Lymphedema is defined as a chronic condition characterized
by the abnormal accumulation of interstitial fluid due
to insufficiency of the lymphatic system. It is a problem
that remains under-diagnosed & undertreated. Lymphedema
may be the result of malformations of the lymphatic
system (primary lymphedema) or due to secondary causes.
The most common cause of primary lymphedema is the result
of hypoplasia of the lymphatics, in which there is an
abnormal number or decreased diameter of collecting
vessels. Primary lymphedemas can be present at birth
(connatal), develop in early childhood (praecox), or
appear anytime after the age of 35 (tarda).
Secondary lymphedema occurs following damage to the
lymph vessels &/or nodes. This decreases the body's
ability to transport lymph and results in progressive
swelling, skin changes and functional deficits. In the
USA, the most common cause of secondary lymphedema is
related to cancer surgeries and treatments. However,
other conditions that may result in lymphedema include:
Primary or metastatic cancer - Trauma Infection - Chronic
Venous Insufficiency Venous bypass surgeries - Scars
from multiple surgeries Crush injury - Compound fracture
Severe laceration - Degloving skin injury Burns - Morbid
obesity Lipedema - Liposuction
Studies are showing that if addressed early, lymphedema
can be effectively treated. Early signs include the
feeling of heaviness, ache or pain, and fatigue in the
limb. As lymphedema progresses, edema becomes visible.
First, it is soft and pitting, but if left untreated
will become fibrotic. Early recognition and initiation
of treatment is key in controlling lymphedema. Patients
should always be medically evaluated prior to treatment
to rule out tumors, DVTs or cellulitis as cause of onset.
Treatment consists of manual lymph drainage, compression
bandaging, exercise and patient education. Patient education
is ongoing, and focuses on risk reduction strategies,
skin care, self bandaging and HEP. Additionally, "at
risk" patients benefit from PT so that they may receive
education that may reduce the onset and allow them to
recognize the signs, as well as a HEP to address scar
and ROM issues that may contribute to the onset of lymphedema.