Overview of Lymphedema
Anatomy and Physiology Review
What is the lymphatic system - tutorial (requires flash player)
Video Summary of Lymphedema and Treatment
- Fluid, proteins, fat and other cellular debris is transported to the venous system via the lymphatic system
- Lymphatic fluid is transferred from the periphery to centrally-located ducts for filtration prior to entering the venous system
- If the water and protein content load exceeds capacity of the lymphatic system, then edema results. (Volume > transport capacity)
- High protein fluid accumulation in interstitial spaces = lymphedema
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Classifications of Lymphedema
Primary = congenital. Defects in the system at birth result in chronic fluid accumulation
Secondary = acquired. Common precursors are lymph node resection, hx of radiation therapy, trauma, venous insufficiency and infection.
Severity of lymphedema is graded and documented in stages:
- Stage 0: subjective reports of limb heaviness/aching; no increase limb volume detected
- Stage I: reversible, sxs decrease with elevation of the affected extremity, pitting edema
- 1+ pitting = slight edema
- 2+ pitting = slight indentation is visible from finger pressure
- 3+ pitting = deep fingerprint is visible from finger pressure for 5-30 seconds
- 4+ pitting = limb swelling 1-2 x normal size
- Stage II: irreversible, no change in sxs with elevation, tissue fibrosis, decreased pitting edema from finger pressure
- Stage III: irreversible, elephantitis
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Lymphedema Signs and Symptoms
- mild warmth
- swelling
- pain
- trophic changes (skin darkening)
- venous ulceration (skin infection)
- decreased ROM
- loss of functional mobility/decreased independence with ADLs (dressing, grooming, etc)
