This power point will lighten up the anatomy, functions, components and flow of lymphatic system. This will inform about causes, complications, types of lymphoedema. This will give the knowledge of scales and severity of lymphoedema. This will enhance the knowledge for difference in lymphoedema and oedema. This will give detail physiotherapy assessment and management for lymphoedema.

1. LYMPHOEDEMA
DR. ANERI PATWARI
MPT:CARDIORESPIRATORY
ASSISTANT PROFESSOR

2. DEFINITION
• Lymphedema is an excessive and persistent accumulation of extravascular and extracellular fluid
and proteins in tissue spaces.
• It occurs when lymph volume exceeds the capacity of the lymph transport system, and it is
associated with a disturbance of the water and protein balance across the capillary membrane.
• An increased concentration of proteins draws larger amounts of water into interstitial spaces,
leading to lymphedema.
• Many disorders of the cardiopulmonary system can cause the load on lymphatic vessels to exceed
their transport capacity and subsequently cause lymphedema.

3. ANATOMY OF LYMPHATIC SYSTEM
• 3 STRUCTURAL COMPONENTS
• LYMPH VESSELS: TRUNKS, COLLECTORS,
PRECOLLECTORS, AND LYMPH CAPILLARIES
• LYMPHATIC TISSUES: LYMPH NODES (600-
700), SPLEEN, AND THYMUS
• LYMPH FLUID: PROTEINS, WBC, MEDICATIONS,
TOXINS, FATS, WATER, BACTERIA

4. LYMPHATIC FLOW

5. FUNCTIONS
• Reabsorbs excess interstitial fluid: returns it to the venous circulation maintain blood volume
levels prevent interstitial fluid levels from rising out of control.
• Transport dietary lipids: transported through lacteals drain into larger lymphatic vessels
eventually into the bloodstream.
• Lymphocyte development, and the immune response.

6. COMPONENTS OF LYMPHATIC SYSTEM
LYMPHATIC
VESSELS
capillaries
Ducts
trunks
LYMPH
LYMPHATIC
CELLS
LYMPHATIC
ORGANS
thymus
Spleen
Lymph
nodes
tonsils

8. Types of
Lymphoedema
Primary Seconda
ry
Congenita
l
Praeco
x
Tarda
It is the result of
insufficient
development
(dysplasia) and
congenital
malformation
of the lymphatic
system
When there is
an inherent problem with the
structures of the lymphatic
system.
When there is an injury to
lymphatic
structures
Age of
presentation
Surgery Inflammati
on and
infection
Obstructio
n and
fibrosis
Combined venous
and lymphatic
dysfunction
•Presen
t at
birth.
•Also
known
as
Milroy’
s
Diseas
e
•Develop
s prior
to 35
years of
age
•Develop
s after
35 years
of age.
Lymph nodes and
vessels often are
surgically removed
as an aspect of
treatment of a
primary
malignancy or
metastatic disease.
Inflammation of the
lymph vessels
(lymphangitis) or
lymph
nodes
(lymphadenitis) and
enlargement of
lymph nodes
(lymphadenopathy)
can occur as the
Due to
trauma,
surgery
or
radiatio
n
therapy.
Chronic
venous
insufficienc
y and
varicose
veins.
Cause of
injury

10. CAUSES
• CONSTANT DULLACHE OR SEVERE PAIN
• BURNING AND BURSTING SENSATIONS IN LIMB
• GENERAL TIREDNESS AND DEBILITY
• SENSITIVITY TO HEAT, CRAMPS, PINS AND NEEDLES
• SKIN PROBLEMS- DEHYDRATION, FLAKINESS, WEEPING EXCORIATION AND BREAKDOWN
• IMMOBILITY OF PATIENT LEADING TO OBESITYAND MUSCLE WEAKNESS
• BACKACHE AND JOINT PROBLEMS
• ATHLETE’S FOOT AND ACUTE INFECTIVE EPISODES

11. COMPLICATIONS
• SLOW WOUND HEALING
• INFECTION- CELLULITIS – LYMPHANGITIS - LYMPHADENITIS
• SKIN ULCERS ,THICKENING OF SKIN ,FOLLICLES FORMS
• MALIGNANCY - LYMPHANGIOSARCOMA ( STEWART TREVES SYNDEROME) -
RETIFORM HAEMANGIOENDOTHELIOMA (LOW GRADE ANGIOSARCOMA )
• SCALE: LYMPHOEDEMA LIFE IMPACT SCALE

13. CLINICAL MANIFESTATIONS: LOCATION
• : IT IS MOST OFTEN APPARENT IN THE DISTAL EXTREMITIES, PARTICULARLY
OVER THE DORSUM OF THE FOOT OR HAND.

