Raven Hill Certified Hand Therapy Occupational Therapy

Lymphedema

Lymphedema is a chronic, abnormal condition of swelling in the body, usually in the extremities, although any part of the body that has lymphatic vessels can be affected. The involved extremities can include not only the arms or legs, but also the neck and genitals.

Regardless of the type or cause of lymphedema in the affected body, the lymphatic system is part of the body's immune system. One of its functons is to return proteins to the venous system for 'recycling.' Under normal circumstances, about 1.5 to 2.0 liters (about 2 to 3 quarts) of lymphatic fluid are returned to the blood stream by this system each day. Lymphedema usually occurs following damage to the lymphatic system as a result of traumatic Injury, infection, cancer, surgery, radiation, parasites or some other cause. Some people experience no obvious cause, and may have been born with a condition which invites the lymphedema. The lymphatic system loses its ability to carry lymph as it did prior to the injury or illness, and fluid begins to collect in the affected body part, causing swelling, and ultimately lymphedema.

Lymphedema is an abnormal accumulation of protein-rich fluid in the tissues causing an inflammatory condition which results in reactive fibrosis. This means that the body senses the abnormal accumulation of proteins in the lymph and fibers begin to grow in reaction to the proteins within the fluid. Over time this hardens and toughens the skin. Swelling continues and gets worse. The affected person is at high risk for infection. such as cellulitis. This can lead to inability to use the body part in normal activity, high risk of infection, inability to wear normal clothing, sexual dysfunction and obvious cosmetic issues.

Lymphedema is not the same condition as what people experience following a sprain or other injury — for instance, where the body is reacting to an acute injury. Usually such swelling resolves rapidly. Lymphedema is a chronic condition, meaning that it is not yet curable, and will always need some degree of management.

Lymphedema is best managed by Complete Decongestive Therapy (CDT), which involves:

Meticulous skin and nail care to avoid the risk of infection
Manual lymphatic drainage (MLD), or specialized massage techniques to stimulate the lymphatic system, soften the tissues, and drain the abnormal fluid
Pressure garments (to prevent the re-infiltration of fluid after MLD)
An exercise program to further reduce the accumulation of fluid

Each case is different, but generally people should expect and p1an to be seen daily for the first 1-2 weeks of treatment (five days per week), or longer if the condition is severe enough. Initial sessions are up to two hours in length, especially if more than one limb is involved, but tend to shorten during treatment to about an hour. Patients should plan on being seen occasionally for maintenance visits, perhaps two or three times per year following initial treatment, to have garments refitted or for additional MLD.

Lymphedema Management at Raven Hill Integrated Therapies