Education

What is Lymphedema?

Lymphedema (or "Lymphoedema", "lymphatic obstruction") is a condition of localized
fluid retention caused by a compromised lymphatic system. The lymphatic system (often
referred to as the body's "second" circulatory system) collects and filters the interstitial fluid of
the body. Lymphedema has been barely recognized as being a serious health problem; however, this
is slowly changing due to education and awareness. The danger with lymphedema comes from the constant
risk of developing an uncontrolled infection in the affected limb. Still, Physicians and medical staff who practice in fields where this disease is uncommon may fail to correctly diagnose the condition due to the apparent lack of information regarding this disease.

Treatment

Treatment of Lymphedema may include the use of pneumatic sequential compression pumps, compression sleeves, massage and bandaging. Most physical therapists or other practitioners of manipulative therapy are trained to perform what is known as a "lymphatic release" or "manual lymph drainage" (MLD) by massaging areas of the body where lymph is found to be flowing irregularly or unable to flow adequately. Such releases are intended to unblock poorly-circulating lymph fluid by stimulating the lymph nodes, thereby increasing the flow of lymph.

The massage technique was pioneered in the 1930's by Dr. Emil Vodder and is now recognized as a primary tool in Lymphedema management.

Increasingly, sequential compression pumps are being used to treat Lymphedema. The system consists of an air pump and an appliance (sleeve) which fits over the extremity. Air pressure is applied to the appliance, which in turn applies pressure in a preset sequence to the extremity. The better devices consist of a pump and appliance with three or more segments which sequentially apply pressure along the extremity, distally to proximally.

Since lymphatic pressure is greater distally than proximally, the preferred method of compression therapy would be to mimic the lymphatic system. This is accomplished by means of a pump that applies gradient pressure to the segmented appliance. This system mimics the lymphatic system wherein it applies gradual, gradient pressure distally to proximally, moving the accumulated fluid from the affected extremities back into the body where it can be naturally eliminated. It simulates a gentle massaging action. Pressure and the subsequent effectiveness can be gradually increased as the patient becomes more tolerant. These devices are expensive, although most medical plans will cover the cost if the device is medically necessary; the pumps are generally comfortable and easy to use for home therapy. It should be noted that these devices are not the same as devices that have been advertised on television commercials.

For every-day use, such as walking or performing basic tasks, compression sleeves and stockings are available for use. While these garments provide only minimal compression, they are ideal for daily activities and may be used along with other therapies.

Causes

Lymphedema may be inherited (primary) or caused by injury to the lymphatic vessels (secondary). It was most frequently seen after surgery and/or radiation therapy, in which unintended damage to the lymphatic drainage system was caused. It was especially common after surgery or radiation therapy when used in combination to treat breast cancer. Lymphedema may also be associated with accidents or certain diseases or problems that may inhibit the lymphatic system from proper function. Many cancer patients find this condition may develop after their therapy has concluded. The symptoms of Primary Lymphedema may not become apparent for many years. In the lower extremity it will be unilateral or bilateral.

Lymphedema affects both men and women. In women, it was most prevalent in the upper limbs after breast cancer surgery and lymph node dissection, occurring in the arm on the side of the body in which the surgery is performed, and in the lower limbs or groin after hysterectomy surgery. In men, lower-limb Lymphedema is most common, occurring in one or both legs or occasionally in the groin. Lymphedema can also occur in those who are obese, as the abdomen area can hang and cause a disruption in the lymph flow, which will cause swelling in abdomen, thighs, or legs.

Conditions in which the Lymphedema Pump has been effective in treating:

  • Chronic and acute edema, including Lymphedema Post trauma and post paralytic edema
  • Venous insufficienc
  • Venous stasis ulcers
  • Non-healing wounds
  • Post-surgical lesions
  • Decubitus ulcers
  • Diabetic wounds

Sources

"Lymphology: An Emerging Field of U.S. Medicine" - Annual Conference 2006 Kansas City,October http://www.lymphology.org
Lymphedema Diagnosis & Treatment, LLTretbar, MD and BB Lee, MD: Springer Verlag 2006 National Lymphedema Network | "What is Lymphedema?"
Schingale, Franz-Josef, "Lymphoedema, Lipoedema, Diagnosis and Therapy: A Guide for Those Affected," 2003, Hannover: Schlütersche GmbH & Co. KG