14. Severity:

15. INCREASED SIZE OF THE LIMB
• AS THE VOLUME OF INTERSTITIAL FLUID IN THE LIMB INCREASES, SO
DOES THE SIZE OF THE LIMB (WEIGHT AND GIRTH).
• INCREASED VOLUME, IN TURN, CAUSES TAUTNESS OF THE SKIN AND
SUSCEPTIBILITY TO SKIN BREAKDOWN.

16. SENSORY DISTURBANCES
• PARESTHESIA (TINGLING, ITCHING, OR NUMBNESS) OR OCCASIONALLY A MILD,
ACHING PAIN MAY BE FELT, PARTICULARLY IN THE FINGERS OR TOES.
• IN MANY INSTANCES THE CONDITION IS PAINLESS, AND THE PATIENT PERCEIVES
ONLY A SENSE OF HEAVINESS OF THE LIMB.

17. STIFFNESS OR LIMITED JOINT RANGE OF
MOTION.
• RANGE OF MOTION (ROM) DECREASES IN THE FINGERS AND WRIST OR TOES AND
ANKLE OR EVEN IN THE MORE PROXIMAL JOINTS, LEADING TO DECREASED
FUNCTIONAL MOBILITY OF THE INVOLVED SEGMENTS.

18. DECREASED RESISTANCE TO INFECTION
• WOUND HEALING IS DELAYED; AND FREQUENT INFECTIONS (E.G.
CELLULITIS) MAY OCCUR.

19. ASSESSMENT
DEMOGRAPHIC DETAILS.
• NAME: XYZ
• AGE/GENDER: F>M ( IN CASE OF PRIMARY LYMPHOEDEMA)
• ADDRESS:
• OCCUPATION: MORE PREVALENT IN JOBS THAT REQUIRE LONGER STANDING DURATIONS.
• HAND DOMINANCE : RIGHT/ LEFT
• DATE OF ADMISSION:
• DATE OF OPERATION:
• DATE OF EXAMINATION:
• DATE OF DISCHARGE:
In case of any
surgery

20. CHIEF COMPLAINT
• PATIENT MAY COMPLAIN OF HEAVINESS IN UPPER LIMB OR LOWER LIMB WITH
(MAYBE) PAIN/ TINGLING , NUMBNESS AND DIFFICULTY IN THE MOVEMENT OF
THE LIMB SINCE……….

21. HISTORY OF PRESENT ILLNESS
• Chronic venous dysfunction like varicose veins.
• Local trauma
• Surgery like radical mastectomy or any other surgeries that include the removal of the lymphatic
vessels or nodes.

22. • PAST HISTORY: ANY HISTORY OF INFECTION, TRAUMA, SURGERY, OR
RADIATION THERAPY OR IF A PATIENT HAS A HISTORY OF CANCER AND
RECEIVED CHEMOTHERAPY.
• PAST MEDICAL HISTORY: ASK FOR ANY HISTORY OF
DIABETES MELLITUS
HYPERTENSION
MALIGNANCY.
• PAST SURGICAL HISTORY: ASK IF ANY SURGERIES WERE DONE
AROUND THE AFFECTED PART.

23. PAIN ASSESSMENT
• Site of pain : may or may not be present over the affected site. (Most common : dorsum of foot or dorsum of
hand.)
• Onset of pain : gradual.
• Duration of pain: subjective.
• Type of pain: paraesthesia ( tingling, numbness) or mild aching pain might be felt.
• Intensity of pain: nprs :at rest and during activity
• Aggrevating factor: may be movement of the limb, lifting of weight ( in case of upper limb involvement) and
walking, prolonged standing etc. (In case of lower limb involvement)
• Relieving factor: limb in elevation, using compression stockings etc.

