Exam 4 Flashcards
(72 cards)
1
Q
Lymphathic organs
A
Lymph nodes (600-700 in body) “Filtering stations,” produce WBC, regulate proteins in lymph Lymph vessels Intrinsic contractions, 6-10x/minute Thymus gland Spleen Tonsils Peyer’s patches
2
Q
Lymphatic vessels
A
Capillaries
Pre-collectors
Collectors
Trunks
3
Q
Mechanisms of Transportation
A
Intrinsic contraction Respiration Arterial/venous pulsation Skeletal movement New lymph (creates pressure)
4
Q
Lymph fluid consists of
A
Proteins
75-100 g of proteins are transported by the lymph vessels per day
Water
Cells (RBC, WBC, Lymphocytes)
Waste products and other foreign substances
Fat (intestinal lymph, chyle)
5
Q
Filtration=
A
Resorption + Lymph Flow
6
Q
Lympathic load
A
How much – water, proteins, cells, etc
7
Q
Lymph Time Volume (LTV)
A
Amplitude and frequency of intrinsic contractions
8
Q
Transport Capacity
A
=Max LTV
= 10x LL in intact system
9
Q
Functional Reserve
A
Difference between TC and LL
10
Q
Normal
A
LL< TC
11
Q
Dynamic insufficiency –
A
overload lymphatic system
Venous insufficiency, cardiac edema, DVT, etc
12
Q
Mechanical insufficiency – lymphatic system damaged
A
Surgery, trauma, radiation, etc
Lymphedema always includes mechanical insufficiency
13
Q
Combined insufficiency
A
damaged system and overload
Obesity, CVI, lipedema
14
Q
Lymphedema
A
An abnormal collection of protein-rich fluid in the interstitium, which causes chronic inflammation and reactive fibrosis of the affected tissues
The lymph load exceeds the total capacity of the system
15
Q
Risk Factors of Lymphedema
A
Axillary, inguinal, etc surgery Radiation therapy Partial or total mastectomy Node dissection Obese or overweight Lipedema History of infection in at-risk limb Constriction Tumor causing lymphatic obstruction Scarring lymphatic ducts by either surgery or radiation Intra-pelvic or intra-abdominal tumors Chronic venous insufficiency Drain complications
16
Q
Primary Lymphedema
A
Mechanical insufficiency of the lymphatic system
Malformation of lymphatic vessels
Congenital or hereditary
17
Q
Secondary Lymphedema
A
Known cause for lymphedema Surgery Radiation Trauma Filariasis Cancer/tumor Infection Obesity Self-induced
18
Q
Early signs of Lymphedema
A
Limb feels heavy Skin feels tight Limb is achy (not painful) Clothing or jewelry is tight Can’t see wrinkles in skin
19
Q
Stage: Latency
A
no visible/palpable edema, subjective complaints possible
20
Q
Stage 1:
A
reversible (elevation), pitting edema often present, increased limb girth and heaviness, no fibrosis
21
Q
Stage 2:
A
consistent swelling- does not change with elevation, spongy tissue feeling and often fibrotic changes, pitting becomes progressively more difficult
22
Q
Stage 3:
A
lymphostatic elephantiasis, non-pitting, fibrosis and sclerosis, skin changes (hyperkeratosis)
23
Q
Skin characteristics
A
Hyperkeratosis (Redding but it becomes hard)
Lichenification (leathery and hard)
Peau d’Orange Texture
Ulcers
May be more common with arterial, neutrotrophic, venous, or traumatic conditions
Vesicles (cysts)
24
Q
Infection -lymphedema
A
Reflux
Weeping = lymphorea
25
Differential diagnosis
```
Deep vein thrombosis (DVT)
Renal failure
Postoperative complications
Cysts
Complex regional pain syndrome
Cellulitis
Cardiac edema
Congestive heart failure
Malignancy
```
26
Lipedema
```
Primarily women
Bilateral, symmetrical swelling from ilium-> ankle
Dorsum of feet not involved
Little or no pitting
Palpable nodules fat under skin
Painful to palpation
Bruise easily
```
27
Venous Edema
```
Mid/low calves, malleoli
Skin discoloration
Fibrosis of subcutaneous tissue
Atrophic skin
Wounds
```
28
Do medications help lymphedema?
