Exam 4 Flashcards

1
Q

Lymphathic organs

A
Lymph nodes (600-700 in body)
“Filtering stations,” produce WBC, regulate proteins in lymph
Lymph vessels
Intrinsic contractions, 6-10x/minute
Thymus gland
Spleen
Tonsils
Peyer’s patches
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2
Q

Lymphatic vessels

A

Capillaries
Pre-collectors
Collectors
Trunks

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3
Q

Mechanisms of Transportation

A
Intrinsic contraction
Respiration
Arterial/venous pulsation
Skeletal movement
New lymph (creates pressure)
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4
Q

Lymph fluid consists of

A

Proteins
75-100 g of proteins are transported by the lymph vessels per day
Water
Cells (RBC, WBC, Lymphocytes)
Waste products and other foreign substances
Fat (intestinal lymph, chyle)

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5
Q

Filtration=

A

Resorption + Lymph Flow

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6
Q

Lympathic load

A

How much – water, proteins, cells, etc

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7
Q

Lymph Time Volume (LTV)

A

Amplitude and frequency of intrinsic contractions

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8
Q

Transport Capacity

A

=Max LTV

= 10x LL in intact system

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9
Q

Functional Reserve

A

Difference between TC and LL

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10
Q

Normal

A

LL< TC

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11
Q

Dynamic insufficiency –

A

overload lymphatic system

Venous insufficiency, cardiac edema, DVT, etc

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12
Q

Mechanical insufficiency – lymphatic system damaged

A

Surgery, trauma, radiation, etc

Lymphedema always includes mechanical insufficiency

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13
Q

Combined insufficiency

A

damaged system and overload

Obesity, CVI, lipedema

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14
Q

Lymphedema

A

An abnormal collection of protein-rich fluid in the interstitium, which causes chronic inflammation and reactive fibrosis of the affected tissues
The lymph load exceeds the total capacity of the system

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15
Q

Risk Factors of Lymphedema

A
Axillary, inguinal, etc surgery 
Radiation therapy
Partial or total mastectomy 
Node dissection
Obese or overweight
Lipedema
History of infection in at-risk limb
Constriction
Tumor causing lymphatic obstruction
Scarring lymphatic ducts by either surgery or radiation
Intra-pelvic or intra-abdominal tumors 
Chronic venous insufficiency
Drain complications
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16
Q

Primary Lymphedema

A

Mechanical insufficiency of the lymphatic system
Malformation of lymphatic vessels
Congenital or hereditary

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17
Q

Secondary Lymphedema

A
Known cause for lymphedema
Surgery
Radiation
Trauma
Filariasis
Cancer/tumor
Infection
Obesity
Self-induced
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18
Q

Early signs of Lymphedema

A
Limb feels heavy
Skin feels tight
Limb is achy (not painful)
Clothing or jewelry is tight
Can’t see wrinkles in skin
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19
Q

Stage: Latency

A

no visible/palpable edema, subjective complaints possible

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20
Q

Stage 1:

A

reversible (elevation), pitting edema often present, increased limb girth and heaviness, no fibrosis

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21
Q

Stage 2:

A

consistent swelling- does not change with elevation, spongy tissue feeling and often fibrotic changes, pitting becomes progressively more difficult

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22
Q

Stage 3:

A

lymphostatic elephantiasis, non-pitting, fibrosis and sclerosis, skin changes (hyperkeratosis)

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23
Q

Skin characteristics

A

Hyperkeratosis (Redding but it becomes hard)
Lichenification (leathery and hard)
Peau d’Orange Texture
Ulcers
May be more common with arterial, neutrotrophic, venous, or traumatic conditions
Vesicles (cysts)

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24
Q

Infection -lymphedema

A

Reflux

Weeping = lymphorea

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25
Q

Differential diagnosis

A
Deep vein thrombosis (DVT)
Renal failure
Postoperative complications
Cysts
Complex regional pain syndrome
Cellulitis
Cardiac edema
Congestive heart failure
Malignancy
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26
Q

Lipedema

A
Primarily women
Bilateral, symmetrical swelling from ilium-> ankle
Dorsum of feet not involved
Little or no pitting
Palpable nodules fat under skin
Painful to palpation
Bruise easily
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27
Q

Venous Edema

A
Mid/low calves, malleoli
Skin discoloration
Fibrosis of subcutaneous tissue
Atrophic skin
Wounds
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28
Q

Do medications help lymphedema?

