Lymphedema Rehabilitation

WHAT IS LYMPHEDEMA?

Lymphedema is defined as the accumulation of protein-rich fluid as a result of congenital or subsequent disruption of the lymph circulation outside the blood circulation in the body.

WHAT CAUSES LYMPHEDEMA?

Lymphedema is defined in two ways, primary and secondary. Primary lymphedema occurs as a result of congenital absence or abnormality of lymph tissue. Secondary lymphedema, on the other hand, is a condition that occurs due to a problem in the lymph ducts and is more common in the clinic.

Lymphedema can develop in any type of cancer after surgery or radiation therapy. However, it develops especially after breast, prostate and lower abdomen cancers. The frequency of lymphedema development after removal of the armpit lymph nodes following breast surgery is approximately 25%. 

The bigger the surgery, the greater the number of lymph nodes removed and the greater the risk of developing lymphedema if postoperative radiation therapy is applied. Minor injuries such as blows to the arm or leg, scratches, insect bites, and infections can cause lymphedema.

The type that develops 6-8 weeks after surgery and radiation therapy, heals more slowly. The most common is the type that develops slowly over months or years.

WHAT ARE THE SYMPTOMS OF LYMPHEDEMA?

It is a feeling of tightness or fullness in the arm or leg, pain, heaviness, tingling, swelling and redness, difficulty in movement in the arm, hand or ankle, tightening of the watch, ring, bracelet or shoe, tightness in the skin, distress and discomfort related to this.

When slowly swelling, the patient may not be noticed by the patient’s relatives or the doctor unless the measurement is made. When noticed with the eyes, the environmental difference may have reached the level that needs to be treated.

HOW SHOULD BE PROTECTED IN LYMPHEDEMA?

– Every swelling should be cared for and a doctor should be consulted immediately.– Arms or legs should be kept clean, skin care should be done.– After bathing and during the day, moisturizer should be applied to the skin.– Manicure should not be done. Cuticles should be pushed back instead of cutting.– It should be tried to be protected from all kinds of pressure and restraint (such as blood pressure measurement, pouching, scratching, hitting, inappropriate massage).– Repetitive movements such as rubbing, pulling, pushing with risky arms or legs should be avoided.– If there is scratch, scar or insect bites on the skin, it should be washed with soap and kept clean. Anti-bacterial cream should be used. If there is an open wound, it should be cleaned and covered. In mild burns, after cold application, it should be washed with soap and water and protected.– In terms of infection, one should be alert to symptoms such as redness, swelling, increased temperature, sensitivity and fever, and seek medical advice immediately.– Arm or leg should be protected from sunburn. Sunscreen creams should be used and staying under the sun for a long time should be avoided.– Protective gloves should be used when handling the pots and pans that come out of the oven. Be careful with the steam of boiling water and food coming out of the microwave oven.– In the bathroom, rubbing should not be done.– Avoid excessively hot environments such as saunas, hot springs or going out in excessive heat in summer.

– The risky arm should not be vaccinated, blood pressure should not be measured and blood should not be taken.– It should be paid attention that the elastics of the clothes used are not tight.

WHAT SHOULD YOU DO IN CASE OF SWELLING?

A doctor should be consulted immediately, even if this experience has been experienced before, it would be appropriate to be evaluated by a doctor.

HOW A DIAGNOSIS IS MADE?

The most reliable and simple way to diagnose is to compare circumference measurements between two arms or legs. Imaging methods such as doppler ultrasonography and lymph scintigraphy can also be used in diagnosis.

IS THERE A TREATMENT?

Lymphedema treatment takes time and patience, but the result is successful. If it is swollen recently, the treatment will be shorter, if the arm or leg is swollen for a long time, the treatment will take longer. Therefore, starting treatment as soon as possible will increase the success of the treatment.

The most important goal of lymphedema treatment is primarily to prevent the increase of lymphedema and to increase the lymphatic system flow in order to decrease existing edema. It is also among the primary goals of treatment to prevent joint movement limitations and infection.

The sooner it is noticed and treatment is started, the greater the chance of success in treatment.

HOW DOES LYMPHEDEMA AFFECT?

In the case of lymphedema, infection or clot may develop in the arm or leg. Movement of the swollen arm or leg becomes difficult and there is a limitation in time. Pain, wounds and cracks are disturbing. Choosing clothes becomes difficult. Mental problems can be seen. If left untreated, it is likely to progress. The duration of swelling in lymphedema and how long the arm / leg is swollen affect the success and duration of the treatment.

HOW IS THE TREATMENT?

Compliance with the treatment planned by the Physical Therapy and Rehabilitation physician affects the success of the treatment. The treatment can take longer than a month. If the correct application is not done, success cannot be achieved. 

The aim of treatment is to reduce the swelling and try to prevent it from happening again. For this, the right skin care should be done first. Moisturizer suitable for arm or leg should be applied in one direction from bottom to top twice a day. 

Manual lymph drainage is very important in treatment. Lymph drainage should be performed by experienced people trained in this area. 

The next step is bandaging. If the environmental difference is excessive (2- 2.5 cm between two arms or legs), bandage treatment is started. The bandage treatment and the material used are specific. A multi-layer application is made with a short stretch bandage. 

When the environmental difference reaches the desired limits, the pressure suit is proceeded to.  Pressure pumps (pneumatic compression devices) and exercises are also used in the treatment. Exercises should be done during the follow-up period as part of the treatment and afterwards for protective purposes.