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Lymphedema, The Big Picture

In this post, I'd like to talk about lymphedema from a 30,000 foot view. What is it? How is it treated? Risk factors, and prevention. I will be borrowing a bit of content from our lymphedema pump vendor Lympha Press, as they have a very well written outline.





What is Lymphedema?


"The lymphatic system is part of the circulatory system. It absorbs and transports interstitial fluids back to the blood circulation. Tiny lymph capillaries take up fluids that leak out of the vein capillaries and transport this lymph fluid through larger lymph vessels. The fluid is then returned to the blood circulation.


Symptoms


Lymphedema signs and symptoms, which occur in your affected arm or leg, include:

  • Swelling of part or all of your arm or leg, including fingers or toes

  • A feeling of heaviness or tightness

  • Restricted range of motion

  • Aching or discomfort

  • Recurring infections

  • Hardening and thickening of the skin (fibrosis)

The swelling caused by lymphedema ranges from mild, hardly noticeable changes in the size of your arm or leg to extreme changes that make the limb hard to use. Lymphedema caused by cancer treatment may not occur until months or years after treatment.


Risk Factors & Causes


If a lymph vessel is cut or blocked, or cannot function properly, fluid (edema) builds up in the area under the skin. Inflammation and tissue changes including fat deposition and fibrosis reduce the function of adjacent lymph vessels. This causes the disease to worsen if untreated. Limbs can become extremely large and heavy, and patients are susceptible to dangerous infections such as cellulitis.

  • Primary lymphedema is rare and is caused by malformed or absent lymph vessels.

  • Secondary lymphedema is much more common, and is caused by disease or physical damage to the lymph vessels or nodes, such as:

  • Cancer surgery/radiation or tumor blockage

  • Chronic venous insufficiency disease

  • Infections (for example, lymphatic filariasis)


How is it treated?


Left untreated, lymphedema can cause serious complications! It is extremely important that the patient receive effective and consistent treatment. Generally, treatment focuses on reducing the accumulation of lymphatic fluid and moving it from the affected limb back into the blood circulation.


Treatment methods include:


Wearing medical grade compression garment, complete decongestive therapy (CDT or DLT) performed in clinic and includes manual lymph drainage (MLD), lymphatic bandaging, skin care and exercise.

Pneumatic compression therapy, is another method of treatment for moderate to severe lymphedema. A special device sequentially inflates and deflates a garment worn over the affected area, applying directional compression. The pressure and release cycle encourages emptying and refill of the lymphatics, while the directional compression promotes the flow of lymph upward towards the torso and assists the lymphatic fluid in finding its way around the blockage to healthy lymphatic channels. The patient wears a medical compression stocking in between treatments.

Lympha Press® dynamic compression therapy is an advanced form of pneumatic compression therapy! Lympha Press® can reduce edema significantly, and maintain the reduction. It is easy to use and can be applied by the patient as part of a home care program.


Combining Therapies


Patients with lymphedema, especially those with particularly severe conditions, may benefit from using a combination of various treatment methods.


Particularly helpful: a combination regimen of manual lymph drainage and Lympha Press®. This treatment can be carried out entirely in clinic, or with the Lympha Press® portion of the treatment done the patient’s home. This “combined therapy” allows patients the independence and efficiency of home treatment, with the added benefit of the skilled therapist’s touch. The therapist can oversee treatment and make sure everything is on track.


Some patients with extreme lymphedema are treated with Lympha Press®, manual lymph drainage, and bandaging. After the initial reduction is achieved, the patient can continue maintenance with Lympha Press® treatments at home, along with compression garments, and manual lymph drainage as needed.


Do I have lymphedema?

If you are concerned you may have lymphedema, visit your doctor or see a physical therapist. Physical therapists often have quite a bit of experience with lymphatic drainage massages and wrapping to help in the reduction of swelling. They are a great resource to utilize.


Stemmer's Sign


One at-home test you can try is called the Stemmers test.

The Kaposi-Stemmer’s sign measures the ability of a clinician to lift and tent tissue on the foot. A positive Stemmer’s sign is diagnostic of lymphedema. It is classically measured at the base of the toes in the foot for patients with lower extremity swelling. It can be measured anywhere in the body where lymphedema is suspected. If you can gently pinch and can tent the tissue (bring the skin folds together), then the Stemmer’s sign is negative. If you cannot gently pinch and tent the tissue, this is because the protein rich lymph fluid in the tissues prevents you from bringing the skin folds together and the Stemmer's sign is positive. A positive Stemmer's sign is diagnostic of lymphedema.



Left side shows the patient pinching the skin, it is tended. The left side shows a negative Stemmer's sign, however when they pinch the right side, it will not tent. It will show a positive Stemmer's sign, indicating lymphedema.

The picture on the right shows a positive Stemmer's sign, indicating lymphedema. The inability to tent the skin (see left side image) indicates lymphedema in that limb.



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