A

no

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29
Q

Surgeries

A

lymph node transplant, debulking, liposuction

30
Q

Tests and Measures for lymphedema

A

Lymphoscintigraphy: nuclear imaging method, tissue injection is transported by lymphatic system and allows assessment of superficial and deep lymphatics, no damage to lymph vessels
Venography and Doppler US: rule out venous problems

31
Q

Stemmer’s Sign

A

thickening of skin on the dorsal hand/foot; inability to pinch skin in these areas

32
Q

Complete decongestive therapy

A

Manual Lymphatic Drainage (MLD)
Compression Bandaging (multi-layer, short-stretch)
Exercise
Skin Care
Self Care & Risk Reduction / Education

33
Q

Effects of Complete Decongestive Therapy

A

Decrease swelling (>50%)
Increase lymph drainage from the congested areas
Improve skin condition
Improve patient’s function, quality of life
Reduce risk of infection

34
Q

Reductive Phase

A

Daily (5x/week) treatments until fluid reduction has plateaued
MLD followed by compression bandaging, exercise
60 minute appointments
Bandages stay on until return next appointment

35
Q

Maintenance phase

A
Self-management program
Self-MLD
Compression bandaging or bandaging alternative at night
Compression garments during day
Skin care
Exercise
Pneumatic compression device, sometimes
Periodic monitoring
Replacements of compression garments every 4-6 months
36
Q

CDT Precautions/Contraindications

A

Careful techniques, do not cause genital lymphedema
Do not use long-stretch bandages/ACE wraps (to stretchy so it will add too much pressure)
Skin irritation
Infection
Cognition/communication
Wounds

37
Q

Manual Lymphatic drainage:

A

Increases the movement of lymph/interstitial fluid, including proteins
—Improves lymph transport capacity, lymph vessel contractility
Stretching of the skin affects the superficial lymph vessels
–Pressure phase promotes fluid movement in a desired direction
–Relaxation phase causes a vacuum due to the distention of the tissue and leads to refilling of the lymph vessels
Slow technique, 5-7 repetitions per area
Gentle technique
Do not rub or create redness

38
Q

MLD Sequencing

A

Clear proximal regions and nodes

Move segmentally

Always stretch from distal to proximal

39
Q

Compression Bandaging

A
  • Improves efficiency muscle pump
  • Prevents re-accumulation of evacuated fluid
  • Facilitates softening of fibrotic tissue
40
Q

Remedial Exercise

A

Part of treatment for lymphedema when limb reduction is goal
WITH COMPRESSION
Includes:
Diaphragmatic breathing
Active, repetitive, non-resistive motion; distal to proximal (ROM/flexibility)
Ball squeeze, elbow flex/ext, shoulder flex, cervical flex/ext, scap retraction
Ankle pump, knee flex/ext, hip flex, hip abd/add

41
Q

Exercise

A
WITH COMPRESSION
If arm, include hand compression
Affects deep lymphatics
Pay attention to feelings of heaviness, increased swelling
Avoid extreme temperatures
Allow adequate rest between sessions
42
Q

Resistance training is beneficial

A

Be cautious
Start slow, with low weights, low repetitions
Gradual progression
Limit based on patient / patient’s symptoms

43
Q

Aerobic Training is beneficial

A

increases circulation and immune response
Be cautious
Start slow
Gradual progression

44
Q

Skin Care

A
Low ph moisturizer (Eucerin)
Keep clean
Clean cuts/tissue injuries and cover with an antibiotic ointment
Careful nail cutting
Use electric razor
Avoid sunburns, burns, bug bites
Wear gloves with outdoor work
45
Q

Self-Care

A
Self-manual lymphatic drainage
Self-bandaging
Donning and doffing compression garments
Exercises
Skin/nail care
46
Q

Risk Reduction

A

Maintain normal body weight
Protect skin integrity, maintain good skin hygiene
Avoid trauma to affected area (insect bites, acupuncture, burns, tattoos)
Exercise to prevent musculoskeletal injury
Avoid extreme heat or cold (hot tubs, saunas, extreme temperatures, cold)
Minimize limb constriction (jewelry, clothing, blood pressure)
Plan ahead with lymphedema therapist and physician for surgeries
Wear compression, move around during air travel
Watch for infection

