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This study aimed to compare the effects of virtual reality (VR) training and resistance exercises training on lymphedema symptom severity as well as physical functioning and QoL in women with breast cancer–related lymphedema (BCRL). In a single blinded randomized trial, women diagnosed with unilateral BCRL were randomly divided into two groups: the Xbox Kinect group received VR Kinect-based games (n = 30) and resistance exercise group received resistance training (n = 30). In addition, both groups received complex decongestive physiotherapy (manual lymphatic drainage, compression bandages, skin care, and exercises). The intervention was conducted five sessions per week for 8 weeks. The outcome measures included excessive limb volume, visual analogue scale (VAS), the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, shoulder range of motion (ROM), shoulder muscles strength, hand grip strength, and Study Short-Form (SF-36). The outcomes were evaluated pre and post intervention (week 8). Statistical significant differences were recorded in VAS (pain intensity), DASH, shoulder ROM (p

Die Behandlung von Patienten mit komplexem regionalem Schmerzsyndrom („complex regional pain syndrome“ [CRPS]) findet in einem interdisziplinaren und multimodalen Setting statt. Physikalische Therapien stellen neben physio- und ergotherapeutischen sowie analgetischen Behandlungen einen wesentlichen Behandlungsschwerpunkt dar. Die vorliegende Ubersicht erlautert den Stellenwert im aktuellen klinischen Alltag und vermittelt einen Eindruck der Evidenzlage verschiedener Behandlungen, beispielsweise zu Elektrotherapie, neuromodulierenden Verfahren, manueller Lymphdrainage, CO2-Anwendungen und Paraffinbadern. Soweit aus der klinischen Erfahrung und der wissenschaftlichen Literatur erkennbar, werden die Behandlungsempfehlungen in Abstimmung mit den aktuellen Leitlinien dargestellt.

The study was designed to compare the effectiveness of complex decongestive therapy versus extracorporeal shockwave therapy for the treatment of lymphedema secondary to breast cancer. Twenty patients with a diagnosis of breast cancer–related lymphedema were randomized into two groups. Group 1 patients received complex decongestive therapy consisting of manual lymphatic drainage, bandaging, exercise, and compression garments for 5 days a week for a total of 20 sessions. Group 2 patients received a total of 12 sessions of extracorporeal shock wave therapy three times a week. All patients were evaluated using volumetric and circumferential measurements and Quick DASH scores at baseline, posttreatment, and first month after treatment. Within-group assessment of patients in each group showed statistically significant reductions in volumetric and circumferential measurements and a significant improvement in Quick DASH scores at posttreatment and first month after treatment compared with baseline (p 0.05). For patients with lymphedema secondary to breast cancer, extracorporeal shock wave therapy can be an alternative treatment to complex decongestive therapy.

Fibromyalgia is a chronic disease of unknown origin characterized by widespread pain, fatigue, disordered sleep and joint stiffness among other symptoms. To compare outcomes of manual lymph drainage and myofascial therapy in patients with fibromyalgia. This was a systematic review. The databases PubMed/MEDLINE, CINAHL, SCOPUS, ScieLo, PEDro, Dialnet, Web of Science, and Elsevier were searched for articles in English or Spanish examining the efficacy of myofascial therapy and/or manual lymph drainage to treat fibromyalgia. Of 356 articles extracted, sixteen articles and one doctoral thesis fulfilled the criteria established for inclusion. The methodological quality of the studies reported in the articles was good (PEDro score 7.49 ± 1.47). The studies included compared different treatments with lymph drainage and/or myofascial therapy. Outcomes indicated improved quality of life for both therapies in all the studies. Myofascial therapy and lymph drainage may be effective in patients with fibromyalgia. Further work is needed as the scientific evidence available is still insufficient.

Manual lymphatic drainage (MLD) massage is widely accepted as a conservative treatment for lymphedema. This systematic review aims to examine the methodologies used in recent research and evaluate the effectiveness of MLD for those at-risk of or living with lymphedema. The electronic databases Embase, PubMed, CINAHL Complete and Cochrane Central Register of Controlled Trials were searched using relevant terms. Studies comparing MLD with another intervention or control in patients at-risk of or with lymphedema were included. Studies were critically appraised with the PEDro scale. Seventeen studies with a total of 867 female and two male participants were included. Only studies examining breast cancer-related lymphedema were identified. Some studies reported positive effects of MLD on volume reduction, quality of life and symptom-related outcomes compared with other treatments, while other studies reported no additional benefit of MLD as a component of complex decongestive therapy. In patients at-risk, MLD was reported to reduce incidence of lymphedema in some studies, while others reported no such benefits. The reviewed articles reported conflicting findings and were often limited by methodological issues. This review highlights the need for further experimental studies on the effectiveness of MLD in lymphedema. There is some evidence that MLD in early stages following breast cancer surgery may help prevent progression to clinical lymphedema. MLD may also provide additional benefits in volume reduction for mild lymphedema. However, in moderate to severe lymphedema, MLD may not provide additional benefit when combined with complex decongestive therapy.

