Lymph Evaluation & Treatment

Question 1

When evaluating an individual with suspected lymphedema rule out medical conditions

Answer 1

• CHF
• venous insufficiency
• arterial insufficiency
• renal
• integumentary

Question 2

Special tests for lymphedema

Answer 2

• Stemmer’s sign (thickened skin fold at base of 2nd toe/finger; positive = tissue cannot be lifted only grasped as a lump of tissue)

Question 3

Suggested girth measurements for the UE

Answer 3

• elbow crease, 5/10/15 cm below and above
• wrist crease
• 1st web space
• metacarpal heads
• fingers as needed

Question 4

Suggested girth measurements for the LE

Answer 4

• infrapatellar border, 10/20/30 cm below and above
• malleoli
• navicular
• metatarsal heads
• toes as needed

Question 5

Functional outcome measures for lymphedema

Answer 5

• DASH
• shoulder pain & disability index (SPADI)
• LE function scale (LEFS)
• Emotional QOF (FACT B-4)
• Lymphedema life impact scale (LLIS)
• Lymphedema QOL tool (LYMQOL)

Question 6

Impairment lists for lymphedema

Answer 6

• impaired sensation & pain level
• impaired skin integrity
• connective tissue dysfunction
• increased girth & volume
• lymphedema staging & classification
• active and passive ROM
• posture and gait

Question 7

Complete Decongestive Therapy (CDT)

Answer 7

• manual lymphatic drainage (MLD)
• short stretch multi layer bandaging
• limb clearing exercises/HEP

Question 8

Comprehensive Lymphedema Management

Answer 8

• education on basic anatomy, skin care, self massage, self bandaging, garment care, & infection management
• psychological & emotional support
• custom compression garments (20-60 mmHg)

Question 9

Red flags for lymphedema patients

Answer 9

• any increase in swelling, with or without pain, that lasts for 1-2 weeks
• develop a temp. over 100.5 degree Fahrenheit that is not related to a cold or flu
• any part of their affected leg/groin or arm/armpit is red, feels hot, or has sudden swelling

Question 10

Life long skin protection measures

Answer 10

• avoid dry skin, keep clean and moisturized
• avoid sunburn or extreme temps.
• avoid invasive procedures on the involved limb
• minimize cuts, insect bites, and animal scratches
• protect hands and feet at all times
• avoid harsh chemicals and abrasive compounds
• use extreme caution when cutting fingernails, toenails, or cuticles
• use an electric razor to minimize shaving nicks
• wash shoes frequently & change socks daily
• observe the limb daily for signs of inflammation or infection
• avoid anything that can constrict circulation
• avoid repetitive/strenuous movements
• wear supportive shoes
• avoid prolonged automobile travel
• changes in pressure gradient during air travel require use of compression garments & low salt diet