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Physiotherapy in Specific Groups > Lymphoedema > Flashcards

Lymphoedema Flashcards

1
Q

What is lymphoedema?

A

A chronic swelling of a body part (usually limbs) caused by the accumulation of fluid and 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 occurs when lymphatics are not functioning adequately?

A

Extra cellular fluid accumulates in the tissues.

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3
Q

What are the roles of the lymphatic system?

A
  • Preserves fluid balance
  • Promotes fat absorption via intestinal lymphatics
  • Host defence
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4
Q

What functions assist lymph drainage?

A
  • Intrinstic pumping of lymph vessels
  • Active muscle contraction
  • Passive joint movement
  • Pressure changes above and below the diaphragm with respiration
  • Pulsation of adjacent blood vessels
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5
Q

What functions assist lymph drainage?

A
  • Intrinstic pumping of lymph vessels
  • Active muscle contraction
  • Passive joint movement
  • Pressure changes above and below the diaphragm with respiration
  • Pulsation of adjacent blood vessels
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6
Q

When does primary lymphoedema occur?

A

Congential abnormality/malformation

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7
Q

When does secondary lymphoedema occur?

A
  • Surgery
  • Trauma
  • Vascular conditions
  • Obesity
  • Inflammation
  • Medication complication
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8
Q

What cancers are more commonly associated with lymphoedema?

A
  • Breast
  • Melanoma
  • Gynaecological
  • Head and neck
  • Prostate
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9
Q

What are the possible risk factors for lymphoedema?

A
  • Infection
  • Excess body weight
  • Too little exercise
  • Heat
  • Prolonged tight clothing
  • Poor ungraduated bandaging
  • Air travel
  • High BMI
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10
Q

What effect does exercise have for lymphoedema?

A

Muscle contraction increases lymph flow and reduces the risk of excess fluid accumulating.

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11
Q

What benefit does strength training have on lymphoedema development?

A
  • Decreased symptoms

- Increased quality of life

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12
Q

What is mastectomy?

A

Complete removal of all breast tissue

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13
Q

What procedures are included in breast conservation surgery?

A
  • Wide local excision
  • Lumpectomy
  • Partial mastectomy
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14
Q

When is axillary lymph nodes removal indicated?

A

When cancer is determined to be invasive

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15
Q

What is involved at each level of axillary lymph node dissection?

A

Level 1: contents between lat dorsi, axillary vein, lateral border of pec minor
Level 2: + tissue beneath pec minor
Level 3: + resection of pec minor

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16
Q

What is a sentinel node biopsy?

A

Injection of dye or radioactive substance to locate first affected lymph node, then removed for examination

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17
Q

What are the possible complications of breast cancer surgery?

A
  • Reduced shoulder ROM
  • Pain
  • Scarring
  • Postural changes
  • Arm lymphoedema
  • Breast lymphoedema
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18
Q

What aspect of surgery most affects morbidity associated with the arm and shoulder?

A

Surgery involving the axilla

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19
Q

What aspect of surgery most affects morbidity associated with the arm and shoulder?

A

Surgery involving the axilla

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20
Q

When is axillary web syndrome most prevalent?

A

4-6 weeks post surgery

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21
Q

What factors affect the severity of lymphoedema?

A
  • Extent of surgical intervention
  • Other risk factors i.e. BMI
  • Adjuvant treatment
22
Q

What factors affect the severity of lymphoedema?

A
  • Extent of surgical intervention
  • Other risk factors i.e. BMI
  • Adjuvant treatment
23
Q

What factors affect the combination of treatment for breast cancer?

A
  • Histological type of cancer (including oestrogen receptor status)
  • Size of tumour
  • Stage of cancer
  • Grade of tumour
  • Multifocality
24
Q

Why is chemotherapy used and what is its prescription?

A

Used to eliminate micro metatstases; dose every three weeks for 4-6 cycles

25
Q

When is radiotherapy most commonly used and what is its usual prescription?

A

Wide local excision (95%). Usual course is 9 days of treatment/fortnight over six weeks.