The physical examination has to be modified to accommodate to the virtual method. Active ranges of motion and movements of directional preference are visually assessed. Many provocative tests are performed by the patient through verbal and demonstrative guidance. The patient is educated about how to measure the girth of upper limbs obtaining its volumes with a tape measure focusing anatomical points used in the Cleveland Clinic webpage: Breast Cancer – Arm Volume Calculator [1]. Patients are educated and/or supervised on manual lymphatic self-drainage, functional compressive bandaging, and therapeutic exercise. These orientations are done to promote lymphatic and venous return of the upper limbs and can be daily or at least 3 times a week. Early intervention of shoulder joint mobilization plays an important role for preservation of shoulder kinematics and prevention of adhesions. Pendulum exercises decrease the pain through the effect of distraction and oscillation. It should be done three times a day [3]. Directed exercises of flexion, abduction, and external rotation are more efficient in the rehabilitation of ROM than the performance of free shoulder exercises and should be prescribed since first postoperative day [4]. Abduction, flexion, and functional diagonal of the shoulder—stretching maintained at least for 30 s are recommended (Fig. 1). Exercises examples that can be done throught telerehabilitation A multicomponent exercise program is considered to be the most adequate for breast cancer patient, especially aerobic and resistance training exercises (Fig. 1). It should be done 5 days a week, with adaptation in volume and intensity, at least 150 to 300 min/week of aerobic exercise (moderate intensity—40–60% heart rate reserve or 65–75% of maximal heart rate) and two resistance training sessions per week [5]. In case one does not have specific materials for training, the following options are available in any house for ROM exercises as moving up a wall with the fingers until the maximum limit of flexion and abduction, brushing the hair, or performing shoulder rolls and arm rotation, for muscle strength transporting items with light and moderate weights (vegetables, rice, water, etc.) can be done, and for aerobic exercises walking inside the house or dancing. Mella-Abarca W, Barraza-Sanchez V, Ramirez-Parada K (2020) Model of telerehabilitation for people with breast cancer during the COVID-19 pandemic in Chile. ecancer 14:1085 Article Google Scholar Green BN, Pence TV, Kwan L, Rokicki-Parashar J (2020) Rapid deployment of chiropractic telehealth at 2 worksite health centers in response to the COVID-19 pandemic: observations from the field. J Manipulative Physiol Ther S0161–4754(20):30129–30139 Google Scholar Akkaya N, Akkaya S, Gungor HR, Yasar G, Atalay NS, Sahin F (2017) Effects of weighted and un-weighted pendulum exercises on ultrasonographic acromiohumeral distance in patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil 30(2):221–228 Article Google Scholar de Rezende LF, Franco RL, de Rezende MF, Beletti PO, Morais SS, Gurgel MS (2006) Two exercise schemes in postoperative breast cancer: comparison of effects on shoulder movement and lymphatic disturbance. Tumori 92(1):55–61 Article Google Scholar Jimenez-Pavon D, Carbonell-Baeza A, Lavie CJ (2020) Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Prog Cardiovasc Dis 63(3):386–388 Article Google Scholar Download references This study was funded by Conselho Nacional de Desenvolvimento Cientifico e Tecnologico—428926/2016-9. PhysicalTherapy Department, Centro Universitario das Faculdades Associadas de Ensino – UNIFAE, Largo Engenheiro Paulo Almeida Sandeville, 15, Sao Joao da Boa Vista, SP, Brazil Laura Ferreira de Rezende, Vinicius Emanoel Francisco & Ricardo Laier Franco You can also search for this author in PubMed Google Scholar You can also search for this author in PubMed Google Scholar You can also search for this author in PubMed Google Scholar Correspondence to Laura Ferreira de Rezende. The authors declare that they have no conflicts of interest. Not applicable. Not applicable. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions de Rezende, L.F., Francisco, V.E. & Franco, R.L. Telerehabilitation for patients with breast cancer through the COVID-19 pandemic. Breast Cancer Res Treat (2020). https://doi.org/10.1007/s10549-020-05926-6 Download citation Received: 21 August 2020 Accepted: 02 September 2020 Published: 10 September 2020 DOI: https://doi.org/10.1007/s10549-020-05926-6

