Score & Clinical Sign
0
No edema
A patient is showing clinical signs of deep pitting in the UE. The is depth is 5-10mm deep and takes 10-12 seconds to rebound. Additionally, they are showing foot and leg swelling. What score does the OT document?
3+
Elevation
extremity should be placed above heart
+1
-Barely discernable pit; immediate rebound
-Normal foot and leg contours
A client presents with no signs of pitting. What score does the OT document?
0
Edema elevation CAUTIONS
Avoid extreme positions of elevation for individuals with right-sided heart weakness - this can cause fluid to empty into the heart too fast
+2
-Deeper pit (<5mm); a few seconds to rebound
-Fairly normal foot and leg contours
A client's UE rebounds after a few seconds, and shows less than 5mm of pitting. The client presents with fairly normal foot and leg contours. What score does the OT document?
2+
AROM
assists with fluid drainage
+3
-Deep pit (5-10mm); 10-12 seconds to rebound
-Foot and leg swelling
A client with a history of edema due to an injury 2 months ago is being evaluated for recent swelling. The OT assess and observes even deeper pitting, greater than 1cm that takes longer than 20 seconds to rebound. She presents with severe foot and leg swelling. What score does the OT document?
4+
Manual edema mobilization (MEM)
hands-on-technique that activates the lymphatic system to remove edema
(MEM requires specialized training; and the efficacy is supported by evidence)
+4
-Even deeper pit (>1cm); >20 seconds to rebound
-Severe foot and leg swelling
A client being evaluated in the outpatient clinic shows barely discernable pitting in the UE. Her arm immediately rebounds, and foot and leg contouring presents as normal. What score does the OT document?
1+
Contraindications of manual edema mobilization (MEM)
Patients with:
a. Chronic heart failure (CHF)
b. Cardiac or Pulmonary problems
c. Renal problems
d. Liver disease
e. Active cancer
f. Blood clot
g. Active infection
Retrograde massage
assists with the return of blood and lymphatic fluids to the venous system
(extremity should be elevated)
although retrograde massage is still being used in edema reduction, it has limited evidence to support its efficacy; thus, it is slowly being replaced by MEM
Retrograde Massage
Retrograde Massage:
Technique = Firm, distal to proximal strokes
Target = venous edema (mild to moderate post- surgical or injury-related edema)
Goal = push fluid towards veins for reabsorption
Indications = acute/subacute edema, venous insufficiency
Training Level = can be performed by most healthcare professionals with basic training
Pressure = firm
Direction/Starting point = distal to proximal
Suitability for Complex Edema = less effective for lymphedema or chronic cases
Adjunctive Techniques = none typically used
Manual Edema Mobilization (MEM)
Manual Edema Mobilization (MEM):
Technique = gentle, rhythmic strokes following lymphatic pathways
Target = Lymphatic system,
Chronic or complex lymphedema,
Post-surgical edema
Goal = promote lymphatic drainage and reestablish lymph flow
Indications = chronic edema, lymphedema, lymphatic drainage
Pressure = very light
Direction/Starting Point = Proximal to Distal
Suitability for Complex Edema = highly effective for lymphedema and more complex edema
Training Level = requires specialized training in lymphatic drainage
Adjunctive Techniques = breathing techniques; muscle pumping exercises
Contraindications of Retrograde Massage
retrograde massage should be avoided when cardiac edema is present