LYMPHEDEMA
A. LYMPHEDEMA
● Most common result of a disrupted lymphatic system
● It is the aggregation of protein-rich edema in the interstitium due to the failure of the
lymphatic system to properly meet demands.
● (+) ↑ interstitial colloidal osmotic pressure which leads:
○ ↑ blood capillary filtration
○ ↓ blood capillary reabsorption
● Possible consequence of breast cancer surgery
● Will progress if not reversed
B. EXCESSIVE WEIGHT & LYMPHEDEMA
1. Obesity and cancer
● Obesity is a risk factors for several diseases and one of which is cancer
● Lymphedema can result from breast cancer treatments
2. Effects of obesity in general
● Obesity itself affects lymphatic function
● Irregular inflammatory responses
● Regeneration problems of the lymphatics following injury
Take note: BMI is directly proportional with the severity of arm edema
C. HOW TO PREVENT LYMPHEDEMA
A. SKIN CARE ● Wear sunscreen & insect repellant
● Stay away from injuries & reduce risk for infection
● First Aid kit is a must
B. COMPRESSION GARMENTS ● Use well-fitted garments
● Use compression garment for support during
extreme activities
C. ACTIVITY/LIFESTYLE ● Exercise following the right frequency and intensity
● Rest
● Often check your extremities
● Eat healthy
● Maintain ideal weight
● Avoid unexpected heavy lifting
D. AVOID LIMB CONSTRICTION ● Involved limb should not be used for BP
● Avoid wearing tight clothes & jewelry
E. ADDITIONAL PRACTICES FOR ● Refrain from sustained sitting, crossing of legs, &
LOWER EXTREMITY standing
● Wear proper fitting shoes
F. EXTREMES OF TEMPERATURE ● Exposure to extreme temperatures is not advisable
● Refrain from placing limb in water with temperature
of >38.9 °C
D. STAGES OF LYMPHEDEMA
STAGES CHARACTERISTICS
STAGE 0: LATENCY ● (-) Stemmer Sign
● (-) clinical edema
● “Normal” presentation of skin & tissue
● ↓ capacity of lymph transport
STAGE 1: REVERSIBLE STAGE ● (-) Stemmer Sign
● (+) pitting & soft edema
● (+) reverse upon elevation
● ↑ in standing
● “Normal” presentation of tissue
STAGE 2: SPONTANEOUSLY ● (+) Stemmer sign (maybe negative in early stage)
IRREVERSIBLE STAGE ● (+) Edema → soft & pitting (Early) → progress to non-
pitting “brawny”
● (+) Alteration of skin
● (+) Recurrent infection
● (-) Reverse in elevation
● Adipose tissue production; Fibrosclerotic tissue
STAGE 3 (LYMPHOSTATIC ● (+) Stemmer Sign
ELEPHANTIASIS) ● (+) severe brawny & non-pitting edema
● (+) Recurrent infection
● (+) Skin alterations (deep skinfolds, mycotic
infections, papillomas)
● (-) Reverse upon elevation
● Adipose tissue production; Fibrosclerotic tissue
E. INTERMITTENT PNEUMATIC COMPRESSION
ADVANTAGE DISADVANTAGE
● ↓ limb girth ● Destruction of well-functioning lymph
collectors
● Patients are stationary during pumps
● No effect on fibrotic tissue
● Edema can go to genital area
● Lengthy treatment time (min. of 4 hours)
F. BENEFITS OF COMPRESSION
✓ Reduction in the quantity of lymph to be moved by the lymphatic system
✓ Improvement in lymphatic & venous returns (distal → proximal)
✓ Leads to more effective muscle pump on contraction
✓ Makes hardened fibrotic tissue in advanced stage softer
✓ Supports tissue that has diminished or no elasticity
G. GARMENT SELECTION
COMPRESSION LEVEL TYPE OF KNIT (CIRCULAR VS. FLAT)
● Range from 20- >60 mmHg (LE>UE) ● Circular knit
○ LE —> level III: 40-50 mmHg a. W/o seam
○ UE —> level II: 30-40 mmHg b. Attractive
● Compression gradient c. Less expensive
○ Distal > Proximal ● Flat Knit
● Considerations: a. With seam
○ Patient’s activity b. More expensive
○ Comorbidities c. Customizable
○ Ability to put on off the garments d. Has higher level of compression of
>50 mmHg
H. EXERCISE PRINCIPLES
● Works best when an exercise principle is followed
● Exercises extremities that have sufficient compressions
● Gradual progression of exercises based on frequency, intensity, and mode
● Observe the shape & size of the extremity involved and provide adjustments on interventions
LIPEDEMA
LIPEDEMA
● Symmetrical build-up of fats in tissue that is progressive
● Unusual
● Commonly seen in the buttocks and LE
● Frequently appears in menopausal, pregnant, adolescent females
● Rare in males
● Genetic → present in >1 woman in the family
MANIFESTATIONS
● Distribution
○ Bilateral (LE > UE)
○ Affects proximal areas (e.g. thigh, buttocks)
○ Rarely on feet
● Effects on Skin
○ ↓ elasticity
○ Pressure sensitive
○ Prone to bruises
LIPEDEMA VS. LYMPHEDEMA
MANIFESTATION LIPEDEMA LYMPHEDEMA
Material Fats Proteins
Distribution Symmetrical Asymmetrical; common in 1 leg
LE > UE Proximal > Distal
Gender Females (exclusive) > Male (rare) Females > males
Family hx Usual Unusual
Cellulitis Unusual Usual
Stemmer Sign (-) (+)
Pain on pressure (+) (-)
Distal edema (foot) (-) (+)
Hematoma/easy bruising (+) (-)
of involved area
Reference:
● Hillegass, E. (2017). Essentials of Cardiopulmonary Physical Therapy (4th ed.). Elsevier: St.
Louis, Missouri
