LymphedemaTreatment & Management

Shivangi Dave, MS,OTR/L, CLT

Lymphatic systemComponents & Functions

Components of Lymphatic System:

Lymph vesselsLymph nodesSpleenThymus glandTonsilsLymphocytes

Lymphatic systemComponents & FunctionsFunctions : Transports proteins and fluid

from the tissues to cardiovascular system

Transports fat from intestinal lymph vessels to cardiovascular system

Has important immunological functions

Re: Benjamin Cummings

Lymph Vessels

Re: Kublik Re: Weissleder

Lymphatic drainage

Picture: Kublik

What is Lymphedema?Lymphedema is the

swelling of a body part(s), most often arm(s) or leg(s) as a result of lymphatic failure.

It is an abnormal accumulation of proteins in the body’s tissue ( unlike dependent edema).

Over the period, lymphedema causes tissue proliferation of the affected areas. Re- compressionstore.com

Types of LymphedemaPrimary lymphedema- Born with insufficient or compromised lymphatic system

Secondary lymphedema- May be a result of : Surgery and/or radiation

for cancer, Cancer, Filariasis, Trauma, Infection, Chronic Venous

insufficiency or Obesity

Signs and Symptoms of LymphedemaSwelling starts gradually and may be

preceded by a feeling of heaviness or fullness in the affected area

Rings, bracelets, clothing or a watchband may feel tighter than normal

Pitting EdemaDecreased ROM/ mobilityRecurrent cellulitis infections

Early detection and lowering risk for Lymphedema Educate about lymphedema- “ spread the word”Specialized clinicians can diagnose on the basis of

clinical examinationEarly assessment of unilateral UE Lymphedema

with use of L-DEX

Eat healthy and strive to be as normal body weight as possible

Be active and exercise; if uncertain about the right kind of exercise, check with your CLT

Management of LymphedemaComplete Decongestive Therapy (CDT) as the

method of choice- includes two phases Decongestion phaseMaintenance phase

Blue indicates Phase I = intensive phase

Green indicates Phase II = maintenance phaseRe-FÖLDI M., FÖLDI E., KUBIK S., Textbook of Lymphology

Components of CDTManual lymphatic drainage (MLD)Compression BandagingExerciseSkin and nail careInstructions in self care

About MLD

• lymphatic uptake• lymph vessel pulsation• Promotes movement of fluid

from edematous areas to regions of normal lymphatic drainage • Promotes relaxation• Analgesic effect Re-klosetraining.com

Does it work?

Pictures: Providence St. Peter Hospital, Lymphedema Clinic, Olympia, WA

Short Stretch bandaging & MLD (CDT)

Re-klosetraining.com

Compression garmentsEssential after decongestive treatmentCustom Made vs. Ready to Wear Garments

Various compression grades and styles Flat knit, circular knit, cut & sew

Prophylactic benefit Proper compression gradeEnsure good fit

Re-klosetraining.com

ReferencesTextbook of Lymphology by M. Foeldi, E. Foeldi, S. Kubik

(EDS.) Urban Fisher Verlag, 2003 ISBN: 0-9729535-0-7

Lymphedema Diagnosis and Therapy by H. Weissleder, Ch. Schuchhardt, 3rd Edition, Viavital Verlag, 2001

ISBN: 3-934371-24-8A Primer on Lymphedema by Deborah Kelly, Prentice Hall,

2001 ISBN: 0-13-022410-3

Modern treatment of lymphoedema (5th ed.) by Casley-Smith J.R. & Casley-Smith J.R.(1997). Adelaide Australia: The Lymphedema Association of Australia

Introduction and Treatments for Lymphedema by Sabrina S. Selim, BA, Francine Manuel, RPT, Cheryl Ewing, MD, Ernest Roseenbaum, MDwww.medsalsupplier.com/lymphguide.html

Additional Website Links at: www.klosetraining.com

Infrastructure for Lymphedema ProgramPrivate Room- to make patients feel comfortableHi-Low Table -to make therapist comfortable

http://www.pattersonmedical.com/app.aspx?cmd=getProduct&key=IF_921022485http://www.pattersonmedical.com/app.aspx?cmd=getProduct&key=IF_97701

Disposable gowns/Medical gowns - http://www.pattersonmedical.com/app.aspx?cmd=getProduct&key=IF_921020678

Disposable GlovesArm bandages Compression garments- need to find local

resources/fittersEucerin/ Aquaphor Micropore TapeBolsterHoyer lift if legs to be treated

Questions ?