24. ON OBSERVATION
• General condition : good/average/poor
• Built : endomorphic/ mesomorphic/ ectomorphic.
• Posture: arm-trunk distance might be reduced.
• Oedema : present.
• Bruising/ ecchymosis : may be present in case of trauma.
• Skin changes : skin may appear taut and glossy and also dark in case of varicose veins.
• Scar: may be present in case of surgeries like radical mastectomy etc.
(Scar assessment)

25. ON PALPATION
• Tenderness: may/may not be present
around the affected part.
• Trigger point : may/ may not be present.
• Scar : tender/non-tender or
mobile/adherent.
• Oedema: present. (According to stages).

26. ON EXAMINATION:
• ROM : MAY/MAY NOT BE AFFECTED.
• IN CASE OF RADICAL MASTECTOMY, SHOULDER JOINT RANGE OF MOTION IS AFFECTED.
• MMT: MAY BE AFFECTED OF THE MUSCLES OF THE JOINT AFFECTED.
• GIRTH MEASUREMENT:

27. VOLUMETRIC MEASUREMENTS
• AN ALTERNATIVE METHOD OF MEASURING LIMB SIZE IS TO IMMERSE THE LIMB IN
A TANK OF WATER TO A PREDETERMINED ANATOMICAL LANDMARK AND
MEASURE THE VOLUME OF WATER DISPLACED.

28. • SKIN INTEGRITY:
STEMMER’S SIGN: IT IS CONSIDERED POSITIVE IF THE SKIN ON THE
DORSAL SURFACE OF THE FINGERS OR TOES CANNOT BE PINCHED
OR IS DIFFICULT TO PINCH COMPARED WITH THE UNINVOLVED
LIMB.A POSITIVE STEMMER SIGN CAN BE INDICATIVE OF A
WORSENING CONDITION.

29. ICIDH-2
• BODY STRUCTURE:
DIRECT: LYMPHATIC SYSTEM
INDIRECT : MUSCLES, VESSELS OR OTHER SURROUNDING STRUCTURES OF THE AFFECTED PART.
• BODY FUNCTION :
DIRECT : PAIN, OEDEMA AROUND THE AFFECTED JOINTS
INDIRECT:
• PARTICIPATION RESTRICTION: PATIENT MAY NOT BE ABLE TO DO ADLS, ATTEND SOCIAL FUNCTIONS, DO THEIR JOB LIKE
THEY DID PREVIOUSLY ETC.
• ACTIVITY LIMITATION: DIFFICULTY IN OVERHEAD ACTIVITIES AND LIFTING HEAVY WEIGHT (IN CASE OF UPPER LIMB
INVOLVEMENT)
•DIFFICULTY IN PROLONGED STANDING, WALKING ETC. (IN CASE OF LOWER LIMB
INVOLVEMENT)

30. PFD
• A __ YEAR OLD MALE/FEMALE HAS (MAYBE) PAIN, IMPAIRED SKIN SENSATION,
IMPAIRED SKIN INTEGRITY, IMPAIRED MOBILITY, IMPAIRED MUSCLE
PERFORMANCE ASSOCIATED WITH LYMPHOEDEMA.

31. GENERAL MANAGEMENT
• INVASIVE (SURGICAL)
• FEMOROPOPLITEAL BYPASS GRAFT
• PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY OR STENT PLACEMENT
• ATHERECTOMY
• LIFESTYLE: DIET: LOW CHOLESTEROL, CESSATION OF SMOKING, PHYSICAL
ACTIVITY, WALKING, LEG EXERCISES
• MEDICATION: ANTIPLATELET THERAPY-ASPIRIN OR CLOPIDOGREL

32. MANAGEMENT
• THE BEST GLOBAL TREATMENT OF LYMPHOEDEMA, ACCORDING TO THE
INTERNATIONAL GUIDELINES OF THE INTERNATIONAL SOCIETY OF
LYMPHOLOGY IS CDT. COMPLETE DECONGESTIVE THERAPY
1. MLD(MANUAL LYMPHATIC DRAINAGE)
2. COMPRESSION THERAPY
3. EXERCISE
4. SKIN CARE
5. SELF CARE MANAGEMENT

