Definition

The lymphatic system is a part of our circulatory system. The fluid, ‘lymph’, carries the harmful substances such as bacteria to the lymph node, where the harmful substances are quarantined. The fluid will then return to the blood system. The flow of fluid is led by muscle contraction and blood flow, so it flows slower than the blood at approximately 6-10ml/min. Lymphedema is the dysfunction of the lymphatic system. The fluid is clogged and cannot return to the blood circulation. This weakens the backflow prevention ability of the lymph nodes. The accumulated fluid infiltrates the skin from the lymph nodes, causing lymphedema. Lymphedema commonly appears with aches, swelling, numbness, pins, and needles, and/or heaviness.

Self File | 淋巴水腫lymphedema1

 

 

Causes



Lymphedema is more likely to happen when the lymphatic system is disturbed or overloaded:

  • When lymph nodes are removed after breast cancer surgery. A study showed more than 20% of patients who underwent treatment for breast cancer would develop breast cancer-related lymphedema
  • When radiotherapy causes fibrosis of the soft tissue and damage to the lymph nodes
  • When chemotherapy causes edema all over the body

Self File | 淋巴水腫 Lymphedema2

 

 

Risk Factors

Apart from lymphatic system damages, bacterial or viral infection, serious bodily injury or obesity may also cause lymphedema.

 

 

Common Symptoms

Normally, lymphedema should not cause other physical injuries, but some patients may feel some limbs heaviness or find aches when over-swelling. The pain is mainly caused by the tight soft tissues, such as axillary cording and scar adhesion, or sometimes by neurological problems. As the congestive lymph will cause chronic inflammation and thus fibrosis, symptoms such as cellulitis, redness, pins and needles and fever can also be caused when bacteria infect the affected limbs.

 

Besides, since lymphedema also affects patients’ appearance, it affects their mental health and quality of living. Examples include the selection of hygienic and healthcare products, selection of clothes, the intensity of daily activities, and whether they should take long flights.

 

 

Management

There are five aspects for the management of lymphedema, namely skin and soft tissue caring, the balance of daily activities, exercise therapy, lymphatic drainage, and compression therapy. Apart from exercise therapy, compression therapy, and ‘manual lymphatic drainage’, physiotherapists will teach patients how to integrate the management into daily habits, such as skincare and the wearing of compression stockings for better results.

 

The theory of lymphatic drainage is to drive the excess lymph back to the normal lymph ducts. It normally starts from the trunk, then shoulder, elbow, wrist, and finger. During lymphatic drainage, the physiotherapist will gently and slowly massage the skin to stimulate the lymph ducts at the superficial skin structure. More pressure is needed to soften fibrotic areas, and then apply the gentle massage like the above.

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Preventive Measures
  • Perform lymphatic drainage regularly.
  • Clean the body part and apply moisturizer every day.
  • Do not cut the nails too close to the nail bed.
  • Put on sun cream and prevent possible skin abrasions. When wounded, use disinfectant and cover it appropriately. If the lymph bursts out, apply a compression bandage.
  • Exercise regularly. Hydrotherapy in warm water can improve lymphatic circulation and reduce swelling.
  • Avoid lifting heavy objects.
  • Avoid high-temperature activities such as sauna and steam bath.
  • For the first few days after breast cancer surgery, patients should keep their arms above their chest level to prevent swelling. In case of redness, swelling, warmth, and pain, please consult your physiotherapist or doctor for assistance

Self File | 淋巴水腫 lymphedema4

 

 

 

 

 

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