The scars derived from the treatment of breast cancer lead to adverse effects such as fibrosis or retractions of the connective tissue. Myofascial release (MR) seeks to reduce restrictions of the fascial system. Therefore, the aim of this study was to analyze the clinical impact of MR treatment on women survivors of breast cancer. We enrolled 24 women with breast cancer, 13 received myofascial release treatment (MR) and 11, a placebo manual lymphatic drainage treatment (PMLD). Both interventions were administered over a period of 4 weeks. The outcomes studied were pain, shoulder range of motion (ROM), functionality, quality of life (QoL), and depression, immediately after treatment and 1 month later. After 4 weeks of treatment, only the participants who received MR experienced a significant decrease in pain intensity in the short and midterm (p

Background: We investigated the comparability of Complete Decongestive Therapy (CDT) including manual lymphatic drainage (MLD) vs. without MLD in the management of arm lymphoedema in patients with breast cancer. Methods: Patients randomised into either treatment including MLD (T+MLD) or treatment without MLD (T−MLD) received treatment 2×weekly for 4 weeks. The primary outcome was the volume reduction (%) of arm lymphoedema at 7-month follow-up. The secondary outcomes were volume reduction after the end of treatment, circumference of the arm, patient experience of heaviness and tension, and health status. Results: Despite difficulties enrolling the planned number of patients (160), 77 were randomised and 73 (38 in T+MLD, 35 in T−MLD) completed the trial. In both groups, the volume of lymphoedema decreased significantly, with no difference between groups (1.0% [95% CI, −4.3;2.3%]): the precision in the 95% confidence interval indicates that the efficacy was comparable; the mean (SE) changes at month 7 were −6.8%(1.2) and −5.7% (1.2) in the T+MLD and T−MLD, respectively. There were no statistically significant differences with respect to any of the secondary outcomes. The results were robust and the conclusion was not sensitive even to various alternative assumptions or analytic approaches to data analysis. Conclusion: Manual lymphatic drainage adds no further volume reduction in breast cancer patients.

Migraine is a complex, multifactorial, neurovascular disorder of the brain. Patients frequently have pericranial trigger points, but trigger point (TP) therapy for migraine has not yet been adequately studied. In contrast, lymphatic drainage (LD) has been studied in patients with migraine. The multifactorial origin of migraine suggests using a combination of approaches such as TP therapy and lymphatic drainage. The present study evaluated the effectiveness of TP therapy alone and in combination with LD in preventing migraine during treatment period and over an 8‑week period after completion of treatment. A wait list control group served as a control group. Patients completed a headache calendar. The results of this pilot study suggest a beneficial effect for TP alone and TP combined with LD for migraine prophylaxis for 8 weeks after completion of treatment.

Purpose The aim of this study was to evaluate the effects of physical therapy (PT) combined with manual lymphatic drainage (MLD) on shoulder function, pain, lymphedema, visible cords, and quality of life (QOL) in breast cancer patients with axillary web syndrome (AWS).

The amount of physical pressure plays an important role in complex decongestive therapy (CDT). As a function of pressure, microcirculation takes place between blood vessels and tissue. As part of the total lymphatic system, lymphatic vessels transport the lymphatic load from the interstitial space to the blood stream. The lymphatic vessel system, characterized by specific anatomical conditions like initial lymphatic vessels, precollectors, collectors, and lymphatic strains, is the therapeutic target of complex decongestive therapy. Components of CDT include manual lymphatic drainage, compression therapy, decongestive kinesitherapy, and good skin care, which increase the transport capacity of the lymphatic vessel system. Currently, CDT is acknowledged as the main conservative treatment of lymphedema of primary and secondary genesis, lipolymphedema, and phlebolymphedema. In clinical practice, we are increasingly confronted with edema of multifactorial genesis requiring a critical discussion and stocktaking of comprehensive clinical findings in terms of the indication for CDT. Therapeutic success depends on a joint application of all CDT components and patient compliance. To an increasing extent, medical research tries to combine successfully CDT with adjunct treatment options.