26
Q

Why and when is hormone therapy used?

A

To block oestrogen in receptor positive individuals. Usually starts after chemotherapy and radiotherapy

27
Q

For what period of time is hormone therapy commonly used for?

A

Five years

28
Q

What additional procedures may be offered to pre-menopausal women to reduce oestrogen effects?

A
  • Bilateral oophrectomy

- Ovarian oblation by radiation

29
Q

What are the common side effects of chemotherapy?

A
  • Nausea and vomiting
  • Fatigue
  • Hair loss
  • Bone marrow suppression, leading to immunosuppression
  • Peripheral oedema
  • Weakening of skin and nails
  • Peripheral neuropathy
30
Q

What are the common side effects of radiotherapy?

A
  • Fatigue
  • Skin reactions
  • Breast and upper limb oedema/lymphoedema
  • Fibrosis of skin and chest wall muscles
31
Q

What are the common side effects of hormonal therapy?

A
  • Reduced bone density
  • Hot flushes
  • Incontinence
  • Joint pain/inflammation
32
Q

What are the roles of physiotherapy in the management post-mastectomy?

A
  • Regain shoulder ROM and function
  • Minimise secondary complications: scar, contraction, cording, sensory disturbance, weakness
  • Education and management of lymphoedema
  • Fatigue management
  • Establish/re-establish regular exercise routine
33
Q

What principles may physiotherapy treatment by based on?

A

Physiotherapy Management Care Plan (PCMP) developed in 1993

34
Q

What are the subjective signs and symptoms of lymphoedema?

A
  • Heaviness
  • Aching
  • Soreness
  • Tightness
  • Pins and needles
35
Q

What are the objective signs of lymphoedema?

A
  • Visual swelling
  • Pitting
  • Increased skin folds
  • Stemmers sign
  • Skin changes
36
Q

What is stemmers signs?

A

Thickened skin at base of second finger, indicating presence of lymphoedema

37
Q

What objective measure is used for lymphoedema diagnosis and how is it performed?

A

Circumferential measures: taken at 10cm intervals up both limbs for comparison

38
Q

What limb circumference is considered clinical significant?

A

> 2cm difference from opposite side

39
Q

What are the precautions of physiotherapy intervention for lymphoedema?

A
  • Heat applications
  • Constrictions i.e. tubigrip
  • Vigorous massage/soft tissue work
  • Dry needling
  • Progression of strength exercise
40
Q

What are the precautions of physiotherapy intervention for lymphoedema?

A
  • Heat applications
  • Constrictions i.e. tubigrip
  • Vigorous massage/soft tissue work
  • Dry needling
  • Progression of strength exercise
41
Q

What are the red flags associated with lymphoedema?

A

Any unusual pain or new symptoms in a patient with a history of cancer

42
Q

What aspects are recognised in the best practice treatment guidelines for lymphoedema?

A
  • Lymphatic drainage massage
  • Exercise
  • Skin care
  • Compression
  • ADL advice
43
Q

What are the most important treatment components in early/mild lymphoedema?

A
  • Self massage program
  • Skin care
  • Exercise
  • Compression garment
44
Q

What is the most important component of moderate-severe lymphoedema management?

A

Complex lymphoedema therapy

45
Q

What is lymphorrhea?

A

Leaking lymph

46
Q

What are the effects of compression therapy?

A
  • Reduced capillary filtration
  • Increased uptake of lymphatic collectors
  • Increased movement of lymph through lymph vessels with skeletal muscle action and joint movement
47
Q

What compression pressures should be used and when?

A

Low resting pressure

High working pressure

48
Q

What are the classes of compression garments?

A

Graduated compression:

  • Class 1: 15-20mmHg
  • Class 2: 22-36mmHg
  • Class 3: 35-46mmHg
  • Class 4: 45-55mmHg
49
Q

What compression pressure do TEDS stockings provide?

A

10-20mmHg

50
Q

What can low level laser therapy be used for?

A
  • Pain reduction

- Oedema management

Physiotherapy in Specific Groups (5 decks)

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