Lymphedema Management
Approximately 3 million Americans are affected by Lymphedema and require lymphedema management. When the lymphatic system develops irregularities in the flow of lymphatic fluid between the thoracic duct, bloodstream and tissues, excess lymphatic fluid can build up in the tissues (fluid retention) where the lymph notes are located causing swelling, and this swelling is termed lymphedema.
Lymphedema differs from other forms of edema (tissue swelling) because it arises from the lymphatic system – lymph nodes and lymph vessels – where other forms of edema result from alternate sources. The severity of lymphedema depends on the type, cause and the extent of obstruction or damage in the lymphatic system to either the nodes or vessels.
Types and Causes of Lymphedema
The two types of Lymphedema are:
- Primary lymphedema – less common, unknown cause, sometimes genetic, symptoms appear at any time but often at puberty
- Secondary lymphedema - more common, caused by trauma to the lymphatic system, such as chronic infection, deep vein thrombosis, surgery, radiation and tumors (such as cancer)
Diagnosing (evaluating) Lympthedema
Symptoms of lymphedema may be evaluated by visual inspection of the swollen site, applying pressure to the site to determine degree of swelling, measuring limb circumference (particularly applicable to arms and legs) and enlargement of nodes, checking pulses, using bioimpedance measurement to identify the amount or volume of fluid retention, and impedance analysers to determine severity.
Symptoms and Stages of Lymphedema
Lymphedema can present as swelling in the arms, under the armpits, in the legs, groin and trunk (chest and abdomen) of the body. Traumatic events (accidents with bruising and cuts, sports injuries, and sunburn), infection, aircraft travel (swelling with changes in pressure); may result in the skin and limbs feeling thick and heavy with limited joint flexibility, and jewellery may suddenly feel tighter. These are signs of Lymphedema. The symptoms present in four stages:
- Latent (mild) – damage to lymph vessels with uninterrupted lymphatic fluid flow
- Spontaneously reversible (moderate) – damage to lymph vessels with interrupted lymphatic fluid flow where tissue holds indentation when pressed
- Spontaneously irreversible (severe) – damage to lymph vessels with interrupted lymphatic fluid flow and further damage to tissue causing swollen fibrotic tissue that is harder and unresponsive to pressure
- Lymphostatic elephantiasis (massive/gigantic) – extensive tissue swelling in the affected area with increased fibrotic tissue, and unresponsiveness
Lymphedema Management
Physical therapists do evaluations to determine the cause and extent of the lymphedema when designing Lymphedema Management plans. Lymphedema cannot be cured therefore Lymphedema therapy is used to soothe symptoms and to manage the condition. The therapy may consist of:
- Elevating the limb
- Diet plans for weight regulation – low fat and salt
- Using lymphatic sleeves - elastic bandage over swollen site to force the fluid into the lymphatic systems for release
- Using pneumatic sleeves (sequential gradient pump therapy) – an air device placed over the swollen site with an air pump that massages to direct excess fluid through the lymphatic system
- Compression clothing
- Exercise therapy – stretching and massage
- Manual lymphatic drainage – through use of CDT
- Complete decongestive therapy (CDT)
- Low level laser therapy – stimulates lymphatic system function
- Surgery – excision techniques and lipsuction
Complete decongestive therapy (CDT) includes skin care, exercise therapy, use of short elastic compression bandages, and manual manipulation of the lymphatic ducts through massage. Through this manual technique, lymphatic drainage is initiated because the blood circulation and lymphatic system is stimulated to pump the excess lymphatic fluid for release. Part of the treatment for Lymphedema is also aimed at prevention by:
- Avoiding infections
- Keeping the skin clean
- Consuming low fat and salt diet
- Replacing tight clothing with loose-fitting garments
- Avoiding tight jewellery that can chaff
- Staying in environments with normal temperature (not high)
- Seeking medical attention when needed for injury or change in symptoms