EDEMA Flashcards
Edema definition
An accumulation of an excessive amount of watery fluid in cells, tissues, or serous cavities
What system does edema usually involve?
The lymphatic system
What is the lymphatic system and why is it important?
It is important for immune responses, however, this area is often neglected by therapists.
What are the three MOST COMMON types of edema?
Peripheral (legs, arms, hands)
Abdominal
Chest (lungs)
The two other least common ones: eyes and cerebral
Stages/types of peripheral edema
Low protein edema
high protein edema
Pitting edema
What is low protein edema and what stage is it usually associated with(beginning, middle, end)?
Beginning stage.
Usually resolved with elevation, icing, and AROM. Quick re-bound
What is high protein edema and what stage is it usually associated with(beginning, middle, end)? How is it developed?
Middle stage.
Starts about a week after low protein edema. It is developed due to excessive plasma proteins that become trapped in interstitium and can’t move out of damaged lymphatic systems.
What is pitting edema and what stage is it usually associated with(beginning, middle, end)?
The end stage of edema.
DANGEROUS
In which external pressure leaves a persistent depression (“pit”) in the tissue.
What are the five effects that we see of edema in the hands?
- hyperextension of the MCP joints
- Adduction of thumb/index web space
- Collapse of hand arches
- Joint stiffness
- Limited tendon excursion
What are the four general issues we see with edema?
Pain
Decreased PROM & AROM
Delayed healing
Stiffness (can be seen as joint contractures or decreased tendon excursion)
What are the five potential problems we can see in relation to the physiology of injury?
Edema Stiffness Inflammation Scar Formation Fibrosis
Does low protein edema that resolves quickly usually lead to stiffness?
NO! It does not usually lead to significant sittifness.
What type of edema leads to stiffness? Why?
High protein edema that does not resolve quickly (chronic edema)
Chronic edema will fill tissues with fluid and prevent movement.
What is stiffness?
Decreased passive ROM and increased force needed to reach the end of the range
What is inflammation?
local response to injury that destroys, dilutes, or walls off injuries agent and injured tissue
What is Scar formation?
Tissue that body creates to close a wound/defect
What is fibrosis?
A condition marked with an increase of fibrous tissue
What two ways do we measure edema?
Tape measure
volumeter
What are the three traditional techniques to reduce edema?
Elevation
Active ROM
Retrograde Massage
Compression (Coban and gloves)
What is the order you massage during a retrograde massage
Stroke distal to proximal.
Start with proximal, then middle, then fingers (LAST)
Is there evidence that supports the use of contrasts baths and edema?
NO – but patients report some decrease of symptoms, however, there is no evidence to support it.
What is manual edema mobilization (MEM)?
Manual Edema Mobilization (MEM) is a technique to decrease sub- acute persistent and chronic hand edema post surgery, trauma or stroke. Clinically this edema presents as thick, spongy, slow to rebound when pitted, and eventually becomes hard and fibrotic. It is an edema due to an overload and/or compromise of the lymphatic system.
The five principles as it relates to MEM.
Know the etiology (low protein vs high protein; acute vs chronic) Start at the trunk Frequent exercise LIGHT compression Neutral warmth
Is there evidence to support MEM?
Not exactly. It is relatively new.
When massaging what do you use as your guide during MEM?
The lymphatic systems
What are the components of the ideal patient when using MEM?
presumed health lymphatic system, is an active particpant, and performs the techniques between therapy sessions.
When should you not use MEM?
Inflammation, open wounds Blood clot, hematoma Active cancer CHF, cardiac problems Inflammatory stage of wound healing Renal failure, kidney disease Pulmonary problems Post-mastectomy lymphedema
What is lymphedema?
Lymphedema is a collection of protein-rich lymphatic fluid, usually in the arm or leg. Which accumulates within the soft tissues. It is caused by interruption of normal lymphatic flow which can be due to surgery, radiation, infection or trauma.
What are the two types of lymphedema?
Primary and secondary
What is primary lymphedema?
Resulting from lymphatic dysplasia and can be present at birth or develop with no known cause
Example: Turner’s Syndrome
What is secondary lymphedema?
The cause is known! Such as trauma, radiation, infection of lymphatic system
What type of lymphedema is more common and more likely to be seen during OT?
Secondary (especially after mastectomy)
What is the cause of lymphedema?
With normal lymphatic flow, the amount of fluid going into arms/legs = the amount coming out.
With lymphedema the amount going in is > amount going out.
What are the two main types of treatment for lyphedema?
Manual Lymphatic Drainage (MLD)
Complete Decongestive Therapy (CDT)
What is MLD for lymphedema and what does it do?
is a very gentle type of massage therapy used to drain excess fluid from the body and improve the overall functioning of the lymphatic (immune) system. MLD is most commonly used to treat Lymphedema, which is characterized by the blockage of lymph nodes in the arms and legs.
What does CTD for lymphedema include?
MLD Bandaging Exercise Skin Care Nail Care
Is CTD invasive?
NO, it is non-invasive and gentle.
What is the most highly effective treatment of lymphedema according to the evidence?
CTD
What is CTD?
Complete Decongestive Therapy (CDT) is the most successful treatment for chronic extremity lymphedema. Post mastectomy lymphedema and other related conditions extremity lymphedema. Post mastectomy lymphedema and other related conditions respond extremely well to this gentle, non-invasive, and highly effective therapy. CDT is sometimes referred to as Complete/Complex Decongestive Physiotherapy (CDP).
What are the steps of CTD?
- Manual lymphatic drainage
- Compression wrapping exersise
- skin care
- patient education
What are two other treatments that are not generally successful and does not generally occur with OTS?
Surgery
Medication
Pneumatic compression pump
What medication should those with lymphedema not be given?
DIURETICS WILL MAKE THE CONDITION WORSE
What are the six guidelines for lymphedema patients that should be explained during patient education?
- With skin – avoid trauma/injury to decrease likelihood of infection.
- Lifestyle build-up & intensity of activites
- avoiding limb constriction
- Use of compressive garments
- Avoiding extreme temperatures
- LE Practices
What are the LE practices for those with lymphedema?
NO prolonged sitting, standing, crossing legs.
Must wear good shoes and compressive garments.
