BPT MPT

1. Lymphoedema: PT Management
Dr. Shreya Monpara
Guide: Dr. D. N. Bid

2. INTRODUCTION
• Lymphoedema is a chronic disease marked by the increased collection
of lymphatic fluid in the body, causing swelling, which can lead to skin
and tissue changes
• The chronic, progressive accumulation of protein-rich fluid within the
interstitium and the fibroadipose tissue exceeds the capacity of the
lymphatic system to transport the fluid

3. LYMPHATIC SYSTEM
• Initial lymphatics
• Larger lymph vessels
• Lymph nodes
• Lymph

4. • The lymphatic system is a one-
way drainage system leading
fluid from the tissues of the
body to the veins in the neck.
FUNCTION OF LYMPHATICS
• Waste Disposal
• Immunological
• Maintenence of tissue
fluids

5. PHSIOLOGICAL
CAUSE OF OEDEMA
• An equilibrium is normally
maintained between tissue fluid
formation and reabsorption in
the body which is dependent
upon hydrostatic and osmotic
pressures, known as Starling’s
forces, across the capillary wall.

6. FACTORS RESPONSIBLE FOR CAUSING OEDEMA
• Increased permeability of capillary walls.
• Decreased plasma osmotic pressure.
• Increased plasma hydrostatic pressure.
• Reduced lymphatic system transport capacity.
TYPES OF LYMPHOEDEMA
PRIMARY LYMPHOEDEMA
• Primary lymphoedema arises from an abnormality occuring within
the lymphatic system

8. Classification according to age
Classification of according to
lymphographic appearance

9.  SECONDARY LYMPHOEDEMA
• It arises from the influence of an
external factor which affects the
function of lymphatic system.
CAUSES: Infection
Inflammation
Trauma
Cancer and its treatment

10. STAGES OF LYMPHOEDEMA

11. CLINICAL FEATURES
• Swelling in an arm or a leg
• Can be fibrosis and pitting oedema.
• Limbs can feel heavy and achy.
• There is altered sensation.
• Reduced mobility and range of
movement.
• Pain and joint discomfort.
• Skin changes, for example redness
and increased temperature.
• Nail discoloration
• Hyperkeratosis and
lymphangiectasia.
• Hardening, thickening, or tightness
of the skin

12. COMPLICATIONS
• Chronic lymphoedema
• Compression therapy
complication
• Lymphorrhoea
• Malignant disease
• Psychological morbidity
• Venous complications
CHRONIC
LYMPHOEDEMA
Lymphorrhoea

13. INVESTIGATION
• Lymphoscintigraphy
• Lymphoangiography
• MRI
• CT scan

14. ASSESSMENT
• Assessment of the condition of the skin
• Assessment of the shape of the swollen limb
• Assessment of the degree and extent of the swelling
• Assessment of limb function and discussion of the influence of the
lymphoedema on the patient’s limb movement, their day-to-day
roles, hobbies, social activities and occupation.

15. • MEASURING LYMHOEDEMA
Simple surface measurement
Limb volume measurement

17. CALCULATING LIMB VOLUME
• Once all the measurements of the limb have been recorded, the volume
of the limb can be determined.
• The mathematical formula for calculating the volume of a cylinder is
used as it considers the limb as a series of cylinders, each with a height
of 4 cm. The formula is: circumference2 / ∏.
• By totalling the volumes of all the cylinders, the total limb volume can be
reached.
• If the limb volume of the opposite limb is also calculated, the excess
volume in the swollen limb can be estimated. The following is an
example of how this can be done. Swollen left arm limb volume 2701.5
ml minus Normal right arm limb volume 2394.8 ml equals 306.7 ml.
• 100 ÷ Normal limb volume × volume difference between the two arms
• 100 ÷ 2394.8 × 306.7 = 13% .
• The swollen left arm is 13% bigger than the normal right arm

20. PITTING EDEMA SCALE
• Grade 0: No clinical edema
• Grade 1: Slight pitting (2 mm depth) with no visible distortion that
rebounds immediately.
• Grade 2: Somewhat deeper pit (4 mm) with no readily detectable
distortion that rebounds in fewer than 15 seconds.
• Grade 3: Noticeably deep pit (6 mm) with the dependent extremity
full and swollen that takes up to 30 seconds to rebound.
• Grade 4: Very deep pit (8 mm) with the dependent extremity grossly
distorted that takes more than 30 seconds to rebound.

21. MANAGEMENT
• The best global treatment Of
lymphoedema, according to the
international guidelines of the
International Society of
Lymphology is CDT.
MLD(manual lymphatic drainage)
Compression therapy
Exercise
Skin care
Self care management

22. MANUAL LYMPHATIC DRAINAGE
• MLD is a light, skin-stretching massage that helps promote the
movement of lymphatic fluid out of the swollen limb.
• MLD is composed of four main strokes:
• stationary circles,
• scoop technique,
• pump technique,
• rotary technique.
 TECHNIQUE
• Usually performed with the patient in the lying position
• Starts and ends with deep diaphragmatic breathing.

23. • The unaffected lymph nodes and region of the body are treated
first.
• Moves proximal to distal to drain the affected areas.
• Slow and rhythmical movements .
• Uses gentle pressure.
CONTRAINDICATIONS
• Cardiac insufficiency
• Acute inflammation caused by pathogenic germs
(bacteria, fungi, viruses).
• Deep venous thrombosis (DVT)
• Acute renal failure

24. COMPRESSION THERAPY
• Products used for
compression therapy are
low-stretch bandages and
elastic garments.
• Even when MLD is
performed correctly, swelling
does not decrease without
compression.
• Compression bandages
should remain on the
extremities until the next
session of MLD.

25.  Principles :
• The size and shape of the swollen limb
This principle forms part of the Law of
laplace.
• The construction and type of
compression material.
 COMPRESSION GARMENTS
• Construction : Circular, seamless
knitted garments.
: Flat-knit garments
• Style of garments
• Measuring for compression garments
• Application and removal of
compression garments

26. CONTRAINDICATIONS
• Arterial insufficiency
• Deep vein thrombosis
• Poorly controlled cardiac failure

27. EXERCISES
• It consist of gentle
stretching and
range of
motion exercises.
• Wear your
compression
garment or
bandages when
exercising to get
the best out of the
muscle pump
action.

29. SKIN CARE
• Wash the skin daily
• Treat any cuts or breaks in the skin antiseptically.
• Keep the skin moist
• Wear well-fitting, comfortable shoes if the feet are affected
• Pay attention to care of the nails on the hands or feet: do not cut or
tear cuticles – use a cuticle stick covered with cotton wool.

30. SELF CARE MANAGEMENT
• Avoid chemical hair removers when removing unwanted hair.
• Avoid extremes of temperature such as hot baths and cold showers.
• Wear loose clothing that does not constrict the limb.
• Make sure that any jewellery does not constrict the limb.
• Put on and care for their compression sleeves and garments.

31. ADDITIONAL
TREATMENT
• CircAid
• Kinesiotaping
• Low-level laser
therapy
• Pneumatic
compression
pumps
• Reid sleeve

32. REFRENCES
• Lymphoedema care- Mary woods
• Physiopedia
• Validation of the lymphoedema life impact scale version-2 : A
condition specific measurement tool for persons with lymphoedema

33. THANK YOU