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Lymphedema

Implementation

With development of lymphedema, it is important to take precautionary measures as soon as possible. Treatment with compression is the component which seems to be most effective in reducing the swelling. Manual lymph drainage is often used in combination with bandaging in the first 1-2 weeks of the treatment. This complete decongestive therapy is a composite treatment including multiple techniques which are performed by a specially trained physical therapist.

The intensive phase

  • Compression treatment – possibly with bandaging and thereafter adjustment of an elastic stocking
  • Manual lymph drainage
  • Circulation and drainage inducing exercises
  • Skin care

During the intensive phase, the patient is usually treated 5 days a week with continuously bandaging until the desired volume reduction is achieved. This usually takes one to two weeks.

Bandaging

After stimulating the lymphatic flow by manual lymph drainage, a compression stocking is used or the whole arm is bandaged for one to two weeks. The bandages should be worn as long as they are not too uncomfortable. Correct bandaging with short, elastic bandages provide the tissue with high pressure under activity and low pressure while resting.

  • An ointment with a low pH (5.5) should be applied to the skin.
  • A light tube gauze should be worn.
  • The padding is then applied.
  • The bandaging starts distally to the lymphedema.
  • The bandages are laid evenly, circularly, and in multiple layers.
  • The pressure should decrease gradually from distal to proximal.
  • The pressure is regulated partially with the bandaging technique and mainly by the number of layers of bandages.

Compression stocking

  • The stocking may be removed at night.
  • At night an ointment is preferably applied to the skin.
  • With incipient  lymph edema, wear the stocking during activity.
  • In moderate and extensive lymph edema, the stocking is usually worn all day.
  • The stocking should be washed at least every third day.

A poorly customized stocking may create faulty compression. The most frequent error is that the compression stocking is used after it has lost its elasticity (worn out) and therefore has less effect.

Manual Lymph Drainage

The massage strokes should be performed in the direction of the lymphatic drainage with light pressure and with slow motions. The treatment should not be painful.

Manual lymph drainage has four main movements: standing circles, pumping grip, turning grip, and corkscrew grip.

Pressure massage with pulsator

Pulsation is never a first choice for treatment of lymphedema, but could be a measure over time when monitoring has shown that the treatment is effective. At the start, the patient should be informed about possibly complications. Sometimes, an increase in edema is seen proximal to the cuff. Further pulsation treatment should then be postponed until manual lymph drainage and exercises have improved the condition. If the pressure is too high, the lymphatic vessels may be damaged and the amount of interstitial fluid may increase.
The pressure should be moderate and the patient should experience the treatment as comfortable. It is not the amount of pressure that is important, but uniform rhythmic pressure wave. Tuning of rate and pressure are adjusted for each patient.
Usually, the treatment should last for twenty minutes at the start increasing gradually to thirty to forty minutes. Can be used daily or when needed. Pulsation treatment may also be performed by the patient at home.

Skin Care

Regardless of whether the patient has lymphedema or not, it is important to hinder the occurrence of scratches, sores, and unnecessary skin irritation. Use of gloves is appropriate in some situations. The patient should also be cautious of overheating and sunburn. The main goal of skin care is to prevent infections, because this can trigger an eruption of lymph edema.

Regular use of bandages and compression stockings dries out the skin. Use of skin care products and cleansers with a low pH (5.5) are recommended. Good skin care keeps the skin soft and supple and maintains the skins natural ability to fight infection.

Disinfecting ointment and adhesive tape should be used in the event of an ulcer or scratch or if there is danger of infection.

Maintenance phase

  • Use of elastic stocking and/or glove as needed
  • Skin care
  • Regular exercises to facilitate the muscle-joint pump
  • Possible intermittent pressure massage with pulsator

The patient obtains some treatment during the maintenance phase and may have treatment by a physical therapist if necessary. In the short term, the treatment is almost always satisfactory. In the long run, the result depends on the patient practicing the measures recommended. The pulsator may usually be borrowed from a health care center.

Exercises to improve mobility and lymph flow of the shoulder/arm

Dynamic exercises with a relaxation phase are optimal. "Throwing" movements may feel uncomfortable. Many experience that it is better to walk with poles, but it is important to maintain a loose grip of the pole.

Correctly adjusted movement exercises:

  • induce circulation without straining the reduced lymphatic system
  • provide adequate joint movements
  • stimulate dynamic change between tension and relaxation, preferably in conjunction with respiration

Movement therapy in a heated pool may be favorable for some lymphedema patients. Water pressure stimulates lymphatic drainage and simultaneously activates circulation and movement.

 

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