3: Lymphedema Flashcards
What is the definition of lymphedema?
- Chronic disease
- Increased collection of lymphatic fluid causing swelling
- Leads to skin and tissue changes
What are the two classifications of lymphedema?
- Primary/Genetic
- Acquired/Secondary
What are the six components of lymph?
- WBC
- Triglycerides
- Bacteria
- Cell debris
- Water
- Protein
What are typical symptoms of lymphedema?
- Distal swelling
- Proximal swelling
- Decreased ROM
- Skin discoloration
- Pain and altered sensation
- Limb heaviness
- Difficulty fitting into clothes
What are the three subtypes of primary lymphedema?
- Congenital
- Lymphedema praecox
- Lymphedema tarda
Describe congenital primary lymphedema
Present at birth or recognized within two years
Describe lymphedema praecox
Occurs at puberty through the start of the third decade
Describe lymphedema tarda
Begins after age 35
What is the general cause of secondary lymphedema?
Injury or obstruction of the lymphatic system
What is the most common cause of secondary lymphedema worldwide?
Infection - wuchereria bancrofti
How does lymphedema develop from infection?
Parasitic infestation in the lymph nodes due to mosquito bites
What is the second most common cause of secondary lymphedema?
Malignancy or related treatments - breast cancer specifically
What is the incidence of primary lymphedema?
1/100,000
What is the incidence of secondary lymphedema in women with breast cancer?
20%
What % of people with head and neck cancer develop lymphedema?
90%
What % of women treated for gynecologic cancer develop lymphedema?
37%
What are important questions to include in you history related to lymphedema?
- Duration of swelling
- Distribution
- Past infection
- International travel
- Cancer
- Liver or cardiac dysfunction
- Prior surgery
Describe how lymphedema presents in the initial stages?
- Resembles general edema,
- Pitting is present
- Skin is soft
- Elevation will resolve swelling
Describe how lymphedema begins to progress?
- Pitting no longer visible
- Skin hardening
- No change with elevation
What are the 4 key lymphedema symptoms?
- Edema in extremity
- Hyperkeratosis
- Lymphangioma
- Lymphorrhea
What is hyperkeratosis?
Skin thickening and scaly presentation
What is lymphangioma?
Small bumps and blisters on the skin
What is lymphorrhea?
Leakage of lymph fluid from skin
What is Stemmer’s Sign?
Inability to pinch a fold of skin at the second toe
When will Stemmer’s Sign be present?
Develops after stage 1
What are the two components of a physical exam for lymphedema?
- Size of limb
- Imaging
What difference in limb size is considered to be mild or moderate?
< 20%
What difference in limb size is considered to be severe?
> 20%
What are the four types of diagnostic imaging for lymphedema?
- Lymphscintigraphy
- MRI
- CT
- Ultrasound
What are 6 treatment options for lymphedema?
- Decongestive lymphedema therapy
- Manual lymph drainage
- Compression
- Skincare
- Exercise
- Surgery
What is decongestive lymphedema therapy (DLT)?
Moderate to severe lymphedema to mobilize lymph and dissipate fibrosclerotic tissue
What is manual lymph drainage (MLD)?
Lymph massage to increase lymphatic flow
Describe compression to treat lymphedema?
- Assists with drainage
What are two risks of compression as a treatment for lymphedema?
- Skin irritation
- Increased risk of infection
Why is skincare important in lymphedema management?
Secondary infection prevention
Why is exercise important for lymphedema treatment?
Promotes lymph drainage and protein absorption vis muscle contraction
What are the 4 stages of lymphedema?
0 = Latency Stage
1 = Spontaneous
2 = Spontaneously Irreversible
3 = Lymphostatic Elephantiasis
Describe Stage 0
At risk for lymphedema due to injury or lymph vessel but lack clinical signs of lymphedema
What patients are in Stage 0?
Pts with breast cancer who have undergone biopsy or radiation that
Why are patients in Stage 0 at risk for developing lymphedema?
Decreased lymph transport predisposing patient to lymphatic overload and resultant edema
How should you monitor pt’s in Stage 0?
Volumetric measures repeated every 3 months for the first year - then twice a year for up to 5 years
What are interventions for Stage 0?
- Education
- Self massage
- Compression garments
- Complete Decongestive Therapy
What exercises are Grade A recommendations for Stage 0?
- Progressive resistance training
- Individualized aerobic exercise program
- Monitor for exercise tolerance and adverse effects weekly
What are the three characteristics of Stage 1?
- Reversible
- Pitting edema
- Swelling is soft and will respond to elevation
What interventions are Grade A recommendations for Stage 1?
- Compression garment fitting
- Exercise program
- Education
What interventions are recommended for Stages 2 and 3?
- Manual drainage
- Compression
- K tape
- Self care management
- IPC
- Laser
What are the characteristics of Stage 2?
- Tissue fibrosis/induration
- No change with elevation
- Skin and tissue thickening occurs as limb volume increases
- Pitting may be present but difficult to assess due to fibrosis
What are the characteristics of Stage 3?
- Pitting edema
- Fibrosis
- Skin changes
- Papillomas, infection, cellulitis, dry skin
Describe massage for lymphedema?
Start proximal and work distal
How should exercise be designed for lymphedema?
Proximal to distal exercises incorporating diaphragmatic breathing to improve volume reduction
Is yoga effective for limb volume reduction?
No, but it is safe
What is the prognosis for lymphedema?
- No cure
- Treatment focused to lessen disease progression and prevent complications
What should be included in pt education?
- Self massage
- Infection prevention
- Exercise
- Weight control
- Compression
What two things are contraindicated with lymphedema?
- Venipuncture in affected extremity
- BP measures on affected extremity