33. PHASES OF CDT
ACTIVE PHASE (PHASE 1)
• CONSISTS OF THE MOBILIZATION OF FLUID
AND THE INITIATION OF A DECREASE IN THE
PROLIFERATED CONNECTIVE TISSUE[1].
• THE NUMBER OF WEEKS DEPENDS ON THE
AMOUNT OF SWELLING AND TISSUE FIRMNESS.
• COMPLETE DECONGESTIVE THERAPY FOR
ONE-HOUR SESSIONS, 4 TO 5 DAYS PER WEEK.
• BANDAGES WITH FOAM ARE WORN ABOUT 23
HOURS PER DAY AND OFTEN ONLY REMOVED
TO BATHE.
MAINTENANCE PHASE (PHASE 2)
• MMAINTAINS THE SWELLING REDUCTION AND
AIMS FOR OPTIMIZATION OF CONNECTIVE
TISSUE REDUCTION
• SHOULD LAST FOR MONTHS OR FOR YEARS.
• ELASTIC COMPRESSION GARMENTS THAT FIT
LIKE A SECOND SKIN ARE WORN DURING THE
DAY.
• OFTEN BANDAGES WITH FOAM ARE WORN AT
NIGHT TO DECREASE DAILY DAYTIME
SWELLING.
• EXERCISES ARE DONE WHILE WEARING
COMPRESSION.
• SELF MANUAL LYMPHATIC DRAINAGE IS DONE
FOR 20 MINUTES PER DAY.

34. MANUAL LYMPH DRAINAGE (MLD)
A MANUAL TECHNIQUE TO MOBILIZE FLUID IN THE LYMPH SYSTEM, BY
MOVEMENT OF PROTEINS AND FLUID INTO THE INITIAL LYMPHATIC VESSELS. THIS
MANUAL TECHNIQUE IS DONE LIGHTLY AND SLOWLY.
BASIC PRINCIPLES:
1.Proximal area is treated first, clearing first the adjacent and
unaffected lymphotomes, then proximal sections of the affected
lymphotomes.
1.The direction of pressure depends on the areas of edema and
the direction should always be towards a cleared lymphotome.
Technique and variations are repeated rhythmically
Pressure phase lasts longer than relaxation phase. As a rule
there should be no reddening of the skin

35. • THE BEST GLOBAL TREATMENT OF LYMPHEDEMA, ACCORDING TO THE
INTERNATIONAL GUIDELINES OF THE INTERNATIONAL SOCIETY OF
LYMPHOLOGY IS CDT (COMPLETE DECONGESTIVE PHYSIOTHERAPY). MANY
STUDIES HAVE DEMONSTRATED THE EFFECTIVENESS OF CDT FOR IMPROVING
LYMPHEDEMA SYMPTOMS SUCH AS SWELLING AND PAIN.
• REDUCE PAIN AND SWELLING
• CAN EFFECTIVELY REDUCE THE VOLUME OF LYMPHEDEMA,
• IMPROVE PATIENTS’ MOBILITY
• INCREASE QUALITY OF LIFE.

36. HOW TO DO
• MOBILIZE THE SKIN
• APPLY PRESSURE
• RELAX
• TECHNIQUE IS DONE LIGHTLY AND SLOWLY

37. TREATMENT OF ABDOMEN - DEEP
• POSITION PATIENT SO THAT HIPS AND KNEES ARE FLEXED
• PATIENT PERFORMS SLOW DIAPHRAGMATIC BREATHING
• ON EXHALE APPLY SLOW, GENTLE BUT FIRM PRESSURE ON AREA
• PRESSURE IS TOWARD THE CISTERA CHYLION
• INHALE GIVE GENTLE RESISTANCE TO PROMOTE INCREASED EXPANSION AND
PROVIDE PROPRIOCEPTION
• IF YOU CAN PALPATE THE AORTA DO NOT APPLY PRESSURE
• CONTRAINDICATIONS: PREGNANCY, ENDOMETRIOSIS, HIATAL HERNIA