The most important column in the conservative lymphedema therapy still represents the complex decongestive physical therapy/KPE.This is a multimodal therapy, which consists of four components. (1) skin restoration and/or skin care, (2) manual lymphatic drainage, (3) compression therapy and (4) decongestive exercises. The KPE is also divided into two phases. Phase 1-the decongestion-serves primarily the mobilization and transporting away the banked protein-rich oedema fluid and seamless transition into the Phase 2-the maintenance phase, which serves to preserve the achieved treatment success. The implementation of the KPE should be stage-adjusted, but depends also on the location (genital, head, face), and on co-existing comorbidities (congestive heart failure, diabetes mellitus, obesity, muscular-skeletal disorders, mental illness, etc.). It should be modified for children, elderly persons and for patients with malignant lymphedema.

Breast cancer-related lymphedema (LE) is a progressive, chronic disease that affects millions of cancer survivors and primarily results from surgical lymphatic vessel/node removal and radiation therapy. Patient education and support for importance of early detection is essential in helping health care providers detect lymphedema early, when there is the best chance to prevent progression. Improved imaging and surgical techniques have decreased the incidence of LE; however, effective risk-reduction and treatment have historically lacked the level of evidence necessary to standardize effective treatment. The purpose of this article is to report an extensive review of literature, including highlighted multidisciplinary studies within the past three years, in order to update best practice guidelines in assessment, risk reduction, management, and surveillance for post-breast cancer lymphedema.

Lymphoedema is an important cause of morbidity in the population, but little is known of its epidemiology and impact on patients or health services. Thus we looked for use of manual lymphatic drainage (MLD) in Germany with its unique health system to see any trend in the prescription of MLD and tried to draw conclusions regarding the number of possible affected people. Roughly 90% of the population in Germany is statutorily insured and the statutory health insurance (SHI) publishes quarterly federal reports based on the unaudited, service-provided billing records. From these reports we extracted data regarding the general costs and numbers of MLD 45 (manual lymphatic drainage sessions of 45 min length) and MLD 60 (60 min length) prescribed annually in Germany. In 2010 the cost for MLD 45 and MLD 60 only were 408.7 million €. The cost increased from 226.4 million € in 2004. MLD 45 was more frequently prescribed than MLD 60. The cost for MLD 45 and MLD 60 increased disproportionately compared to the other cost. The rate of costs for MLD 45 increased from 3.6% in 2004 to 5.4% in 2010 and that for MLD 60 from 2.7 to 3.9%. Together the rate for MLD increased from 6.3 to 9.5%. In 2010, MLD 45 sessions totaled up to 11,659,815, while MLD 60 sessions totaled 5,379,076. Accepting that a patient suffering from lymphoedema needs a minimum of 1 session of MLD a week, 327,671 patients could have theoretically received MLD, whereas postulating that people suffering from lymphoedema need MLD three times a week, only 109,224 could have received adequate treatment. Of all the costs that are spent on treatments in Germany in 2010 at least 9.5% are associated with MLD and the proportion has risen even faster than the total costs indicating an increasing need for MLD.

Breast cancer continues to be the most common malignancy among women in the United States. Despite its high incidence, early detection and modern treatment have made long-term survival more common. One of the most important sequelae of the treatment of breast cancer is the development of lymphedema. There are many issues for women to deal with after treatment for breast cancer. Focusing on the quality of life after breast cancer means dealing with issues such as an altered body image, changes in relationships with partner and children, living with any ongoing side effects, and the fear of tumor recurrence. The objective of this paper is to elucidate these issues concerning lymphedema.

Lipoedema is a disease of women, characterised by a circumscribed accumulation of subcutaneous fat, mainly in the legs, with oedema, hematomas, and pain from tension and pressure. Up to now, only conservative treatment with manual lymphatic drainage and compression was possible.Nowadays surgical therapy with liposuction under tumescent local anaesthesia can not only improve morphology but can also reduce complaints. When performed with modern techniques by experienced surgeons, liposuction is very safe and highly effective.The combination of conservative and surgical methods can considerably improve quality of life.

Complex regional pain syndrome (CRPS) is a disorder characterized by pain, edema, skin color changes and autonomic abnormalities. Its treatment is quite difficult and in most of the patients effective results cannot be reached. Manual lymphatic drainage is a very rare method for managing limb edema in CRPS. In this case report, the dramatic response of an excessive edema to lymphatic drainage was discussed in a CRPS patient.

