LYMPHEDEMA
SARASIJ BIT
BPT, MPT (Ortho)
Clinical Tutor (PT), NILD
AGENDA
•Introduction
•Types
•Clinical feature
•Stages
•Assessment
•Complication
•PT Management
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INTRODUCTION
Lymphoedema is a
chronic disorder
marked /
characterized by the
abnormal
accumulation
(increased
collection) of
lymphatic fluid in
the tissues of one or
more body parts
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TYPES
Primary Secondary Lymphedema
Lymphedema Caused by injury to one or more
components of lymphatic system
Congenital/Hereditary where
They may be dissected, blocked,
lymph nodes or vessels are fibrosed or altered
abnormally formed Surgical Excision due to
Hypoplasia malignancy (breast cancer)
Milroys disease – from birth Filariasis (infection by Wuchereria
bancrofti)
Meige’s disease – develops in
Chronic Inflammation
childhood or adolescent
Radiation therapy
It begins distally and spreads
proximally
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CLINICAL FEATURE
Distal Swelling in legs, arms, not relieved by Elevation (POLICE)
Constant dull ache or severe pain
Altered (numbness, burning and bursting) sensations in limb
General tiredness, heaviness and debility
Sensitivity to heat, cramps, pins and needles
Skin problems- dehydration, flakiness, discolouration, weeping
excoriation and breakdown
Restricted range of motion in the joints because of swelling and tissue
changes
Immobility of patient leading to obesity and muscle weakness
Backache and joint problems
Athlete’s foot and acute infective episodes (with impaired wound healing)
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STAGES
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ASSESSMENT
Observation Sensory Motor
Palpation Assessment Assessment
Posture ROM of affected
Hyperkeratosis & limb
Lymphangiectasia MMT
Oedema
Limb
Pitting at acute Measurements
non pitting at at set level
chronic
Nail
discolouration
HYPERKERATOSIS (THICKENING OF THE SKIN) AND LYMPHANGIECTASIA (DILATED SUPERFICIAL LYMPH VESSELS) 7
COMPLICATION
Cellulitis: often recurrent Cosmetic embarrassment
Lymphangitis Amputation
Superficial bacterial and fungal Complications following surgery
infections are common and include:
Lymphangio-adenitis Partial wound separation
Deep vein thrombosis (DVT) Seroma
Hematoma
Severe functional impairment
Skin necrosis
Psychosocial dysfunction
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PNEUMATIC COMPRESSION
THERAPY
There are two types of
compression
Intermittent (Inf : Def = 3:1)
Sequential
Average 3 Sessions of 3
hours for 5-14 days
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BANDAGING
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SOFT TISSUE MANIPULATION
Efflurage :- a
gliding,
lengthening stroke
that is applied
from distal
proximal
Kneading :- a
circular technique
where tissues are
lifted, rolled and
squeezed in a
compressive
action
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ASSOCIATED EXERCISE
Limb can be
placed elevated
(in acute stage)
Exercise to
improve joint
range of motion
Exercise to
improve strength
Deep Breathing
ex
Pumping ex
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COMPLETE DECONGESTIVE THERAPY
Manual Lymphatic Drainage (MLD): A light skin stretching technique that
stimulates the lymphatic system.
Compression Therapy: Layered bandaging with foam or specially fitted
garments that support the area to control swelling.
Exercises: With compression, special exercises will help to pump lymph out of
the swollen area.
Skin and Nail Care:
Keeping the skin and nail clean will help prevent infection
It is important to keep skin moisturised to protect the integumentary system and
prevent the risk of developing infections such as cellulitis or fungal infections.
Self-Care Management and Training
Other support services: counselling, nutritional advice
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