Primary and secondary lymphedema

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Name Tissue Type of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome


Lymphedema may be primary or secondary. Primary lymphedema is a lymphatic malformation developing during the later stage of lymphangiogenesis. In contrast, secondary lymphedema is the result of disruption or obstruction of the lymphatic system.

Secondary lymphedema can occur as a consequence of tumors, surgery, infection, inflammation, radiation therapy and trauma. Secondary lymphedema is one of the most significant complications after the surgical treatment of breast cancer, with significant impact on the quality of life. A substantial number of women develop secondary lymphedema after surgical treatment of breast cancer, with reported incidence between 6% and 63% depending on the population studied, the measurement criteria used and the reported length of follow-up.

Lymphedema is divided in three stages.
Stage IA (latent lymphedema) presents without clinical evidence of edema, but with impaired lymph transport capacity.
Stage IB (initial lymphedema) is characterized by edema that totally or partially decreases by rest and draining position.
In Stage IIA (increasing lymphedema) vanishing lymph transport capacity is seen and fibroindurative skin changes appear.
Stage IIB (column shaped limb fibrolymphedema) presents with lymphostatic skin changes and worsening disability.
In Stage IIIA (elephantiasis) scleroindurative pachydermitis and papillomatous lymphostatic verrucosis is observed together with life-threatening disability, and Stage IIIIB is extreme elephantiasis with total disability.

Diagnosis of lymphedema is based on the clinical features of the disease (extremity circumference measurement before and after surgery; a difference of more than 2 cm points to the development of lymphedema). Diagnostic imaging (plain radiographs, duplex ultrasonography, radionuclide lymphoscintigraphy and other imaging modalities) should be considered to rule out other causes of increased extremity circumferences, or to establish the diagnosis of lymphedema when in doubt.

Treatment should start with manual lymphatic drainage and compression bandage-centered decongestive lymphatic therapy. An alternative is sequential intermittent pneumatic compression using pumping devices. Radial shock wave therapy (RSWT) has been demonstrated being efficient for lymphedema stages IIA and IIB. Surgery should be considered for recalcitrant cases of lymphedema not responding or responding poorly to the aforementioned treatment options. Surgical options include lympho-venous or lympho-venous-lymphatic bypass anastomosis, lympho-lymphatic segmental interposition, free lymph node transplantation, and ablative surgery in case of massive limb changes or fibrotic induration.



Michelini et al., Eur J Lymphol 2008;19:10.

Treatment of lymphedema with shockwave therapy: preliminary study



Number of treatment sessions 6 to 8
Interval between two sessions 2 times a week
Air pressure Evo Blue® 2 to 4 bar
Air pressure Power+ 1.5 to 3 bar
Impulses 1000 impulses / cm2
Frequency 8Hz to 12Hz
Applicator 36mm
Skin pressure Light

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