Week 2 - Edema Lecture Flashcards
edema
an accumulation of an excessive amount of watery fluid in cells, tissues, or serous cavities.
Which layer of the lympathics is edema involved with?
The most superficial layer (dermal layer)
Describe the location of the lymphathic system.
Very superficial
The part of the circulatory system that is concerned especially with scavenging fluids and proteins which have escaped from cells and tissues and returning them to the blood, with the phagocytic removal of cellular debris and foreign material, and with the immune response and that consists especially of lymphoid tissue, lymph, and lymph-transporting vessels.
Lymphatic system
Name the 3 most common areas for edema.
- peripheral (legs, arms, hands)
- abdomen (ascites)
- chest
How does initial low protein edema resolve?
resolves with elevation, icing, AROM. Generally quick to rebound.
When and why does high protein edema develop?
After a week; develops because excessive plasma proteins become trapped in interstitium and can’t move out of damaged lymph system.
Pitting edema
fluid is thick, viscose and when indented it “pits.” Edema in which an external pressure leaves a persistent depression in the tissue.
How is pitting edema classified?
There is a scale for pitting (not just new or old).
Name 5 effects of edema on the hand.
- hyperextension of the MCP joints.
- adduction of the thumb/index web space.
- collapse of hand arches (which are critical for function).
- joint stiffness
- limited tendon excursion
Name 5 potential problems related to physiology of injury.
- stiffness
- edema
- inflammation
- scar formation
- fibrosis
- decreased passive ROM
- increases force needed to reach end range.
stiffness
low protein edema
resolves quickly, does NOT lead to significant stiffness
high protein edema
does NOT resolve quickly (chronic edema) often does lead to stiffness.
What does a cast do in addition to stabilizing bone?
Applies compressive force to stop edema.
local response to injury which destroys, dilutes, or walls off injuries agent and injured.
inflammation
tissue that body creates to close a wound, defect, etc.
scar formation
condition marked by increase of interstitial fibrous tissue; if we wait too long to treat it, tissue can become inelastic
fibrosis
connective tissue in which white inelastic fibers predominate as distinguished from elastic tissue
fibrous tissue
Does cold reduce edema? explain
yes, but it can also turn skin red and cause inflammation. (be mindful of this).
Figure of 8 Method
method of measuring edema with a tape measure; used when whole hand is swollen.
volumeter
method of measuring edema in which whole hand/arm is placed in water.
Name 3 traditional techniques to reduce edema.
- elevation
- AROM
- retrograde massage
Retrograde massage
Stroke DISTAL to PROXIMAL, applying slight pressure trying to move fluid out. Good easy first step.
How can we reduce swelling under a splint?
Compression glove under a splint.
High Volt Pulses Galvanic Stimulation
helps intrinsics of hand contact and relax.
Contrast baths
- used for early edema
- warm water 4 mins, cold water 1 min (for ex.)
- no evidence, but some pts. say it works
Which pts. can’t use contrast baths?
pts. with Raynaud’s Disease due to circulation.
a technique to decrease sub-acute persistent and chronic hand edema post surgery, trauma, or stroke.
Manual Edema Mobilization (MEM)
Does MEM work for lymphedema?
No
Describe MEM techniques.
Rest hand underneath pts. arm. Put half of hand weight on top of pts. arm. Do a series of “U”s. At the end pt. should raise arm and open and close hand.
MEM includes the use of what 3 things?
exercises, light skin-traction, massage techniques following the lymphatic pathways, and the use of low-compression garments.
MEM should not be used on pts. with what 8 conditions? (contraindications)
- inflammation, open wounds
- blood clot, hematoma
- active cancer
- CHF, cardiac problems
- inflammatory stage of wound healing
- renal failure, kidney disease
- pulmonary problems
- post mastectomy lymphedema
post surgical compressive bandage
a type of soft splint bandage consisting of many layer of soft material wrapped around a joint or extremity.
what is the purpose of a post surgical compressive bandage?
to compress and to limit mobility in order to provide support, reduce bleeding, and limit swelling following surgery or trauma.
a collection of protein-rich lymphatic fluid, usually in the arm or leg which accumulates within the soft tissues. it’s caused by interruption of normal lymphatic flow which can be due to surgery, radiation, infection of trauma.
lymphedema
primary lymphedema
- resulting from lymphatic dysplasia
- can be present at birth
- can develop later with no apparent cause
secondary lymphedema
- more common
- causes known ex: surgery, radiation treatment for cancer, after injury - trauma, scarring, infection of lymph system
What causes lymphedema?
-the amount of fluid going into the arms or legs is greater than the amount that can go out bc of the damage to the transport system.
Manual Lymphatic Drainage (MLD)
- rerouting the fluid
- gentle manual technique
- activates lymph system
- usually not done as only treatment modality
Complete Decongestive Therapy (CDT)
- most successful for chronic lymphedema
- gentle, non-invasive and highly effective
Name the 5 components of CDT
- MLD (manual lymphatic drainage)
- bandaging
- exercise
- skin care/nail care
- education
a very gentle type of massage therapy used to drain excess fluid from the body and improve the overall functioning of the lymphatic (immune) system. Most commonly used to treat lymphedema, which is characterized by the blockage of lymph nodes in the arms and legs.
Manual Lymph Drainage (MLD)
most successful treatment for chronic extremity lymphedema. Post mastectomy lymphedema and other related conditions respond extremely well to this gentle, non-invasive and highly effective therapy.
Complete Decongestive Therapy (CDT)
Which medications should not be used to treat lymphedema?
diuretics (makes condition worse)
Pneumatic compression pump
compresses and relaxes to reduce/control swelling
Name 6 guidelines for lymphedema patients (patient education).
- skin - avoid trauma/injury to reduce risk of infection.
- lifestyle - build up duration and intensity of activity
- avoid limb constriction
- use compression garments
- avoid extremes of temperature
- LE practices - NO prolonged sitting, standing, crossing legs, wear good shoes, compression garments.
How would you start OT on someone with edema?
- measure the edema (tape measure, volumeter)
- measure AROM
- assess pain levels
- assess sensibility
- treatment - elevation, compression glove, positioning (Splint) - safe position but not 24/7