no
29
Surgeries
lymph node transplant, debulking, liposuction
30
Tests and Measures for lymphedema
Lymphoscintigraphy: nuclear imaging method, tissue injection is transported by lymphatic system and allows assessment of superficial and deep lymphatics, no damage to lymph vessels
Venography and Doppler US: rule out venous problems
31
Stemmer's Sign
thickening of skin on the dorsal hand/foot; inability to pinch skin in these areas
32
Complete decongestive therapy
Manual Lymphatic Drainage (MLD)
Compression Bandaging (multi-layer, short-stretch)
Exercise
Skin Care
Self Care & Risk Reduction / Education
33
Effects of Complete Decongestive Therapy
Decrease swelling (>50%)
Increase lymph drainage from the congested areas
Improve skin condition
Improve patient’s function, quality of life
Reduce risk of infection
34
Reductive Phase
Daily (5x/week) treatments until fluid reduction has plateaued
MLD followed by compression bandaging, exercise
60 minute appointments
Bandages stay on until return next appointment
35
Maintenance phase
```
Self-management program
Self-MLD
Compression bandaging or bandaging alternative at night
Compression garments during day
Skin care
Exercise
Pneumatic compression device, sometimes
Periodic monitoring
Replacements of compression garments every 4-6 months
```
36
CDT Precautions/Contraindications
Careful techniques, do not cause genital lymphedema
Do not use long-stretch bandages/ACE wraps (to stretchy so it will add too much pressure)
Skin irritation
Infection
Cognition/communication
Wounds
37
Manual Lymphatic drainage:
Increases the movement of lymph/interstitial fluid, including proteins
---Improves lymph transport capacity, lymph vessel contractility
Stretching of the skin affects the superficial lymph vessels
--Pressure phase promotes fluid movement in a desired direction
--Relaxation phase causes a vacuum due to the distention of the tissue and leads to refilling of the lymph vessels
Slow technique, 5-7 repetitions per area
Gentle technique
Do not rub or create redness
38
MLD Sequencing
Clear proximal regions and nodes
Move segmentally
Always stretch from distal to proximal
39
Compression Bandaging
- Improves efficiency muscle pump
- Prevents re-accumulation of evacuated fluid
- Facilitates softening of fibrotic tissue
40
Remedial Exercise
Part of treatment for lymphedema when limb reduction is goal
WITH COMPRESSION
Includes:
Diaphragmatic breathing
Active, repetitive, non-resistive motion; distal to proximal (ROM/flexibility)
Ball squeeze, elbow flex/ext, shoulder flex, cervical flex/ext, scap retraction
Ankle pump, knee flex/ext, hip flex, hip abd/add
41
Exercise
```
WITH COMPRESSION
If arm, include hand compression
Affects deep lymphatics
Pay attention to feelings of heaviness, increased swelling
Avoid extreme temperatures
Allow adequate rest between sessions
```
42
Resistance training is beneficial
Be cautious
Start slow, with low weights, low repetitions
Gradual progression
Limit based on patient / patient’s symptoms
43
Aerobic Training is beneficial
increases circulation and immune response
Be cautious
Start slow
Gradual progression
44
Skin Care
```
Low ph moisturizer (Eucerin)
Keep clean
Clean cuts/tissue injuries and cover with an antibiotic ointment
Careful nail cutting
Use electric razor
Avoid sunburns, burns, bug bites
Wear gloves with outdoor work
```
45
Self-Care
```
Self-manual lymphatic drainage
Self-bandaging
Donning and doffing compression garments
Exercises
Skin/nail care
```
46
Risk Reduction
Maintain normal body weight
Protect skin integrity, maintain good skin hygiene
Avoid trauma to affected area (insect bites, acupuncture, burns, tattoos)
Exercise to prevent musculoskeletal injury
Avoid extreme heat or cold (hot tubs, saunas, extreme temperatures, cold)
Minimize limb constriction (jewelry, clothing, blood pressure)
Plan ahead with lymphedema therapist and physician for surgeries
Wear compression, move around during air travel
Watch for infection
47
Compression Garments