Breast-cancer-related lymphoedema, either caused by the tumour itself or its therapy, can be found in approximately 24% of all patients. It results in disabilities, psychological distress and reduced quality of life. Therefore, proper therapy for this entity is very important. Guidelines recommend a therapy in two phases, an intensive phase I for 3 weeks for volume reduction and, between the cycles of phase I, a reduced phase II to maintain the result. During phase I therapy, manual lymphatic drainage often cannot be administered on weekends or holidays; only a reduced therapy, mainly by application of a more or less passive compression by bandaging, is administered. For this, conventional low-stretch bandages are hitherto being used. Several attempts have been made to overcome this disadvantage by either impregnating or covering the bandage with sticky or adhesive substances such as india rubber, elastomeres, polyacrylates, etc. Recently, new bandages are available, which are drenched with alginate that becomes semi-rigid after drying for approximately 6 h. It was the aim of this study to compare alginate bandaging to a conventional lymphologic-multilayered low-stretch bandaging with individual supportive lining as to their effect concerning their congestive capacity in exactly delimited time periods of reduced decongestive therapy as well as the patients’ tolerance. From December 2007 until May 2008, 61 female patients with a one-sided lymphoedema of the axillary tributary region after axillar dissection who underwent a phase I complex decongestive therapy were prospectively selected for our investigation. On weekends, group A got the conventional low-stretch compressive bandaging, whereas group B got an alginate semi-rigid bandage. Arm volumes were measured before and after these bandages were applied. Additionally, the subjective sensations of the skin caused by the compression were measured by means of a five-level Likert scale. The initial volumes (V 0) of the two groups (A, 2,939.0 ml ± 569.182; B, 3,062.6 ml ± 539.161) varied within the same magnitude, with somewhat smaller values in group A. The same was true for the final volumes (V 6), measured at day 22 (A, 2,674.5 ml ± 480.427; B, 2,740.1 ml ± 503.593). During the weekends, the arm volumes re-increased (first weekend: A, 16.4 ml vs. B, 4.7 ml; second weekend: A, 14.2 ml vs. B, 2.7 ml; third weekend: A, 7.5 ml vs. B, 1.1 ml). A significantly smaller volume increase appeared in the alginate group during the weekends. There were no serious side effects in both groups. Concerning the patients’ comfort, the values of the alginate group were clearly better than those of the conventionally bandaged group. Additionally, the volume changes in the alginate group revealed fewer fluctuations. As a summary, one can state that a good alternative to the conventional bandaging is available with the alginate bandages, bringing distinct advantages for the patients when administered properly.

Eosinophilic fasciitis is a rare disease characterized by edema, painful indurations, and progressive muscle weakness. Mainly the extremities are involved. We report on a 22-year-old woman with eosinophilic fasciitis presenting with progressive muscle weakness of both hands and feet and a reduced general condition. She showed symmetrical and firm swelling of the extremities with painful restriction of joint movement. Systemic treatment with glucocorticosteroids as well as physiotherapy and manual lymphatic drainage led to continuous improvement of her symptoms. The differentiation from other diseases, such as systemic scleroderma, eosinophilia-myalgia syndrome, and pseudoscleroderma, might be difficult at the beginning of the disease. The gold standard for diagnosis is--as was done in our case--a deep skin-to-muscle biopsy. Further imaging, especially magnetic resonance imaging, can support the diagnostic procedure.

The objective of this study is to investigate the efficacy of manual lymphatic drainage (MLD) therapy in edema secondary to the reflex sympathetic dystrophy (RSD). A total of 34 patients were allocated randomly into two groups. All of the patients undertook nonstreoidal anti-inflammatory drug, physical therapy and therapeutic exercise program for 3 weeks. Patients in study group undertook MLD therapy additionally. Then the patients continued 2-month maintenance period with recommended home programs. Volumetric measurements pain scores and functional measurements were assessed at baseline, after treatment and 2 months after the treatment. After treatment, improvement in edema was statistically significant in the study group but not in the control group. At follow-up, with respect to baseline, improvements were not significant in both of the groups. Between the groups, difference of the percentage improvements in edema was statistically significant with superiority of MLD group after treatment, but not significant at follow-up. In this pilot study, MLD therapy was found to be beneficial in the management of edema resulted from RSD. Although the long-term results showed tendency towards improvement, the difference was not significant.

