What is Lymphedema?
Lymphedema is a failure of the lymphatic system whereby inadequate drainage of fluid and proteins results in the swelling of tissues. This swelling is typically in the arms and legs, however, other areas such as the breast, genitals and gut, can be affected as well.
The patient may experience increased pain in the area, heaviness, tightness, diminished range of motion in the affected limb and increased difficulty performing normal activities.
In the course of lymphedema development, the protein-rich interstitial fluid is replaced by fibrotic tissue. This can lead to skin alterations, infection (cellulitis), lymphatic arthropathies and alterations of ligaments and tendons.
If you notice persistent swelling, it is very important that you seek immediate medical advice as early diagnosis and treatment improve the clinical outcome.
The decisive difference between lymphedema and virtually all other types of edema is the high content of protein in the interstitial fluid.
Lymphedema – Diagnosis & Therapy, Horst Weissleder & Christian Schuchhardt, 4th edition, 2008
Two types of lymphedema: (Click for images and more information)
What are the symptoms?
As a result of swelling, the affected limb might feel tight and heavy, and there may be pain due to associated nerve injuries, obstruction of veins, and strain on ligaments from the increased limb weight.
What if lymphedema is untreated?
Left untreated, lymphedema leads to chronic inflammation, infection and hardening of the skin that, in turn, results in further lymph vessel damage and distortion of the shape of affected body parts.
NLN Medical Advisory Committee Updated February 2011
Who is a candidate for lymphedema treatment?
Persons who have experienced swelling following lymph node removal, radiation, infection, trauma, inflammation and surgery.
Persons who have noticed an increase in swelling due to venous edema.
Persons who have congenital (born with) impairment of the lymphatic system.
Can lymphedema be cured?
Lymphedema cannot be cured; however, it can be reduced and controlled with therapy and self management for a healthier and more successful lifestyle.
What is the treatment for lymphedema?
A specific program is designed to fit the individual needs of each person.
The current recommended treatment for chronic lymphedema is Combined Decongestive Therapy (CDT) which aims to improve lymph drainage through existing lymphatic vessels and to encourage collateral circulation. It can be subdivided into two treatment phases:
1) An edema reduction phase of approximately 1 month that involves specific massage techniques (manual lymphatic drainage) and application of non-elasticized bandages, for 5 days per week.
2) A maintenance phase which is a life-long commitment to wearing a graduated pressure elastic garment during the day and to performing daily specific remedial exercises. Additional manual lymph drainage and bandaging can be performed as needed during the maintenance phase in those with more severe degrees of lymphedema.
Drug treatments are not effective for chronic lymphedema. Therefore, research into physical treatments and methods of self-management are of primary importance in this chronic life-long condition.
McGill Lymphedema Research Program - Updated on Fri, 2011-02-04 16:04
Combined Decongestive Therapy (CDT)
Combined Decongestive Therapy (CDT) utilizes a hands-on technique, involving manual lymph drainage, compression, meticulous skin care and nail care, and exercise to re-route lymphatic fluid to allow for limb drainage, reduced risk of infection, and increased function.
Goals of CDT
Decongest swollen body parts
Eliminate fibrotic tissue
Utilize remaining lymph vessels and other lymphatic pathways to allow for drainage to affected areas
Avoid re-accumulation of lymph fluid
Prevent / eliminate infection
Maintain normal / near normal size of limb
Manual Lymph Drainage (MLD)
Manual lymph drainage is a gentle, manual treatment that improves the activity of the lymph vascular system. In lymphedema, it re-routes the lymph flow around the blocked areas into more centrally located healthy lymph vessels that drain into the venous system. Manual lymph drainage improves lymph production and lymph circulation, reduces areas of fibrosis and may decrease pain.
Compression is a gradient of pressure used to increase the tissue pressure in the swollen extremity. This is accomplished by using several layers of short stretch bandages, custom compression garments, or one of many other alternatives.
Compression is utilized twenty-three hours per day for optimal results. Compression increases re-absorption of fluid and the efficiency of the muscles, prevents re-accumulation of lymph fluid, decreases fibrosis and conserves the results obtained during manual lymph drainage.
Gentle, range of motion exercises completed daily will assist with edema reduction, increase mobility, and increase overall function. Exercise increases lymph vessel activity and improves lymph circulation.
Exercise combined with compression prevents re-accumulation of fluid, increases range of motion and strength.
Skin and Nail Care
Daily hygiene, lotion, and prevention techniques used to decrease infection and wounds:
- Eliminate bacterial and fungal growth
- Reduce the chance of infection (cellulitis)
Lymphedema Diagnosis and Therapy, Horst Weissleder and Christian Schuchhardt, 4th edition, 2008
For further information on Lymphedema: