Lymphoedema

Lymphoedema – The Condition
Oedema is the medical term for a swelling, so lymphoedema is the name given to describe a swelling which is due to some abnormality, malfunction or obstruction of the lymphatic system.

Lymphoedema – The Causes
Lymphoedema may be divided into two basic types – primary and secondary.

The cause of primary lymphoedema is unknown but it is thought to be due to impaired lymph vessel and/or lymph node development due to a birth defect when there is an absence, or a reduced number, of lymphatic vessels, or those that are present do not work properly.

Secondary lymphoedema follows trauma to the lymphatic system. In developed countries, the most common cause is surgical removal of lymph nodes in the treatment of cancer. For example, lymphoedema of an arm can develop following removal of armpit nodes in the treatment of breast cancer, or leg lymphoedema can develop following removal of groin or pelvic nodes in the treatment of cancer of the uterus, cervix or prostate gland. Secondary lymphoedema can also be caused by severe trauma such as deep penetrating wounds or compound fractures as seen in motor vehicle accidents. The oedema does not always appear immediately, whether the condition is primary or secondary. It can occur months or years later in life, being triggered by an incident which overloads the lymphatic system in the limb such as an insect bite which becomes infected, an injury or a plane flight.

Lymphoedema – The Symptoms
The usual symptoms of lymphoedema include any combination of aching, heaviness, tightness, itching, prickling, numbness, pins and needles, skin redness or pain. The affected limb can become grossly swollen, heavy, unsightly and incapacitating.

Lymphoedema – The Treatment
Lymphoedema in the very early stage does not require any physical treatment as such. It is obviously important for the patient to understand the nature of the condition and how it should be managed, but all that is usually required is the fitting of a compression garment on the limb and a self-management programme devised by the lymphoedema therapist.

For lymphoedema which requires further attention, the most effective and safest treatment to date in the long and short term is Complex Physical Therapy (CPT). The treatment is usually given daily for approximately one hour, six days a week for one to two weeks or sometimes longer, depending on the severity of the condition, the length of time it has been present and the progress made. CPT reduces the oedema, improves the lymphatic drainage, softens areas of hard oedema and increases the mobility of the limb, thereby relieving the aching, discomfort and incapacity. CPT is recommended by the International Society of Lymphology (ISL).

Low level laser therapy is also used to assist in softening hard oedema, reducing soft oedema, in scar management and to reduce cording.

At the completion of intensive treatment, patients are fitted with a suitable compression garment such as a sleeve, glove or stocking to maintain the improvement gained from the treatment and to keep the swelling under control. They are also given a home management programme consisting of self-massage and a suitable exercise routine.