Lymphedema Flashcards
Lymphedema
An abnormal amount of lymph fluid in tissue space
Types of Lymphedema
(2)
Primary Lymphedema
- Congenital malformation of the lymphatic system
- Insufficient development of the lymphatic system
Affects F>M
LE > UE
Secondary Lymphedema (a result of another issue, condition, Tx, disease, etc)
- Surgical dissection of lymph nodes
- Inflammation & infection (systemic infection &/or direct trauma to vessels/nodes = inflammation)
- Obstruction or fibrosis - trauma to the area OR growth of cancer OR radiation therapy
- Chronic venous insufficiency
= Statis &accumulation of fluid = to much pressure in venous circulation (hydrostatic pressure is not working in the lymphs favor)
Clinical Manifestations
2 Types
Location
- Most often apparent in the distal extremities, especially the dorsum of the hand & foot (dependent edema)
Severity
- Quantitative (how much edema)
INC limb girth = INC severity
- Qualitative
1. Pitting edema
Pressure on edema surface & indents (pitting) & a few seconds after letting go it returns back to normal
2. Brawny edema
Occurs when there is fibrotic changes in the subcutaneous tissue
** Not getting pitting anymore = disease is more progressed
3. Weeping edema
More severe & long standing edema
Occurs almost exclusively in LE
** Causes significant impairments in wound healing - impairs ability to close up & heal & INC risk of infection
S/S
(4)
- INC size of limb
More volume = INC weight & girth - Sensory Disturbances
Causes paraesthia & pain - Test sensation - DEC ROM
INC fluid = INC pressure in & around the joints = cannot achieve full ROM - Skin changes (fibrosis, brownish pigmentation)
Excess fluid under the skin = skin has to stretch more = more taut & INC risk the skin will breakdown
Interventions: Manual Lymphatic Drainage (MLD)
Describe
Exerting external pressure/ forces to INC interstitual space pressure so fluid will go from HIGH-LOW pressure
Promotes fluid back towards the venous system - direct it towards clusters of lymph nodes
Start: Proximal -> distal to preventbottling affect in the area
Intervention: Compression
(2) Types
Low-stretch bandage (early phase)
- REDUCE
- Exerts low resting pressure
- USE: To decrease resting edema
- WEAR: majority of the day - only take off for skin care/wash
Compression Garmets (later phase)
- MAINTAIN
- Exerts high resting pressure
- Helps to stabilize an area - maintain limb girth
Intervention: Exercise
3 + Considerations
AROM & Stretching
- Maintain ROM
Low-intensity resistance exericses
- mm pump contractions can change the pressures around the area to help move localized edema
Low-intensity cardiovascular/ pulmonary endurance exercises
- prevent the affects of deconditioning
Considerations
1. Wear the compression garmets during exercise
2. Select exercises that promote limb elevation OR that does not put the limb in a dependent position
Ex. Shoulder FLEX ROM in supine
List all the interventions
(5)
- Manual Lymph Drainage (MLD)
- Compression
- Elevation
- Exercise
- Skin & Nail Care
Complex Decongestive Therapy (CDT) Program
Explain the phases
Phase I
- Manual lymph drainage
- Compression therapy
Multiple layer compression bandaging (low-stretch)
- Exercise
- Skin & nail care
Phase II
- SELF MLD by patient
- Compression therapy
Compression garmets during the day
Multiple layer bandaging (low-stretch) at night
- Exercise
- Skin & nail care
Lymphatic Cording (Axillary Web Syndrome)
Syndrome is caused by the interruption of the lymphatics in the axilla area d/t biopsy or disection & what occurs as a result is this cord-like appearance in the region
Tx - gentle stretching & soft tissue release
Impairments & Complications related to Breast Cancer Tx
(8)
- Post-operative Pain
Incisional pain
Posterior cervical & shoulder girdle pain - mm guarding & spasm - do not want to move it
** Atrophy & DEC ROM = INC likelihood of lymphedema in UE - Post-operative vascular & pulmonary complications
DVT - INC immobility (bed ridden)
Pneumonia - not moving/DP as frequently & not coughing d/t incisional oain = INC risk of infection & atelectasis - Lymphedema
- Chest Wall Adhesions - scarring of tissues under the chest wall from Sx & radiation
- DEC Shoulder ROM
Scarring, weakness, postural malalignment, lymphatic cording - Weakness of involved UE
If pec major was impacted/ removed during Sx
Long thoracic nerve damage
Disuse atrophy - Postural Malignment
- Fatigue & DEC endurance
Shoulder & UE extremity ROM & strengthing exercise considerations…
Post-op & lymphedema patients
- AVOID excess tension on the incision or blanching of scar during shoulder ROM
- Avoid exercsies with involved arm in DEPENDENT position
- Progress graded exercise program slowly
