(Primary Lymphedema; Secondary Lymphedema)
Definition
Definition
The lymph system is a series of organs, vessels, nodes, and fluids. This system creates and carries fluids that play an important role in the immune system and maintaining the balance of fluids in the tissue. Lymphedema is a build up of fluid normally transported by the lymph system. The fluid build up leads to swelling in the affected area. While lymphedema occurs most often in the arms and legs, it can eventually spread to the core of the body and head. Lymphedema can range from mild swelling to swelling that dramatically increases the size of the limb and causes skin discoloration.
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Causes
Causes
Lymphedema is caused by defect, damage, or infection of an area in the lymph system.
Primary lymphedema is caused by defects of the lymph nodes or lymph vessels. The structures may be missing or may not work properly. Though the defect are present from birth, lymphedema may not develop until later in life. Conditions associated with primary lymphedema include:
- Milroy’s disease
- Meige disease
Secondary lymphedema develops when there is injury, infection, or nearby growth that blocks the flow of fluids in the lymph nodes or lymph vessels. It may be caused by medical conditions, medical treatments, or trauma.
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Risk Factors
Risk Factors
Lymphedema is more common in older adults.
Medical treatments or conditions that may increase your risk of lymphedema include:
Symptoms
Symptoms
Symptoms of lymphedema include:
- Swelling in arms, legs, fingers, or toes
- Clothes, shoes, or jewelry may begin to feel tight even though there is no weight change
- Heaviness in limb
- Changes in skin such as a feeling of tightness, hardening, or reddening of the skin
- Loss in range of motion and flexibility in nearby joints
- Aching, pain, discomfort, or tingling in the limb
Lymphedema can also lead to complications like a breakdown of the skin, infections of the skin, or massive changes in the size and shape of the limb.
Diagnosis
Diagnosis
The doctor will ask about any symptoms and medical history. A physical exam will be done. The degree of swelling can be tested by pressing a finger into the swollen area. The indent in the skin will indicate the severity of swelling. Measurements will also be taken around the affected limb and compared to the healthy limb. The doctor may diagnose lymphedema based on the swelling and appearance of the skin and medical history.
If the cause of swelling is unclear, the doctor may want to do further testing. Image tests may help to determine the cause of the lymphedema. Tests may include:
- MRI scan
- CT scan
- Duplex ultrasound or Doppler ultrasound
Lymphangiography is a test that uses a radioactive dye to create images of the lymph system. It is rarely used.
Treatment
Treatment
Treatment will depend on the severity and cause of lymphedema. Some causes may respond to treatment and stop causing lymphedema but most will have a continued risk of lymphedema. Initial treatment may require more intensive treatment over a few weeks. A long term plan will be developed once initial goals are reached. Long term plans will include understanding factors that may worsen swelling . Managing lymphedema flare up early may prevent complications.
Options to treat lymphedema itself and prevent complications include the following:
Reduction of Swelling
Fluid is moved through the lymph vessels when nearby muscles and tissue contract or squeeze during normal movement. Mimicking this compression may help move excess fluid out of the affected area. Some methods that may help include:
- Exercise—light gradual strength training can help decrease swelling. The doctor or a physical therapist can suggest a program that won’t make swelling worse.
- Compression—special stockings, sleeves, or elastic bandages can help provide constant gentle pressure over the affected area. Some devices will adjust as the swelling goes down. The doctor or therapist will discuss different options to help find one that is best for each situation.
- Manual therapy—a certain type of massage may help move fluids. A therapist can teach the proper technique to avoid adding more fluid to the affected area. The therapy may not be appropriate for all conditions, especially those with cancer present.
- Pneumatic compression—a device creates pressure at regular intervals using a sleeve over the affected arm or leg.
A combination of treatment may provide the best results. A method called complete decongestive therapy combines the methods above plus the lifestyle habits and education below. Different methods will be tried until the best method or combination for each individual is found.
Certain lifestyle changes or habits may also help reduce the risk of increasing fluid in the affected area:
- Reaching or maintaining a healthy weight—obesity can increase the risk of lymphedema and impair fluid flow.
- Healthy nutrition guidelines—certain foods can increase fluid retention in the body. Good nutrition choices will also affect overall health and weight.
- Maintaining good skin health to reduce risk of more swelling and complications. Basic steps may include:
- Keeping affected arm or leg clean.
- Keeping hands and feet protected by wearing gloves and shoes.
- Using an electric razor to shave to decrease cuts to skin.
- Using sunscreen when outdoors to prevent burns.
- Avoidance of actions or activities that may further impair lymph fluid flow in the area.
- Avoiding blood draws or blood pressure measurements on affected arm or leg.
- Avoiding positions that impair flow of fluid like crossing legs or carrying items on shoulder if either area is at risk.
- Avoiding ice or heat treatments to the affected areas.
- A medical bracelet can let medical professionals know about risk for lymphedema. This may keep them from performing tasks that may make swelling worse.
Surgery
Surgery may be needed for severe lymphedema. The goal of surgery is to remove extra tissue from the arm or leg to unblock the lymphatic system and help reduce swelling.
Prevention
Prevention
Doctors or physical therapists will work with you if you are at risk for developing lymphedema because of medical treatments or conditions. Certain lifestyle changes and monitoring may prevent the development of lymphedema. If you had lymph nodes in your armpit removed during cancer surgery, a strength and physical activity program in recovery may help prevent lymphedema.
RESOURCES:
CANADIAN RESOURCES:
Lymphedema Association of Quebec http://www.infolympho.ca
References:
http://www.ebscohost.com/dynamed
Updated November 10, 2014. Accessed February 18, 2015.
Lymphedema. Society for Vascular Surgery website. Available at:
http://www.vascularweb.org/vascularhealth/Pages/lymphedema.aspx
Updated December 2011. Accessed February 17, 2015.
Poage E, et al. Demystifying Lymphedema: Development of the Lymphedema Putting Evidence into Practice. Clinical Journal of Oncology Nursing. 2008, 12(6), 951-964. Available at: https://cjon.ons.org/cjon/12/6/demystifying-lymphedema-development-lymphedema-putting-evidence-practice%c2%ae-card.
Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: Diagnosis and Management. Am Fam Physician. 2013 Jul 15;88(2):102-10. Available at:
http://www.aafp.org/afp/2013/0715/p102.html
1/22/2010 DynaMed’s Systematic Literature Surveillance
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Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, et al. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ. 2010;340:b5396.
Last Updated: 2/20/2015