Lymphoedema Flashcards
(29 cards)
What is lymphoedema?
- Chronic swelling of a body part (usually limbs)
- Caused by the accumulation of fluid & protein in the tissue spaces arising from congenital malformation of the lymphatic system, or damage to lymphatic vessels and/or lymph nodes
What happens when the lymphatics are not functioning adequately?
- ECF accumulates in the tissues
- This fluid contains proteins, cell debris, fat and bacteria that are unable to pass into the venous circulation
What is the common progression of lymphoedema?
- Usually becomes chronic
- Tends to worsen without good management
- Limb can become heavy, unsightly, achy and may become too big to fit into regular clothes or shoes
What is the function of the lymphatic system?
- Preserves fluid balance
- Promotes fat absorption via intestinal lymphatics
- Host defence
- Collects & transports ECF to maintain homeostasis (called lymph once in lymphatic vessels)
- Lymph filtered at regional lymph nodes
- Returned to venous circulation via venous angle at the subclavian vein
What is the function of lymph nodes?
- Filters lymph
- Immune function
Under normal conditions, how much lymph is collected & moved through the lymphatic system in 24 hours?
2-4L
What is lymph drainage assisted by?
- Intrinsic pumping of lymph vessels
- Active muscle contraction
- Passive joint movement
- Respiration (pressure changes above/below diaphragm)
- Pulsation of adjacent blood vessels
What are the causes of primary lymphoedema?
- A developmental fault
- E.g. dysplasia, aplasia, hyperplasia
What are the 3 types of primary lymphoedema?
- Congenital abnormality/ malformation: <2yrs
- Late onset due to underlying malformation: >2yrs
- Syndromal conditions eg Klippel-Trenaunay, Prader Willi
What are the causes of secondary lymphoedema?
- Damage sustained later (cancer related)
- Lymph node resection
- Radiotherapy to lymph nodes
- Obstruction e.g. tumour
- Infection, inflammation, vascular conditions, obesity etc.
What are the triggering/aggravating factors for lymphoedema?
Anything that increases lymphatic load on the limb or obstructs/reduces drainage
- Infection
- Excess body weight
- Too little exercise or movement
- Heat
- Tight constricting clothing
- Travelling by air without a compression garment
How does exercise help prevent lymphoedema?
Muscle contraction increase lymph flow & reduces risk of excess fluid accumulating
What evidence is there about strength training in lymphoedema?
- Resisted exercise does not lead to worsening or triggering of lymphoedema
- May lead to decreased self-reported flare ups & increased QOL
What is a precaution for exercise in lymphoedema?
When unfit/deconditioned it is important to increase load and intensity slowly
What cancers are most commonly associated with lymphoedema?
- Breast
- Melanoma
- Gynaecological
- Head & neck
- Prostate
What are the signs & symptoms of lymphoedema?
- Burning pain
- Dull ache
- I/T shooting pain
- Tightness
- Obvious oedema
- Invisible veins
- Pain on movement of neck or shoulder
- Increased skin folds/ thickness
What objective measures can be used for lymphoedema?
- Limb circumference at 10cm intervals
- Bioimpedance (body comp)
What advice can be given for managing early lymphoedema?
- Continue to do exercises
- Elevate when able to
- Avoid prolonged sitting or static postures
- Prompt referral to lymphoedema PT
What are the precautions for physio treatment for lymphoedema?
- Heat applications- caution
- Constrictions eg tubigrip
- Vigorous massage, soft tissue work
- Dry needling
- Build up exercise/ strengthening gradually
What is the medical management of lymphoedema?
- Currently no known cure or drug that safely treats lymphoedema
- Managed by complex lymphoedema therapy
What are the best practice treatment guidelines for lymphoedema?
- Lymphatic drainage massage
- Exercise
- Skin care
- Compression
- ADL advice
What are the common treatments for early/mild lymphoedema?
- Self massage programme
- Skin care
- Exercise
- Compression garment
What are the common treatments for mod-severe lymphoedema?
- Complex Lymphoedema therapy (massage, exercise, bandaging, compression garments, skin care)
- Laser
What are the benefits of manual lymphatic drainage massage in lymphoedema?
Stimulates the patient’s lymphatic system to drain the area more effectively
