Lymphedema
2. What is it caused by?
3. Mechanical or dynamic insufficiency?
4. Symptoms or disease process?
1. Abnormal accumulation of protein in the interstitial space (protein is hydrophilic)
2. Hereditary, cancer/treatment, filariasis (global, 3rd world countries)
3. Mechanical
4. Disease process
Stages 0-3
0. Latency stage: TC has been reduced (injury), but LL is still below TC, making FR smaller
1. Reversible lymphedema: Soft, pitting, recedes overnight, no skin changes
2. Spontaneously/chronic irreversible: Lymphostatic fibrosis, longstanding accumulation of protein-rich fluid in the interstitium, stemmer sign is present, frequent infections, deep skin folds, fibrosis, CDT will reduce, constant compression is fibrinolytic
3. Lymphostatic elephantiasis: Extreme limb volume, skin changes (fungus, papillomas, ulcers, cysts, fistulas), frequent infections, OR stage 2+ any wound
Compression
1-2. Stages 1+2
3. What happens when a consistent compression is applied to a leg from distal to proximal?
4. What does compression do?
1. Compression bandages/wraps (short-stretch)
2. Sleeves/socks during the day, wraps or alternatives at night
3. A natural gradient occurs
4. Reduces filtration, increases reabsorption, & improves muscle pump to prevent re-accumulation of lymph fluid
1. Most common type of amputation
2. Main causes
1. BK
2. DM, Vascular, Trauma
1-5: K-Levels
Extras:
-Documentation needs to back it up
-Microprocessors/stumble recovery are available for K2 & up
-PTs give unbiased outcome measure
1. K0: No leg
2. K1: Transfers bed to WC
3. K2: WC to Publix, limited community ambulation, geriatrics, multi-trauma
4. K3: Normal person, can change speeds, unlimited community ambulation
5. K4: Athlete, child, caregiver, running leg
1. What is edema?
2. What is it caused by?
3. Mechanical or dynamic insufficiency?
4. Symptoms or disease process?
1. Water in tissue
2. Kidney failure/disease, CHF, pregnancy, venous insufficiency
3. Dynamic insufficiency
4. Symptom
Diagnostic imaging
1. Lymphography
2. MRI
3. CT
4. Lymphoscintigraphy
5. Venous doppler
6. Ultrasonography
Short Stretch
1. __ working pressure, __ resting pressure
Ace/Elastic Bandages
2. __ working pressure, __ resting pressure
1. High, low
2. Low, high
Post-Op
1. ACE wrap consideration
2. Shrinker consideration
1. Won't stay up with AK
2. Better than ACE, helps with edema, not until staples are removed, hard to put on
When does the limb change the most?
First year
The lymphatic system includes what?
1. Capillaries
2. Pre-collectors
3. Collectors
4. Nodes
5. Trunks/ducts
Lipedema
1. Proliferation of adipose tissue located between the __ & __
2. + or - Stemmer
3. Pitting?
Extra:
-Liposclerosis (skin hardens)
-Painful to touch
-Compresses superficial lymph collectors
1. Iliac crest & ankles
2. -
3. None
Compression Levels:
-Pressure in mmHg & Level of Compression
1. Class 1
2. Class 2
3. Class 3
4. Class 4
1. 10-20, Mild
2. 21-30, Moderate
3. 31-40, Strong
4. >40, Very strong
Extras:
-LEs recommend 30-40 minimum
-Non-complicated UE sleeves: 20-30, typically 30-40 mmHg
Limb shapes
2. Conical: Matured limb
3. Cylindrical
1. What type of socket is good for pediatrics
2. Ply #
2. 2-3 ply
Primary lymphedema
1. What is it?
2-5. 4 Malformations
6. Where is it normally found
1. Malformation of the lymphatic system
2. Hypoplasia: Reduced # of collectors
3. Hyperplasia: Increased collector diameter causes insufficient pump; reflux
4. Aplasia: Absence of capillaries or nodes in a certain area
5. Inguinal Lymph Node Fibrosis: Kinmonth syndrome, which affects lymph transport through nodes
6. In the LEs
CDT
1. 4 tenets
2-3. 2 stages
1. Compression, manual draining, skin care, exercise
2. Intensive Phase (1): Daily sessions include all 4 components, Goal: Decongest the involved extremity
3. Improvement Phase (2): Improve & maintain phase 1, Day & night garments
Exercise
1. Light or heavy
2. __ min, __x/day
3. Wear compression?
4. Strenuous activity
-10-15 minutes, 2x/day
-Yes
-No
1. How long until staples come out?
2. How long do you wear the shrinker?
3. Wear __ to casting apt
1. 4 weeks
2. 7-10 days
3. Liner
Suspension
1. Cushion
2. Locking: Pin (mature limb), Lanyard (better for new AK's)
Secondary lymphedema
1. What is it?
2. What are some examples?
1. Known insult/injury to the lymphatic system
2. Lymph disection, radiation, trauma, infection, self-induced
3. Lymphatic filariasis (3rd world countries) (worms feed on protein)
4. Malignant lymphedema
5. Stewart treves syndrome
6. Malignant lymphangiosis (looks like cellulitis)
7. A lot more
MLD
1. What is the purpose?
2. __ local sympathetic & general parasympathetic response
3. __ lymph production
4. __ venous return
Extra:
-Analgesia
1. To improve the activity of lymph vessels (re-routes)
2. Increases
3. Increases
4. Increases
ABI
1. What does it stand for?
2. Must align to at least __ to provide compression
1. Ankle brachial index
2. 0.8
1. Wear schedule
2. Redness
3. Follow up?
1. 20-30 minutes wear & double every day, By the first week should be wearing 6-7 hrs/day
2. Red ring on the thigh is normal
3. Follow up the following week
Application Order
(dont quote me on this, idrk what it is)
Sock > Liner > Socket