39. PHASE I WITH COMPRESSION
BANDAGES:
• BANDAGING IS A MAINSTAY OF TREATMENT
FOR STAGE 2 AND STAGE 3 LYMPHEDEMA
(MODERATE TO SEVERE LYMPHEDEMA).
• BANDAGING INVOLVES CREATING A SOFT CAST
ON THE ARM OR UPPER BODY BY WRAPPING
WITH MULTIPLE LAYERS.
• MAIN COMPONENT OF THECDT.
• BANDAGING IS A REDUCTIVE THERAPY,
MEANING IT MAKES THE LIMB SMALLER. WHEN
THE ARM IS BANDAGED, MUSCLES ARE “HELD
IN” BY THE MULTI-LAYER SOFT CAST EVERY
TIME THE ARM IS USED (THIS IS KNOWN AS
WORKING PRESSURE).
PHASE II WITH MEDICAL COMPRESSION GARMENTS:
• COMPRESSION GARMENTS ARE DESIGNED TO KEEP A CONTINUOUS
PRESSURE ON THE SWOLLEN/AFFECTED AREA TO ASSIST THE
DRAINAGE OF FLUID AND MINIMIZE SWELLING. IMAGE R:
LYMPHEDEMA COMPRESSION SLEEVE, DISPLAYED ON MANNEQUIN
• EXTERNAL COMPRESSION PROVIDES A COUNTER FORCE TO THE
WORKING MUSCULATURE (IE WORKING PRESSURE).
• WORKING PRESSURE HELPS TO PREVENT RE-ACCUMULATION OF
FLUIDS WHICH WERE EVACUATED DURING INTENSIVE COMPLETE
DECONGESTIVE THERAPY (CDT) AND CONSERVE THE RESULTS
ACHIEVED DURING MANUAL LYMPHATIC DRAINAGE (MLD)[4].
• SLEEVE WORN ON THE ARM, FINGERLESS GLOVE OR A GAUNTLET
(WHICH DOES NOT HAVE INDIVIDUAL FINGER OPENINGS), OFTEN
WORN WITH A SLEEVE
• ALL OF THE GARMENTS ARE MADE OF FLEXIBLE FABRIC. SLEEVES
ARE TIGHTER AT THE BOTTOM THAN THEY ARE AT THE TOP
CREATING THE GRADED PRESSURE THAT KEEPS THE LYMPH MOVING
OUT OF THE ARM. THERE IS A VARIETY OF FABRICS AVAILABLE: SOME
FEEL SOFTER, OTHERS STIFFER, AND SOME MAY INCLUDE MATERIALS
SUCH AS WOOL OR LATEX.
COMPRESSION THERAPY

40. COMPRESSION THERAPY
BANDAGING VS. COMPRESSION SLEEVES
• BANDAGES WORK DIFFERENTLY THAN COMPRESSION SLEEVES, WHICH
SUPPORT THE FLOW OF LYMPH IE MOVE FLUID OUT OF AND DECONGEST THE
LIMB. SLEEVES APPLY WHAT’S KNOWN AS RESTING PRESSURE, MEANING THAT
THE PRESSURE IS HIGHER WHEN THE ARM IS AT REST. WHEN YOU MOVE YOUR
ARM, THE ELASTIC FABRIC MOVES RIGHT ALONG WITH IT, WHICH ACTUALLY
REDUCES THE AMOUNT OF PRESSURE. A COMPRESSION SLEEVE MAY BE
ENOUGH FOR MILD LYMPHEDEMA, HOWEVER MORE ADVANCED CASES
REQUIRE BANDAGING BEFORE A COMPRESSION SLEEVE CAN BE USED.
BANDAGING WORKS BY REDUCING LIMB VOLUME[

41. BANDAGES
• RESTING PRESSURE - PRESSURE FROM THE OUTSIDE IN THE RESTING POSITION
OF THE MUSCLE. PRESSURE APPLIED FROM FASCIA, BANDAGES
• WORKING PRESSURE - PRESSURE FROM THE INSIDE WHEN THE MUSCLES ARE
ACTIVE. PRESSURE GENERATED BY THE MUSCLES

42. FOUR LAYER BANDAGE SYSTEM
Layer 1: orthopaedic wool
• Orthopaedic wool provides a layer of padding that protects areas at risk of high pressure.
Layer 2: crepe bandage
• This is the least effective layer as it simply adds extra absorbency and smooths down the
orthopaedic layer prior to the application of the two outer compression bandages.
Layer 3: elastic extensible bandage:
• It is a highly extensible bandage that provides a sub-bandage pressure of approximately
17mmhg when applied at 50% overlap using a figure-of-eight technique.
Layer 4: elastic cohesive bandage
• A frequent misconception is that the outer cohesive layer within the four-layer system is there
simply to maintain the bandage position. In fact, this layer provides the higher level of
compression (sub-bandage pressure approximately 23mmhg).

