6.3 - Lymphatic System Flashcards
Describe the function of the lymphatic system
Transportation of lymph (clear, extracellular fluid derived from blood plasma)
Collects waste
Assists immune response
Describe the function of lymph nodes
Filter lymph & fight infection
How much of the blood plasma and proteins return via lymph vessels?
10-20%
Describe the anatomy of the lymph vessels
Have contractile tissue, valves, and smooth muscle
Pump lymph fluid back to the subclavian veins
What promotes lymph flow?
Lymph vessel contraction
Accessory muscle contraction
Pressure changes during breathing
Dermal mechanical stimulation
What is lymphedema?
Inability of lymphatic system to transport water & protein from tissues
Lymph fluid has a high _____________ content.
What can this lead to?
Protein content
Hardening, infections, & increased volume of lymph
Describe primary vs secondary lymphedema
Primary:
- Congenital / developmental
- ex: lymph node hypoplasia, Milroy’s disease
Secondary (most common)
- Caused by injury or disruption of the lymphatic system
- Ex: cancer treatment (surgery, chemo, radiation)
Describe the clinical presentation of lymphedema
- Gradual onset of sx (months to years)
- “Heaviness” or “fullness” of limb
- Typically unilateral
- Gradually worsening edema
- Edema not relieve by elevation
- Early stages –> pitting edema; late stages –> non-pitting edema
- Skin changes
- Hx of lymph node disturbance
What does an abnormal lymph node feel like?
FIRM
Mobile or non-mobile
Tender or non-tender
Describe Stemmer’s sign
For lymphedema
(+) = cannot lift dorsal fold of foot / hand
Describe the “2-cm rule”
Limb discrepancy is >2 cm –> should trigger referral and treatment for lymphedema
What is lymphoscintigraphy?
Radiological imaging of lymphatic nodes / vessels
Helps determine extent and location of flow obstruction
Describe the staging of lymphedema
“SPIT” - Subclinical, Pitting edema, Irreversible, Trunk-like (elephantiasis)
Preclinical (stage 0)
- “Heaviness” or “fullness” of limb
- Minimal to no observable edema
Stage 1 - REVERSIBLE lymphedema
- PITTING edema
- Edema decreases w/ elevation; reduced in the morning
- Edema increases with standing, activity
Stage 2 - IRreversible Lymphedema
- NON-pitting edema
- NON-reversible edema
- Skin changes begin - fibrotic changes
- (+) Stemmer sign
Stage 3 (Lymphostatic elephantiasis)
- Skin changes
- Hardening of dermal tissue
- Elephant-like skin
Describe the grading of pitting edema
How much pressure should be used for grading?
1+ = indentation barely detectable
2+ = slight indentation, returns in 15s
3+ = deeper indentation, returns in 30s
4+ = deep indentation, lasts >30s
“Fingertip pressure” - enough to blanch the nail bed of the thumb
Describe normal capillary refill
Nail bed refills w/in 3s
Describe the grading for pulses
0 = absent
1 = diminished
2 = normal
3 = bounding
What can cause decreased skin temperature in those w/ lymphedema? Increased skin temp?
Decreased = poor perfusion
Increased = infection, cellulitis
Describe lipidemia vs lymphedema
Lymphedema - dysfunction of lymph system
- Typically unilateral
- Swelling of foot
- Not typically painful
Lipidema - pathological fatty deposirs
- BIL presentation
- NOT present in foot
- Often PAINful
Is there a cure for lymphedema?
NO
What is the goal of PT?
Decrease the effects of lymphedema & improve function
What is axillary web syndrome?
Lymph node interruption in the axilla that creates lymphatic “cording”
Intervention: gentle stretch of “cords”
What does complete decongestive therapy involve?
Manual lymphatic drainage
Compression therapy
Decongestive exercise
Skin care
Compression therapy should be performed below ______ mmHg. Why?
45 mmHg
Greater than this causes lymphatic collapse
What type of bandages should be used for compression therapy for lymphedema? Describe these bandages
Short stretch bandages
“don’t stretch much”
Low resting pressure (15-20 mmHg), high working pressure (increase muscle pump action)
How should manual lymphatic drainage be performed?
Proximal segments first followed by distal segments
Strokes performed in the direction of flow
Gentle pressure <20 mmHg
What exercise should be used for those w/ lymphedema?
Gentle, low impact exercise
Aquatic therapy, functional training, breathing exercises, aerobic exs
Describe the contraindication to manual lymphatic drainage
Acute infection
Acute DVT
Malignancies
Renal failure
Cardiac edema
Renal & cardiac probs –> increased fluid return overloads these tissues
Infection & DVT –> don’t want to spread these
Describe the contraindications to compression therapy
Peripheral arterial disease - ABI <0.8
