lymphovenous insufficiency of the right upper limb 1 tbsp. (197.2) Shoulder-scapular periarthrosis on the right. (М75.1) Date of hospitalization: 07/08/2019 - 07/19/2019

Treatment performed: exercise therapy, CMT therapy, LED photomatrix therapy, intermittent pneumatic compression (see Fig. 5, table 5; Fig. 6, table 6).

Example 4. Patient M., 68 years old, was admitted to the department with a diagnosis of:

Primary: Cancer of the left breast, Art. 3A pT1N2M0, condition after 6 courses of neoadjuvant polychemotherapy, surgical treatment (radical mastectomy on the left of 03/14/2018), 4 courses of adjuvant chemotherapy, postoperative course of radiation therapy, during hormone therapy, class. gr. 3 (C50.8)

Complications: Postmastectomy syndrome. Secondary lymphovenous insufficiency of the left upper limb 3 tbsp. (197.2) Shoulder-scapular periarthrosis on the left. (M75.1) Cervicobrachial plexitis. (M53.1)

Date of hospitalization: 07/03/2019 - 07/16/2019

Treatment performed: exercise therapy, electrostatic massage, LED photomatrix therapy, intermittent pneumatic compression (see Fig. 7, table 7; Fig. 8, table 8).

Example 5. Patient N., 60 years old, was admitted to the department with a diagnosis of:

Primary: Cancer of the left breast, Art. 3A pT4bN2M0, condition after 6 courses of neoadjuvant polychemotherapy, surgical treatment (radical mastectomy on the left of 02/14/2018), 4 courses of adjuvant polychemotherapy, postoperative course of radiation therapy, during hormone therapy, class. gr. 3 (C50.9)

Complications: Postmastectomy syndrome. Secondary lymphovenous insufficiency of the left upper limb 3 tbsp. (197.2) Shoulder-scapular periarthrosis on the left. (M75.1) Cervicobrachial plexitis. (M53.1)

Date of hospitalization: 06/10/2019 - 06/21/2019

Treatment performed: exercise therapy, CMT therapy, LED photomatrix therapy, electrostatic massage, intermittent pneumatic compression (see Fig. 9, table 9; Fig. 10, table 10).

Results of the study: The study of the method of restorative treatment of complications after breast surgery shows that the rehabilitation treatment of patients after combination therapy for breast cancer contributes to the regression of PMES, in all four groups there is an improvement in overall well-being, a decrease in pain, an increase in the range of motion in the shoulder joint, restoration of sensitivity in the area of the axillary nerve on the side of mastectomy, a decrease in the volume of the upper limb on the side of surgical treatment, however, the most pronounced significant decrease in the volume of the upper limb is observed in patients of group 4 (see Fig. 1, table 1; Fig. 2, table 2).

Thus, the standard set of methods of restorative treatment contributes to positive dynamics in the treatment of PMES, but at the same time, the addition of passive physiotherapeutic methods of treatment to the standard program, namely electrostatic massage of the upper limb on the affected side and CMT therapy, enhances the therapeutic effect.

The proposed invention has the following advantages in comparison with the prototype and other known technical solutions:

- increasing the therapeutic effect of the PMES rehabilitation treatment;

- reduction of treatment time.

Claims (1)

A method of restorative treatment of complications after breast surgery, including carrying out physiotherapy exercises once a day for 25-30 minutes in the amount of 10 procedures, therapy with sinusoidal modulated currents, electrostatic massage and intermittent pneumatic compression, characterized in that therapeutic sessions are sequentially carried out physical education, then therapy with sinusoidal-modulated currents, then electrostatic massage and intermittent pneumatic compression with a break between procedures 40-60 minutes, while the effect of sinusoidal modulated currents is carried out on the cervicothoracic spine and subscapularis, with a modulation frequency of 100-150 Hz and with a modulation depth of 25-50%, while the current strength is brought to the sensation of vibration for 4-6 minutes daily, once a day in the amount of 7-10 procedures, electrostatic massage is performed using a manual applicator of the upper limb on the side of the operation by successive exposure to frequency 100 Hz for 5 min, with a frequency of 14-18 Hz for 5 min and a frequency of 850 Hz for 4 min on the area of the hand, the inner and outer surfaces of the forearm, shoulder with the transition to the area of the shoulder girdle and subscapularis with movements in the form of circular, rectilinear and spiral, once a day for 14 minutes in the amount of 7-10 procedures, while the low-frequency oscillation affects the superficial muscles and nerve endings of the skin, and the high-frequency oscillation - on deep, intermittent pneumatic compression is carried out at a pressure of 40-60 mm Hg. , compression 40 sec, decompression 20 sec for 40 min, daily in the amount of 8-10 procedures.

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