43. 3LYMPHATIC DRAINAGE EXERCISES
• Move fluids through lymphatic channels
• Active repetitive ROM exercises are performed
• Follow a specific sequence to move lymph away from a congested area
• Proximal to distal
• Avoid static dependent postures

45. DOSAGE
• 20 – 30 MINUTES
• EACH SESSIONTWICE DAILY
• 7 DAYS A WEEKWEAR COMPRESSION BANDAGES OR GARMENT DURING EXERCISES
• COMBINE WITH DEEP BREATHING
• REST IF POSSIBLE FOR 30 MINUTES FOLLOWING EXERCISES
• CHECK FOR REDNESS OR INCREASED SWELLING
PROXIMAL JOINTS MOVING DISTALLY5 REPS – 20 REPS

46. PRINCIPLES OF BANDAGING
Must use Low stretch
Always start distally and
proceed proximall
Maintain moderate tension Avoid creases and folds
Use tape to secure…not
clips or pins
Applied with greater
pressure distally than
proximally
Do not extend bandage to
maximal length
Check pressure
gradientPlace more layers
for increase compression
rather than applying them
more tightly
Fill indentations with
padding or foam pieces
Cover as much of the limb
as possible
Compression to be worn
until next visit

47. TYPES OF COMPRESSION BANDAGES
ELASTIC
• HIGH RESTING PRESSURE AND LOW
WORKING PRESSURE
• NOT EFFECTIVE FOR TREATING
LYMPHEDEMA HIGH RESTING PRESSURE
DOES NOT ALLOW THE LYMPHATICS TO
FILLAND LOW WORKING PRESSURE DOES
NOT INCREASE TISSUE PRESSURE
EFFECTIVELY ENOUGH TO INFLUENCE THE
LYMPHATIC PUMP BECAUSE IT STRETCHES
WHEN THE MUSCLE CONTRACTS
LOW STRETCH
• LOW RESTING PRESSURE AND HIGH
WORKING PRESSURE LOW RESTING
PRESSURE ALLOWS THE LYMPHATIC TO FILL
HIGH WORKING PRESSURE COMPRESSES THE
LYMPHATIC VESSELS BETWEEN THE MUSCLE
THE BANDAGE FACILITATING LYMPHATIC
FLOW

48. LOW STRETCH
• Form a semi rigid support which causes an increase in interstitial pressure when the muscle
contractswhen a patient wears low stretch compression bandages while sleeping or resting the
increased interstitial pressure will reduce the amount of fluid and protein leaving the arteriole
(ultra filtration) and less edema is formed. When a patient wears low stretch compression
bandages during activity the increased interstitial pressure not only reduces ultra filtration but
increases reabsorbtion into the lymphatic system which decreases lymphedema and well as
venous edema

49. SKIN CARE MANAGEMENT

50. SELF-CARE MANAGEMENT AND TRAINING
• Education regarding “self care” (ie everything client does at home to reduce the risk of the lymphedema coming back or getting worse in
the future) is vital. As a lymphedema therapist you should teach clients how to
• Put on and care for their compression sleeves and garments. Patients need to understand the need to replace the garments on a regular basis
to maintain sufficient compression. Each garment should be washed daily to restore the compression and replaced after 3 to 6 months of
continuous use, although very active patients may require these to be changed sooner[8].
• Protecting arm, hand, chest, or other body part from cuts, injury, overuse, extreme temperatures, and other situations that can increase the
production of lymph, which in turn increases lymphedema risk
• Educate re the signs and symptoms of infection, which is a special concern for people with lymphedema
• Help plan and set an individualised exercise and/or weight control plan
• Teach how to do manual lymphatic drainage on their own, at home. If “self-mld” is appropriate and client can manage technique. Stress to
client that doing more than is recommended, or being more aggressive with the massage strokes for MLD, could be harmfu

