Name some lymphatic organs (organs that have lymph nodes in them)
- Bone marrow
- Thymus gland
How does lymph differ from interstitial fluid?
Lymph fluid is ~95% water while the other 5% is proteins, lipids, carbs, ions and some cells
What is the function of the lymphatic system?
- Fluid balance by draining capillary ultrafiltrates and escaped plasma proteins and returning them to blood circultion
- Nutritional function (intestinal lymphatics are responsible for fat absoprtion)
- Immune response
- Important for self-tolerance
what is lymphedema?
a swelling of a body part, usually an extremity and its adjacent trunk quadrant
What causes lymphedema?
the abnormal accumulation of protein-rich IF
T/F: lymphedema is cureable
List some of the physical consequencs of lymphedema
- Heaviness and decreased motion of limb
- Cosmetic issue
- Altered lifestyle to prevent exacerbation or infection
List some psychological consequences of lymphedema
- increased anxiety, depression
- constant reminder if caused by cancer
- loss of familiar body image
- loss of self-esteem
- loss of control on life/body
- distruct/frustration w/medical staff (if limited or poor knowledge)
what is primary lymphedema?
no cause, congenital defect of the lymphatic system
what is secondary lymphedema?
started by damage to/blockage of your lymphatic system
what is an axillary dissection?
a surgery to remove a malignant node
performed as a biopsy
list some healthy habits for pt edu and individuals w/lymphedema or at risk
- maintain healthy BMI w/low Na diet and regular exercise
- gradually build up duration and intensity of any activity/exercise
- Monitor the at-risk extremity during and after activity for change in size, shape, tissue texture, soreness, heaviness, or firmness
- keep skin moisturized and protected from dryness, bug bits, sunburn and injury
- avoid limb construction
- avoid extreme temps or greater than 15 min in hottub
- compression garments recommended for air travel
- apply first aid to every scratch/puncture on affected limb and monitor for signs of infection
how many stages are there to lymphedema?
describe stage 0 lymphedema
the lymphatic system is already functioning inadequately, but its still managing to keep from swelling for now
Describe Stage 1 lymphedema
- lymphatic system is overburdened and can no longer keep up with the body's damage
- a protein-soft swelling develops in the affected area (pitting edema)
- elevation improved temporarily
Describe Stage 2 lymphedema
- swelling no longer improves w/elevation
- high protein concentrations produce fibrosis, increased hardening of tissues called sclerosis
- stagnant proteins are a perfect environment for bacterial growth
Describe Stage 3 lymphedema
- aka elephantiasis
- swelling is severe, skin is hardened and wart-like growths (papilloma's) appear
- the shape of limb is skewed - with bulges of swelling
- risk for repeated infections is high and skin is susceptible to deep, poor-healing wounds
what are the main stages to lypmhedema treatment?
- good hygiene/skin care
- Manual lymphatic drainage (MLD)
- Compression therapy w/multi-layered low stretch bandages
how is MLD different from massage?
MLD is softer and you start proximally to clear out blockages in ducts before moving distally to start pushing lymph back proximally
How do you achieve compression therapy?
- multi-layering of low stretch bandages are applied to limb
- muscles contract underneath, pushing against the bandages to pump lymph out
T/F: exercising on its own helps reduce lymphedema
except diaphragmatic breathing
exercising w/compression garments is best
what components of the PT eval are necessary to assess the presence and severity of lymphedema?
- history of swelling
- measurements of circumference of limb and ROM of prox joints
what is Stemmer's sign?
use it on hands or feet
if you can tent the skin over the MCP and ICP joints you don't have lymphedema
if you cannot pull the skin up there its considered a + sign
what is typcially involved in a lymphedema treatment session?
- compression therapy
- Exercising w/bandaging on
what is the most important factor in successful treatment of lymphedema?
List some factors that can contribute to failure of effective lymphedema treatment
- non-compliance from pt
- inappropriate PT (misdiagnosed)
- medical considerations or relative CI to trx:
- acute infection
- arterial disease
- active cancer
- acute infection
- arterial disease
- active cancer
list some positive outcomes from successful lymphedema treatment
- prevention/reduction of infections
- reductions to limb size to near normal
- reductions in trunk swelling
- breakdown of fibrotic scar tissue
- Pt edu and family edu → self management
- decreased total impact of the lymphedema on function
- lymph flow more rapid
- lymph node uptake improved and backflow diminished
T/F: elastic support garments help to reduce swelling
they help to maintain the results of a pre-treated lymphedematous limb
List some meds that are commonly prescribed to trx lymphedema
- diuretics → but shouldnt!
why shouldn't diuretics be used to treat lymphedema?
commonly used but make the condition worse by drawing off water and leaving behind proteins which cause thickening/hardening of the tissues and increase risk for infections