Lymphedema

Question 1

What is lymphedema?

Answer 1

Build up of interstitial fluid in soft tissues when the lymphatic system is blocked or damaged

Question 2

Main functions of lymphatic system

Answer 2

• Regulation of fluid balance
• Transportation of immune cells and chemicals

Question 3

Components of lymphatic system

Answer 3

• Lymph vessels - capillaries, pre-collectors, collectors, lymphatic trunks
• Lymph organs - lymph nodes, thymus, spleen, tonsils

Question 4

How does lymph fluid travel to the heart?

Answer 4

Lymph capillaries -> precollectors -> collectors -> lymph nodes -> lymphatic trunks -> subclavian veins -> heart

Question 5

Primary lymphedema etiology

Answer 5

• Aplasia
• Hypoplasia and hyperplasia
• Fibrosis of lymph nodes
• Agenesis of lymph nodes
• Lymphedema precox (early onset)
• Lymphedema tardum (after age 30)
• Milroy’s disease (congenital)

Question 6

Secodary lymphedema etiology

Answer 6

• Dissection of lymph nodes
• Radiation
• Post-traumatic
• Post-inflammation
• Malignancies

Question 7

What is a positive Stemmer sign?

Answer 7

Inability to pinch the skin on the dorsum of the second toe indicates lymphedema

Question 8

What are the stages of lymphedema?

Answer 8

• Stage 0 = Latency stage - no swelling, reduced transport capacity
• Stage 1 = Reversible - edema is pitting, no skin changes, elevation reduces edema
• Stage 2 = Spontaneously irreversible - Fibrosclerotic changes; hardening of skin, frequent infections
• Stage 3 = Lymphostatic elphantiasis - extreme increases in volume and typical skin changes

Question 9

What are the treatment options for lymphedema and which is the gold standard?

Answer 9

• Complete decongestive therapy (CDT) is gold standard
• Pneumatic compression pump
• Surgery
• Elastic support garments
• Medications

Question 10

Main goals of lymphedema treatment

Answer 10

• Utilize remaining lymph vessels
• Eliminate fibrotic tissue
• Avoid re-accumulation of lymph fluid
• Prevent/eliminate infections
• Bring lymphedema to stage of latency

Question 11

What are the components of complete decongestive therapy?

Answer 11

• Meticulous skin and nail care
• Manual lymph drainage
• Compression therapy
• Decongestive exercises

Question 12

What is the purpose of meticulous skin and nail care?

Answer 12

• Prevent infection
• Instruct patient to use moisturizing lotion, avoid cuts, scratches, skin irritants
• Extreme caution with nail care

Question 13

What is the purpose of manual lymph drainage?

Answer 13

• Gentle, slow strokes stimulate the lymphatic system and move lymph to healthy lymph nodes
• Drain x4 reps; glides x 5-10
• Can be used in cases of edema due to surgery, hematomas, DVT, to encourage lymphatic system to assist venous system

Question 14

What is the purpose of compression therapy?

Answer 14

• Use of short stretch compression bandages until the area is completely decongested, then progress to compression garments
• Compression must be worn 24/7 until decongestion complete
• Bandage applied with pressure gradient
• Pressure can be as great as 90 mmHg with bandages, 40-50 mmhg with garments