51. PROTECT THE SKIN
• KEEP ARM CLEAN AND DRY.
• APPLY MOISTURIZER DAILY TO PREVENT
CHAPPING/CHAFFING OF THE SKIN.
• BALANCE LOTION
• ATTENTION TO NAIL CARE; DO NOT CUT CUTICLES.
• PROTECTED EXPOSED SKIN WITH SUNSCREEN AND
INSECT REPELLENT.
• USE CARE WITH RAZORS TO AVOID NICKS AND SKIN
IRRITATION.
• AVOID PUNCTURES SUCH AS INJECTIONS AND BLOOD
DRAWS.
WEAR GLOVES WHILE DOING ACTIVITIES
THAT MAY CAUSE SKIN INJURY
•
IF SCRATCHES/PUNCTURES TO SKIN OCCUR, KEEP
CLEAN AND OBSERVE FOR SIGNS OF INFECTION
• GRADUALLY BUILD UP THE DURATION AND INTENSITY
OF ANY ACTIVITY OR EXERCISE, AND MONITOR ARM
DURING AND AFTER FOR ANY CHANGE IN SIZE, SHAPE,
FIRMNESS OR HEAVINESS.
• AVOID ARM CONSTRICTION FROM BLOOD PRESSURE
CUFFS, JEWELRY AND CLOTHING, PROLONGED (>15
MINUTES) EXPOSURE TO HEAT, PARTICULARLY HOT
TUBS AND SAUNAS
• AIRPLANE FLIGHTS: DUE TO DECREASE PRESSURE IN
CABIN, WILL NEED A COMPRESSION SLEEVE

52. SEQUENTIAL PNEUMATIC DEVICES
• Mobilizes interstitial fluid into the venous system single chamber - JOBST vs. Sequential
compression (gradient)use MLD prior to using the pumpstudies show that it moves only venous
fluidpump never to exceed 40 mmhg for extended periods of time

53. LYMPHA PRESS PRESSURE RANGE IS 20-180
MMHG
• Pressure is distributed into overlapping air compartments which are contained in a special sleeve.
• The compartments are sequentially inflated, from distal to proximal, massaging the limb in a
proximal direction.
• The overlapping compartments prevent any gaps in treatment, to achieve a maximal and safe
reduction of the lymphedema.
• The treatment cycle starts by filling the distal compartment first and continues inflating the
remaining compartments in sequence during the first 24 seconds until all are full.
• The pressure is held in all compartments for 2 seconds, then deflates for four seconds which
completes the 30 seconds cycle. The cycle then repeats itself.

54. LASER
• Another new frontier in the treatment of lymphedema involves using the laser.From various trials
lasers appear to help lymph flow, shown to be effective improvement of wound healing, and it has
been used effectively in treating edema from dvt’s.The FDA has approved a laser device to be
used in the treatment of post-mastectomy arm lymphedema. Clinical trials are currently
underway for leg lymphedema. Lymphedema and its complications can causing "scarring" of the
lymphatic system. The laser is useful in removing the scar tissue, thereby helping lymph flow.

55. KINESIO TAPPING
• IMPROVE CIRCULATION OF LYMPHATIC FLUIDS. LYMPHATIC FLUID IS MOSTLY WATER, BUT IT ALSO CONTAINS
PROTEINS, BACTERIA, AND OTHER CHEMICALS. THE LYMPHATIC SYSTEM IS THE WAY BODY REGULATES SWELLING
AND FLUID BUILDUP.
• THE THEORY IS THAT WHEN KINESIOLOGY TAPE IS APPLIED, IT CREATES EXTRA SUBCUTANEOUS SPACE, WHICH
CHANGES THE PRESSURE GRADIENT IN THE AREA UNDERNEATH YOUR SKIN. THAT CHANGE IN PRESSURE ENHANCES
THE FLOW OF LYMPHATIC FLUID.
• STUDIES HAVE HAD MIXED RESULTS. IN TWO RECENT STUDIES, KINESIOLOGY TAPE REDUCED FLUID BUILDUP IN
WOMEN WHO UNDERWENT BREAST CANCER TREATMENT AND PEOPLE WHO HAD TOTAL KNEE REPLACEMENTS.
• CHANGING THE FLOW OF LYMPHATIC FLUID COULD HELP BRUISES HEAL FASTER.

56. REFERENCES
1. Solomen S, aaron P. Vascular rehabilitation. JP medical ltd; 2017 jul 17.
2. Kisner 6th edition
3. Naci B, ozyilmaz S, aygutalp N, demir R, baltaci G, yigit Z. Effects of kinesio taping and
compression stockings on pain, edema, functional capacity and quality of life in patients with
chronic venous disease: a randomized controlled trial. Clinical rehabilitation. 2020
jun;34(6):783-93.