Lymphoedema Flashcards
What is lymphoedema?
- Chronic swelling of a body part (usually limbs)
- Caused by the accumulation of fluid & protein in the tissue spaces arising from congenital malformation of the lymphatic system, or damage to lymphatic vessels and/or lymph nodes
What happens when the lymphatics are not functioning adequately?
- ECF accumulates in the tissues
- This fluid contains proteins, cell debris, fat and bacteria that are unable to pass into the venous circulation
What is the common progression of lymphoedema?
- Usually becomes chronic
- Tends to worsen without good management
- Limb can become heavy, unsightly, achy and may become too big to fit into regular clothes or shoes
What is the function of the lymphatic system?
- Preserves fluid balance
- Promotes fat absorption via intestinal lymphatics
- Host defence
- Collects & transports ECF to maintain homeostasis (called lymph once in lymphatic vessels)
- Lymph filtered at regional lymph nodes
- Returned to venous circulation via venous angle at the subclavian vein
What is the function of lymph nodes?
- Filters lymph
- Immune function
Under normal conditions, how much lymph is collected & moved through the lymphatic system in 24 hours?
2-4L
What is lymph drainage assisted by?
- Intrinsic pumping of lymph vessels
- Active muscle contraction
- Passive joint movement
- Respiration (pressure changes above/below diaphragm)
- Pulsation of adjacent blood vessels
What are the causes of primary lymphoedema?
- A developmental fault
- E.g. dysplasia, aplasia, hyperplasia
What are the 3 types of primary lymphoedema?
- Congenital abnormality/ malformation: <2yrs
- Late onset due to underlying malformation: >2yrs
- Syndromal conditions eg Klippel-Trenaunay, Prader Willi
What are the causes of secondary lymphoedema?
- Damage sustained later (cancer related)
- Lymph node resection
- Radiotherapy to lymph nodes
- Obstruction e.g. tumour
- Infection, inflammation, vascular conditions, obesity etc.
What are the triggering/aggravating factors for lymphoedema?
Anything that increases lymphatic load on the limb or obstructs/reduces drainage
- Infection
- Excess body weight
- Too little exercise or movement
- Heat
- Tight constricting clothing
- Travelling by air without a compression garment
How does exercise help prevent lymphoedema?
Muscle contraction increase lymph flow & reduces risk of excess fluid accumulating
What evidence is there about strength training in lymphoedema?
- Resisted exercise does not lead to worsening or triggering of lymphoedema
- May lead to decreased self-reported flare ups & increased QOL
What is a precaution for exercise in lymphoedema?
When unfit/deconditioned it is important to increase load and intensity slowly
What cancers are most commonly associated with lymphoedema?
- Breast
- Melanoma
- Gynaecological
- Head & neck
- Prostate
What are the signs & symptoms of lymphoedema?
- Burning pain
- Dull ache
- I/T shooting pain
- Tightness
- Obvious oedema
- Invisible veins
- Pain on movement of neck or shoulder
- Increased skin folds/ thickness
What objective measures can be used for lymphoedema?
- Limb circumference at 10cm intervals
- Bioimpedance (body comp)
What advice can be given for managing early lymphoedema?
- Continue to do exercises
- Elevate when able to
- Avoid prolonged sitting or static postures
- Prompt referral to lymphoedema PT
What are the precautions for physio treatment for lymphoedema?
- Heat applications- caution
- Constrictions eg tubigrip
- Vigorous massage, soft tissue work
- Dry needling
- Build up exercise/ strengthening gradually
What is the medical management of lymphoedema?
- Currently no known cure or drug that safely treats lymphoedema
- Managed by complex lymphoedema therapy
What are the best practice treatment guidelines for lymphoedema?
- Lymphatic drainage massage
- Exercise
- Skin care
- Compression
- ADL advice
What are the common treatments for early/mild lymphoedema?
- Self massage programme
- Skin care
- Exercise
- Compression garment
What are the common treatments for mod-severe lymphoedema?
- Complex Lymphoedema therapy (massage, exercise, bandaging, compression garments, skin care)
- Laser
What are the benefits of manual lymphatic drainage massage in lymphoedema?
Stimulates the patient’s lymphatic system to drain the area more effectively
What is the aim of skin care in lymphoedema?
- Improve & maintain the quality of the skin
- May be dry, thickened, warty
- May be leaking lymph (lymphorrhoea)
- May have a wound which must be treated appropriately
What education should be provided regarding skin care?
- The skin provides the barrier to infection
- A break can lead to cellulitis
- Dermatitis and tinea must be treated
- Avoid injury
- Cleanse with soap-less wash
- Moisturise at minimum daily
How does exercise benefit lymphoedema?
The contraction of adjacent muscles and movement of nearby joints assists in the movement of lymph through the lymph vessels
How does compression benefit lymphoedema?
- Reduced capillary filtration
- Increased uptake of lymphatic collectors
- Increased movement of lymph through lymph vessels with skeletal muscle action and joint movement
What are the benefits of low level laser therapy?
- Response is variable, temporary
- Can reduce pain, hardness and oedema