Designed to maintain limb size, not reduce it
Do not wear at night
If proximal compression is worn without distal pressure, swelling distally is likely
If sleeve is worn without glove, hand swelling is likely
Wash/dry per care instructions
48
Compression Grades
Class 1: 20-30 mmHg (beginning pressure arms)
Class 2: 30-40 mmHg (ideal pressure legs)
Class 3: 40-50 mmHg
49
Compression bandages are not covered by insurance
- about $60-80 for knee-high or arm
| - about $80-$110 for thigh-high
50
Breast surgeries
```
Radical mastectomy
Breast tissue, pec major/minor, nodes
Modified radical mastectomy
Breast tissue, spares pec major, nodes
Lumpectomy
Tumor and surrounding tissues
```
51
Post-Op
Full examination/evaluation
Pay close attention to skin, incisions, skin mobility, muscle guarding
Take limb measurements
Discuss activity modifications that may need to be made
Education on plan/ therapy progression
Lymphedema
Signs/symptoms infection
52
Lymphatic cording
1. Thickened fascial cord(s) running just under the skin, visible or palpable when the upper extremity is in a flexed and abducted end range position
2. Subjective report from the patient includes the experience of “pulling” through area of cording and beyond.
3. Limited range of motion in area of cording
4. Reports of discomfort or pain in area of cording
53
Cording treatment
Myofascial release techniques/ soft tissue mobilizations
Manual lymphatic drainage
Gentle stretching
Diaphragmatic breathing
Neural mobilization of the upper extremity
54
Radiation Fibrosis
Myofascial release techniques/ soft tissue mobilizations
Manual lymphatic drainage
Gentle stretching
Neural mobilization of the upper extremity
55
Cause of UE amputation
Trauma, Congenital, Disease
56
Cause of LE amputation
Disease
57
Reasons for No prosthesis
Limited perceived functional benefit
Reduced sensory input
Comfort
Hot &/or heavy
58
Benefits of oppositional prosthesis
```
Provides aesthetic appearance
Light weight & simple
Functions
Opposition
Holding objects
Restore body image
Proprioceptive feedback
```
59
Limitations of oppositional prosthesis
No active prehension
High cost for custom
Durability
Patient can have unreal expectations for cosmesis
60
Body-Powered Prosthesis
A.k.a. ‘cable driven’
| Relies upon gross body movements captured through a harness
61
Benefits of Body-Powered Prosthesis
Moderate cost and weight
Durable
Environmentally resistant
Proprioception through harness system
62
Limitations of Body-Powered Prosthesis
Grip strength or pinch force
Restrictive & uncomfortable harness
Requires muscle power & excursion
Poor static & dynamic cosmesis
63
Externally Powered
A.k.a. ‘electrically’ powered or ‘myoelectric’
Powered by a battery
Myoelectric signals
Controlled by various input methods
64
Benefits of externally powered
```
Stronger grip force
Moderate or no harnessing
Minimal energy expenditure
Least body movement to operate
Moderate aesthetics
```
65
Limitations of externally powered
Heavier
More expensive
Limited sensory feedback
Extensive therapy training
66
Hybrid Prosthesis
A single prosthesis in which two or more technologies are combined
Less weight than fully powered system
More grip strength than a body powered system
67
Elbow and hand hybrid
Elbow: Body-Powered
Hand: Externally Powered
68
Hybrid benefits
Simultaneous control of the elbow and terminal device
| Reduced weight compared to all electric
69
Traditional myoelectric control has limitations
Lack of control signals…usually just 2 electrodes
Rely on larger muscle groups for signal
Control muscles usually physiologically inappropriate
70
Pattern Recognition
Computer software translates muscle activity into prosthetic movements
Many electrodes
More complete muscle activity picture
71
Multi-articulating hands
Single motor
Single grip pattern
Pronation/supination done passively or with electric wrist rotator
Rigid, solid
72
Rehab therapy post delivery of prosthetic
- Donning of prosthesis
- control of components
- functional training
- occupational performance
