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Physio in Specific Groups > Lymphoedema > Flashcards

Lymphoedema Flashcards

1
Q

What is lymphoedema?

A
  • 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
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2
Q

What happens when the lymphatics are not functioning adequately?

A
  • ECF accumulates in the tissues

- This fluid contains proteins, cell debris, fat and bacteria that are unable to pass into the venous circulation

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3
Q

What is the common progression of lymphoedema?

A
  • 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
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4
Q

What is the function of the lymphatic system?

A
  • 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
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5
Q

What is the function of lymph nodes?

A
  • Filters lymph

- Immune function

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6
Q

Under normal conditions, how much lymph is collected & moved through the lymphatic system in 24 hours?

A

2-4L

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7
Q

What is lymph drainage assisted by?

A
  • Intrinsic pumping of lymph vessels
  • Active muscle contraction
  • Passive joint movement
  • Respiration (pressure changes above/below diaphragm)
  • Pulsation of adjacent blood vessels
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8
Q

What are the causes of primary lymphoedema?

A
  • A developmental fault

- E.g. dysplasia, aplasia, hyperplasia

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9
Q

What are the 3 types of primary lymphoedema?

A
  • Congenital abnormality/ malformation: <2yrs
  • Late onset due to underlying malformation: >2yrs
  • Syndromal conditions eg Klippel-Trenaunay, Prader Willi
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10
Q

What are the causes of secondary lymphoedema?

A
  • Damage sustained later (cancer related)
  • Lymph node resection
  • Radiotherapy to lymph nodes
  • Obstruction e.g. tumour
  • Infection, inflammation, vascular conditions, obesity etc.
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11
Q

What are the triggering/aggravating factors for lymphoedema?

A

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
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12
Q

How does exercise help prevent lymphoedema?

A

Muscle contraction increase lymph flow & reduces risk of excess fluid accumulating

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13
Q

What evidence is there about strength training in lymphoedema?

A
  • Resisted exercise does not lead to worsening or triggering of lymphoedema
  • May lead to decreased self-reported flare ups & increased QOL
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14
Q

What is a precaution for exercise in lymphoedema?

A

When unfit/deconditioned it is important to increase load and intensity slowly

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15
Q

What cancers are most commonly associated with lymphoedema?

A
  • Breast
  • Melanoma
  • Gynaecological
  • Head & neck
  • Prostate
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16
Q

What are the signs & symptoms of lymphoedema?

A
  • Burning pain
  • Dull ache
  • I/T shooting pain
  • Tightness
  • Obvious oedema
  • Invisible veins
  • Pain on movement of neck or shoulder
  • Increased skin folds/ thickness
17
Q

What objective measures can be used for lymphoedema?

A
  • Limb circumference at 10cm intervals

- Bioimpedance (body comp)

18
Q

What advice can be given for managing early lymphoedema?

A
  • Continue to do exercises
  • Elevate when able to
  • Avoid prolonged sitting or static postures
  • Prompt referral to lymphoedema PT
19
Q

What are the precautions for physio treatment for lymphoedema?

A
  • Heat applications- caution
  • Constrictions eg tubigrip
  • Vigorous massage, soft tissue work
  • Dry needling
  • Build up exercise/ strengthening gradually
20
Q

What is the medical management of lymphoedema?

A
  • Currently no known cure or drug that safely treats lymphoedema
  • Managed by complex lymphoedema therapy
21
Q

What are the best practice treatment guidelines for lymphoedema?

A
  • Lymphatic drainage massage
  • Exercise
  • Skin care
  • Compression
  • ADL advice
22
Q

What are the common treatments for early/mild lymphoedema?

A
  • Self massage programme
  • Skin care
  • Exercise
  • Compression garment
23
Q

What are the common treatments for mod-severe lymphoedema?

A
  • Complex Lymphoedema therapy (massage, exercise, bandaging, compression garments, skin care)
  • Laser
24
Q

What are the benefits of manual lymphatic drainage massage in lymphoedema?

A

Stimulates the patient’s lymphatic system to drain the area more effectively

25
Q

What is the aim of skin care in lymphoedema?

A
  • 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
26
Q

What education should be provided regarding skin care?

A
  • 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
27
Q

How does exercise benefit lymphoedema?

A

The contraction of adjacent muscles and movement of nearby joints assists in the movement of lymph through the lymph vessels

28
Q

How does compression benefit lymphoedema?

A
  • Reduced capillary filtration
  • Increased uptake of lymphatic collectors
  • Increased movement of lymph through lymph vessels with skeletal muscle action and joint movement
29
Q

What are the benefits of low level laser therapy?

A
  • Response is variable, temporary

- Can reduce pain, hardness and oedema

Physio in Specific Groups (12 decks)

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