Lymphoedema

It is also known as Lymphatic Obstruction, is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system. The lymphatic system returns the interstitial fluid to the thoracic duct and then to the bloodstream, where it is re circulated back to the tissues. 

There are two main types of lymphoedema:

• Primary Lymphoedema – which develops at birth or after puberty and is caused by faulty genes.
• Secondary Lymphoedema – caused by damage to the lymphatic system as a result of an infection, injury, trauma, or cancer.

Reference:

www.nhs.uk
www.betterhealth.voc.au
www.nlm.nih.gov

The main symptom of lymphoedema is swelling in all or part of a limb.  

Other symptoms include:

• the affected limb feeling heavy and aching
• the affected limb losing some of its mobility
• pain in the affected limb
• painful joints, such as the elbow or knee, caused by swelling in the limb
• repeated skin infections in the affected limb

Reference:

www.nhs.uk

There are two types of Lymphoedema- Primary and Secondary lymphoedema, which have different causes.

Primary lymphoedema:

It is due to alterations (known as mutations) in genes responsible for the development of the lymphatic system. 

Secondary lymphoedema: some of the common causes are-

Surgical treatment of cancer

Cancer spreads around the body via the lymphatic system and so part of the treatment can involve surgically removing the cancerous lymph nodes. There is a significant risk of lymphoedema occurring as a complication of treatment for:

• Breast Cancer
• Skin Cancer
• Gynaecological Cancers, such as cervical cancer and vulval cancer
• Genitourinary Cancers, such as prostate cancer or penile cancer

Radiotherapy

Radiotherapy uses controlled doses of high-energy radiation to destroy cancerous tissue. However, it at times also damage healthy tissue.

Venous diseases 

Venous diseases, which affect the flow of blood through the veins, can cause lymphoedema in some people. The abnormal or damaged veins can result in excess blood or fluid building up in tissues, which causes tissue damage. This can affect the drainage of the lymphatic system.

Some venous diseases that can lead to lymphoedema include:

• Deep Vein Thrombosis (DVT) – A blood clot in one of the deep veins in the body
• Varicose Veins (swollen and enlarged veins) – Where poor drainage of blood in the veins causes higher vein pressure and more fluid passes into the tissues

Infections

In some cases, an infection can cause lymphoedema.

Cellulitis is a bacterial skin infection that can cause lymphoedema, it is also sometimes a complication of the condition. A severe cellulitis infection can damage the tissue around lymph nodes or vessels, leading to scarring.

Another infectious cause of lymphoedema is a parasite infection called filariasis. This can be common in parts of the developing world, such as parts of India.

Inflammation

Conditions that cause tissue to become inflamed (red and swollen) can also permanently damage the lymphatic system. Health conditions that can cause lymphoedema include:

• Rheumatoid Arthritis – which causes pain and swelling in the joints
• Eczema – which causes the skin to become itchy, reddened, dry and cracked

References:

www.nhs.uk

Measuring limb volume- These tests are explained below:

Tape measure

A tape measure is used at 4cm (1.6in) intervals up the leg to measure the limb circumference and then calculate limb volume.

Water displacement method:

The water displacement method is based on the principle that helps to calculate the volume of an object by measuring how much water it displaces.

Patient will be asked to place the affected limb in a tank of water and the amount of water that is displaced will then be measured. This measurement can be used to calculate the volume of limb.

Perometry

Perometry is a technique that uses infrared light to measure the volume of limb. This process can accurately calculate how swollen affected limb is.

Imaging tests

Imaging tests may also be used to help in the diagnosis. These include:

• A Lymphoscintigraph – where radioactive dye is injected, it can be tracked using a special scanner, this shows how the dye moves through lymphatic system and can check for any blockages.
• A Magnetic Resonance Imaging (MRI) Scan – which uses a strong magnetic field and radio waves to produce detailed images of the inside of body.
• An Ultrasound Scan – which uses high-frequency sound waves to create an image of the inside of body.

A computerised (axial) tomography (CT or CAT) scan – which uses X-rays and a computer to create detailed images of the veins or lymph nodes.

Reference :

www.nhs.uk

The recommended treatment for lymphoedema is a treatment plan called Complex Decongestive Therapy (CDT). It is also known as Decongestive Lymphatic Therapy (DLT).

There are four components to CDT treatment:

• Manual lymphatic drainage (MLD) is a specialized massage technique designed to stimulate the flow of fluid and reduce swelling.
• Multilayer lymphoedema bandaging (MLLB) uses bandages and compression garments to move fluid out of the affected limb.
• Remedial exercises designed to activate muscles in the limb to improve lymph drainage. 
• Skin care is required to prevent infection.

Reference : 

www.nhs.uk