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Flashcards in Lymphedema--Jen Deck (42):
1

Lymphotomes

-anatomical regions that drain to same area
-left/right and upper/lower

2

Lymph flows toward:

-nodes from peripheral tissues
-controlled by bicuspid valves of lymphangion

3

lymphangion

-segment of lymph vessel that contains a bicuspid valve
-has smooth muscle
-lined with epithelial cells

4

Smooth Mm Contraction of lymphangion

-initiatied by pressure increase outside the vessel
-pumps only 3-4 times per min
-need skeletal movement to move fluid

5

lymph vessels empty into:

-veins near internal jugular and subclavian veins

6

How many nodes in body

-600

-160: head neck
-200: digestive system

7

Ducts/Trunks

-larger lymph vessels
-lumbar trunk and intestinal trunks flow to cisterna chili then to thoracic duct at venous angle

8

Pressure change by respiration increases____

rate of lymph flow into the thoracic duct

9

Function of Lymph System

-maintain balance of fluids
-return fluid/substances from interstitium to blood stream
-differentiate between foreign and self cells

10

Lymph Fluid Contains

-water
-proteins
-cytokines
-enzymes
-lymphocytes
-macrophages
---bacteria, fungi, viral, tumor cells

11

Lymphadema

-abnormal collection of excessive tissue proteins, edema, chronic inflammation and fibrosis
-lymph load>total capacity

12

complications of lymphadema

-recurrent infection (cellulitis etc)
-chylous reflux
-lymphocutaneous fistulae (weeping) pathways from lymph vessel to surface of skin
-lymphangiosarcoma

13

chylous reflux

-backflow of intestinal lymph

14

Lymphangiosarcoma

-cancer of lymphatic vessels

15

Risk Factors

-axillary surgery (any cancer surgery)
-radiation therapy
-mastectomy
-axillary node dissection
-obese
-delayed wound healing
-tumor causing lymphatic obstruction
-scarring ducts from surgery/radiation
-intrapelvic/intra-abdominal tumors
-chronic venous insufficiency

16

Medical Management

-no meds, no surgery
-PT

17

Diagnosis

-lymphangiography
-Lymphoscintigraphy (gold standard)
-venography/dopplar US

18

PT Tests/Measures

-stemmer's sign: inability to pinch skin on dorsal hand/foot
-volumetrics: water displacement
-Circumferential: use formula to determine volume

-if it resolves with elevation then it's not lymphadema

19

Staging of Lymphadema

stage 1-3

20

Stage 1

spontaneously reversible (elevation)
-pitting edema
-increased limb girth and heaviness

21

Stage 2

-does not change with elevation
-spongy tissue feeling
-fibrotic changes

22

Stage 3

-lymphostatic elephantiasis

23

Precautions/Contraindications with lymphedema complicatiosn

-careful techniques (don't cause genital edema)
-US
-Elastic tubular bandage
-skin irritation
-infection
-CHF
-cognition/communication
-DVT

24

PT for Lymphadema

-Complete Decongestive Therapy (CDT)

25

CDT

-Manual lymphatic drainage (MLD)
-compression bandaging
-exercise
-skin care
-risk reduction

26

Manual Lymphatic Drainage

-increase movement of lymph & interstitial fluid
-stretching of skin
-pressure phase
-relaxation phase
-slow: 5-7 reps per area

27

Stretching of skin effects:

-effects superficial lymph vessels

28

Pressure Phase promotes:

fluid movement in desired direction

29

Relaxation Phase causes:

-vacuum due to distention of tissue and leads to refilling of vessels

30

Compression Bandaging

-short stretch, low elastic
-low resting pressure
-high working pressure
-non stretch tubular layer (wick moisture)
-layered with graduated pressure in limb

31

Compression Garments

-maintain limb size (not reduce it)
-Graded: class 1-4

32

Class 1 Garments

-20-30mmHg

33

Class 2 Garments

-30-40mmHg
-UE

34

Class 3 Garments

-40-50mmHg
-LE

35

Class 4 garments

-60+mmHg

36

Reason of Disuse of Garments

-not fit properly
-not aesthetically pleasing
-uncomfortable fabric
-difficulty to don/doff
-wrong amount of compression

37

Exercise for Lymphadema

-moderate intensity
-diaphragmatic breathing
-muscle pump exercises

38

Muscle Pump Exercises

-ball squeeze
-elbow flex/ext
-shoulder flex
-cervical flex/ext
-scap retraction
-ankle pump
-knee flex/ext
-hip flex/abd/add

39

Skin Care

-low pH moisturizer (Eucerin, Lindi)
-keep clean
-wash garmets
-clean cuts and cover properly with anti-biotic
-careful with nail cutting (podiatrist)

40

Risk Reduction

-protect skin
-avoid insect bites/public pools/burns
-stay clean
-exercise
-avoid increased body temp (hot tub, sauna, steam)
-minimize limb constriction (jewelry)
-healthy nutrition
-hydration

41

Prognosis

-early detection and pt ability to self manage increases prognosis
-progressive disorder
-if unmanaged-->elaphantiasis

42

Abdominal/Pelvic Lymphadema

-difficult to manage and bandage
-good results with pelvic floor Mm training and compression garments (spanks)