47
Q

Compression Garments

A

Designed to maintain limb size, not reduce it
Do not wear at night
If proximal compression is worn without distal pressure, swelling distally is likely
If sleeve is worn without glove, hand swelling is likely
Wash/dry per care instructions

48
Q

Compression Grades

A

Class 1: 20-30 mmHg (beginning pressure arms)
Class 2: 30-40 mmHg (ideal pressure legs)
Class 3: 40-50 mmHg

49
Q

Compression bandages are not covered by insurance

A
  • about $60-80 for knee-high or arm

- about $80-$110 for thigh-high

50
Q

Breast surgeries

A
Radical mastectomy
Breast tissue, pec major/minor, nodes
Modified radical mastectomy
Breast tissue, spares pec major, nodes
Lumpectomy
Tumor and surrounding tissues
51
Q

Post-Op

A

Full examination/evaluation
Pay close attention to skin, incisions, skin mobility, muscle guarding
Take limb measurements
Discuss activity modifications that may need to be made
Education on plan/ therapy progression
Lymphedema
Signs/symptoms infection

52
Q

Lymphatic cording

A
  1. Thickened fascial cord(s) running just under the skin, visible or palpable when the upper extremity is in a flexed and abducted end range position
  2. Subjective report from the patient includes the experience of “pulling” through area of cording and beyond.
  3. Limited range of motion in area of cording
  4. Reports of discomfort or pain in area of cording
53
Q

Cording treatment

A

Myofascial release techniques/ soft tissue mobilizations
Manual lymphatic drainage
Gentle stretching
Diaphragmatic breathing
Neural mobilization of the upper extremity

54
Q

Radiation Fibrosis

A

Myofascial release techniques/ soft tissue mobilizations
Manual lymphatic drainage
Gentle stretching
Neural mobilization of the upper extremity

55
Q

Cause of UE amputation

A

Trauma, Congenital, Disease

56
Q

Cause of LE amputation

A

Disease

57
Q

Reasons for No prosthesis

A

Limited perceived functional benefit
Reduced sensory input
Comfort
Hot &/or heavy

58
Q

Benefits of oppositional prosthesis

A
Provides aesthetic appearance
Light weight &amp; simple
Functions
Opposition
Holding objects
Restore body image
Proprioceptive feedback
59
Q

Limitations of oppositional prosthesis

A

No active prehension
High cost for custom
Durability
Patient can have unreal expectations for cosmesis

60
Q

Body-Powered Prosthesis

A

A.k.a. ‘cable driven’

Relies upon gross body movements captured through a harness

61
Q

Benefits of Body-Powered Prosthesis

A

Moderate cost and weight
Durable
Environmentally resistant
Proprioception through harness system

62
Q

Limitations of Body-Powered Prosthesis

A

Grip strength or pinch force
Restrictive & uncomfortable harness
Requires muscle power & excursion
Poor static & dynamic cosmesis

63
Q

Externally Powered

A

A.k.a. ‘electrically’ powered or ‘myoelectric’
Powered by a battery
Myoelectric signals
Controlled by various input methods

64
Q

Benefits of externally powered

A
Stronger grip force
Moderate or no harnessing
Minimal energy expenditure
Least body movement to operate
Moderate aesthetics
65
Q

Limitations of externally powered

A

Heavier
More expensive
Limited sensory feedback
Extensive therapy training

66
Q

Hybrid Prosthesis

A

A single prosthesis in which two or more technologies are combined
Less weight than fully powered system
More grip strength than a body powered system

67
Q

Elbow and hand hybrid

A

Elbow: Body-Powered
Hand: Externally Powered

68
Q

Hybrid benefits

A

Simultaneous control of the elbow and terminal device

Reduced weight compared to all electric

69
Q

Traditional myoelectric control has limitations

A

Lack of control signals…usually just 2 electrodes
Rely on larger muscle groups for signal
Control muscles usually physiologically inappropriate

70
Q

Pattern Recognition

A

Computer software translates muscle activity into prosthetic movements

Many electrodes
More complete muscle activity picture

71
Q

Multi-articulating hands

A

Single motor
Single grip pattern
Pronation/supination done passively or with electric wrist rotator
Rigid, solid

72
Q

Rehab therapy post delivery of prosthetic

A
  • Donning of prosthesis
  • control of components
  • functional training
  • occupational performance