Dercum's disease which is also termed lipomatosis dolorosa is a rare and relatively unknown disease. In this entity the upper arms, elbows, stomach wall, buttocks, thighs and knees are predominantly affected showing painful subcutaneous adipose tissue deposits. In addition severe hyperalgesia can be triggered by light pressure and touch. Analgesic and/or nonsteroidal antirheumatic drugs have usually only a minor or no effect. Here, we report a patient with Dercum's disease who was successfully treated with pregabalin and manual lymphatic drainage, and present a current overview of the literature.

The current standard of care for soft tissue sarcoma (STS) is limb salvage surgery and adjuvant radiotherapy, with long-term survival rates of approximately 70%. However, the extensive surgical resection and subsequent reconstruction result in 50% of survivors living with chronic disability. Rehabilitation aims to optimize functional independence and quality of life, and is routinely offered to patients undergoing surgical treatment for STS. Unfortunately, there is a dearth of research related to rehabilitation in this area. We propose a model for assessing disability, for designing treatment interventions and for evaluating rehabilitative outcomes in STS. The World Health Organization's (WHO) international classification of functioning, disability, and health (ICF) is divided into three domains: 1) impairments (related to body structure and function), 2) activity limitations (related to usual self-care activities/activities of daily living), and 3) participation restrictions (related to social roles). A literature review of STS rehabilitation reveals that most studies have focused on disability assessment, with few papers describing or evaluating rehabilitation interventions commonly employed in STS. Clinicians are forced to extrapolate findings from other patient populations in order to evaluate the effectiveness of specific rehabilitation strategies (ie, those used for particular sequelae of STS, such as lymphedema or impaired exercise tolerance). There is strongest support for complex decongestive physiotherapy (targeting lymphedema) and aerobic exercise interventions (aimed at alleviating cancer-related fatigue and psychosocial sequelae). The most poorly researched topic is rehabilitation for genitourinary disability (both incontinence and sexual dysfunction). Most studies related to oncologic rehabilitation are restricted to the impairment level (eg, affecting range of motion, muscle strength) of the ICF, with only a small minority addressing activity limitations (eg, affecting activities of daily living) experienced by patients. A consideration of participation restrictions (eg, fulfillment of vocational roles) is almost wholly absent from the literature. Yet social role reintegration is of fundamental importance to patients. Further research is required in these two domains. The ICF provides a comprehensive framework for future research into rehabilitation interventions for STS.

To provide an evidence summary report on the question: What are the treatment options for women with lymphedema following treatment for breast cancer? Cancer Care Ontario’s Supportive Care Guidelines Group (SCGG) employed systematic review methodology to produce an evidence summary on this topic. Evidence-based opinions were formulated to guide clinical decision making, and a formal external review process was conducted to validate the relevance of these opinions for Ontario practitioners. The systematic review search strategy identified ten randomized controlled trials which form the basis of this evidence summary report. Four key opinions offered by the SCGG are outlined below. Responses from the practitioner feedback process supported the validity of these opinions in Ontario. (1) There is some evidence to suggest that compression therapy and manual lymphatic drainage may improve established lymphedema, but further studies are needed. Compression garments should be worn from morning to night and be removed at bedtime. Patients should be advised that lymphedema is a lifelong condition and that compression garments must be worn on a daily basis. Patients can expect stabilization and/or modest improvement of edema with the use of the garment in the prescribed fashion. (2) There is no current evidence to support the use of medical therapies, including diuretics. (3) Additional efforts to define relevant clinical outcomes for the assessment of patients with lymphedema would be valuable. (4) These opinions are appropriate for patients with more than mild lymphedema, where the signs and symptoms are considered significant from the patients’ perspective.

We report on a 70-year-old female patient with dermatomyositis. The connective tissue vascular bed was studied with capillaroscopy to evaluate morphological and functional changes of skin capillaries. Capillaroscopic findings showed morphological alterations such as rarefication of capillaries, avascular fields and tortuosity of nailfold capillaries. In addition, fluorescence-videomicroscopy showed pathologically increased transcapillary diffusion of dye in the apex region of nutritive skin capillaries. Increased capillary leakage probably contributed to the development of oedema in our patient. Immunosuppressive therapy combined with intensified manual lymphatic drainage was successful.

Lymphedema results from an imbalance between capillary filtration and lymph drainage. This disease is progressive, but it can be managed successfully with the appropriate interventions. Internationally, combined physical therapy (CPT) is used in the management of this disease; it is composed of manual lymphatic drainage, compression bandaging, mechanic lymphatic drainage, kinesi/hydrokinesitherapy, and low-level laser therapy