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.
Causes of Lymphedema
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 physical therapy 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 range-of-motion issues that may contribute to the onset of lymphedema.