Lymphedema--Jen Flashcards
Lymphotomes
- anatomical regions that drain to same area
- left/right and upper/lower
Lymph flows toward:
- nodes from peripheral tissues
- controlled by bicuspid valves of lymphangion
lymphangion
- segment of lymph vessel that contains a bicuspid valve
- has smooth muscle
- lined with epithelial cells
Smooth Mm Contraction of lymphangion
- initiatied by pressure increase outside the vessel
- pumps only 3-4 times per min
- need skeletal movement to move fluid
lymph vessels empty into:
-veins near internal jugular and subclavian veins
How many nodes in body
-600
- 160: head neck
- 200: digestive system
Ducts/Trunks
- larger lymph vessels
- lumbar trunk and intestinal trunks flow to cisterna chili then to thoracic duct at venous angle
Pressure change by respiration increases____
rate of lymph flow into the thoracic duct
Function of Lymph System
- maintain balance of fluids
- return fluid/substances from interstitium to blood stream
- differentiate between foreign and self cells
Lymph Fluid Contains
- water
- proteins
- cytokines
- enzymes
- lymphocytes
- macrophages
- –bacteria, fungi, viral, tumor cells
Lymphadema
- abnormal collection of excessive tissue proteins, edema, chronic inflammation and fibrosis
- lymph load>total capacity
complications of lymphadema
- recurrent infection (cellulitis etc)
- chylous reflux
- lymphocutaneous fistulae (weeping) pathways from lymph vessel to surface of skin
- lymphangiosarcoma
chylous reflux
-backflow of intestinal lymph
Lymphangiosarcoma
-cancer of lymphatic vessels
Risk Factors
- axillary surgery (any cancer surgery)
- radiation therapy
- mastectomy
- axillary node dissection
- obese
- delayed wound healing
- tumor causing lymphatic obstruction
- scarring ducts from surgery/radiation
- intrapelvic/intra-abdominal tumors
- chronic venous insufficiency
Medical Management
- no meds, no surgery
- PT
Diagnosis
- lymphangiography
- Lymphoscintigraphy (gold standard)
- venography/dopplar US
PT Tests/Measures
- stemmer’s sign: inability to pinch skin on dorsal hand/foot
- volumetrics: water displacement
- Circumferential: use formula to determine volume
-if it resolves with elevation then it’s not lymphadema
Staging of Lymphadema
stage 1-3
Stage 1
spontaneously reversible (elevation)
- pitting edema
- increased limb girth and heaviness
Stage 2
- does not change with elevation
- spongy tissue feeling
- fibrotic changes
Stage 3
-lymphostatic elephantiasis
Precautions/Contraindications with lymphedema complicatiosn
- careful techniques (don’t cause genital edema)
- US
- Elastic tubular bandage
- skin irritation
- infection
- CHF
- cognition/communication
- DVT
PT for Lymphadema
-Complete Decongestive Therapy (CDT)
CDT
- Manual lymphatic drainage (MLD)
- compression bandaging
- exercise
- skin care
- risk reduction
Manual Lymphatic Drainage
- increase movement of lymph & interstitial fluid
- stretching of skin
- pressure phase
- relaxation phase
- slow: 5-7 reps per area
Stretching of skin effects:
-effects superficial lymph vessels
Pressure Phase promotes:
fluid movement in desired direction
Relaxation Phase causes:
-vacuum due to distention of tissue and leads to refilling of vessels
Compression Bandaging
- short stretch, low elastic
- low resting pressure
- high working pressure
- non stretch tubular layer (wick moisture)
- layered with graduated pressure in limb
Compression Garments
- maintain limb size (not reduce it)
- Graded: class 1-4
Class 1 Garments
-20-30mmHg
Class 2 Garments
- 30-40mmHg
- UE
Class 3 Garments
- 40-50mmHg
- LE
Class 4 garments
-60+mmHg
Reason of Disuse of Garments
- not fit properly
- not aesthetically pleasing
- uncomfortable fabric
- difficulty to don/doff
- wrong amount of compression
Exercise for Lymphadema
- moderate intensity
- diaphragmatic breathing
- muscle pump exercises
Muscle Pump Exercises
- ball squeeze
- elbow flex/ext
- shoulder flex
- cervical flex/ext
- scap retraction
- ankle pump
- knee flex/ext
- hip flex/abd/add
Skin Care
- low pH moisturizer (Eucerin, Lindi)
- keep clean
- wash garmets
- clean cuts and cover properly with anti-biotic
- careful with nail cutting (podiatrist)
Risk Reduction
- protect skin
- avoid insect bites/public pools/burns
- stay clean
- exercise
- avoid increased body temp (hot tub, sauna, steam)
- minimize limb constriction (jewelry)
- healthy nutrition
- hydration
Prognosis
- early detection and pt ability to self manage increases prognosis
- progressive disorder
- if unmanaged–>elaphantiasis
Abdominal/Pelvic Lymphadema
- difficult to manage and bandage
- good results with pelvic floor Mm training and compression garments (spanks)
