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 as 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.
Locate the area of pain through palpation and biofeedback.
Mark the area of pain.
3. APPLY GEL
Apply coupling gel to transmit shock waves to the tissue.
4. APPLY SHOCK WAVES
Deliver Radial or Focused Shock Waves to the area of pain while keeping the applicator firmly in place on the skin.
|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|
Michelini S, Failla A, Moneta G, et al.
Treatment of primary and secondary lymphedema with shockwave therapy. Eur J Lymphol 2008; 19:10
Side effects of Radial Shock Wave Therapy (RSWT®) using the Swiss DolorClast®
When performed properly, RSWT® with the Swiss DolorClast® has only minimal risks.
Typical device-related nonserious adverse events are:
- Pain and discomfort during and after treatment (anesthesia is not necessary)
- Reddening of the skin
- Swelling and numbness of the skin over the treatment area
These device-related nonserious adverse events usually disappear within 36h after the treatment.
Accordingly the following contraindications of RSWT® using the Swiss DolorClast® must be considered:
- Treatment over air-filled tissue (lung, gut)
- Treatment of pre-ruptured tendons
- Treatment of pregnant women
- Treatment of patients under the age of 18 years (except for Osgood-Schlatter disease and muscular dysfunction in children with spastic movement disorders)
- Treatment of patients with blood-clotting disorders (including local thrombosis)
- Treatment of patients treated with oral anticoagulations
- Treatment of tissue with local tumors or local bacterial and/or viral infections
- Treatment of patients treated with cortisone