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Lymphedema

Definition


Disease: Lymphedema Lymphedema
Category: Other Diseases

Disease Definition:

The swelling that usually occurs in the arms or legs is called lymphedema. Even though lymphedema could affect both of the arms or both of the legs, it could also affect only one arm or leg.

In case a blockage occurs in someone’s lymphatic system that prevents the lymph fluid in the arm or leg from draining adequately, swelling occurs. This swelling will continue as the fluid accumulates.

Even though lymphedema could be controlled, it can't be cured. Diligent care of the affected limb is involved in controlling lymphedema.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

The swelling that occurs in lymphedema could be either mild (hardly noticeable changes in the size of the limb), or it could be so severe that using the affected arm or leg could be impossible.

Some of the signs and symptoms of lymphedema may include:

 

  • Restricted range of motion in the affected arm or leg
  • Hardening and thickening of the skin on the affected arm or leg
  • A feeling of heaviness or tightness in the affected arm or leg
  • Recurring infections in the affected limb
  • Swelling of part of the arm or the entire arm or leg, including the fingers and toes
  • Aching or discomfort in the arm or leg

Causes:

Lymphatic system is crucial to keeping the body healthy. It collects bacteria, viruses and waste products by circulating protein-rich lymph fluid throughout the body. The lymphatic system carries these through the lymph vessels, leading to lymph nodes. The wastes are eventually flushed from the body after being filtered out by lymphocytes, which are the infection-fighting cells that live in the lymph nodes.
In case someone’s lymph vessels are not able to drain lymph fluid from their arm or leg adequately, lymphedema occurs. Lymphedema could either occur on its own (primary lymphedema), or it could be caused by another condition or disease (secondary lymphedema).

CAUSES OF PRIMARY LYMPHEDEMA:
Primary lymphedema is caused by problems with the development of lymph vessels in the body. It is a rare and inherited condition. Affecting the legs rather than the arms, primary lymphedema occurs more commonly in women. Some of its causes may be:

Meige disease:
Also called lymphedema praecox, this condition causes lymphedema in childhood or around puberty. This inherited disease causes the forming of the lymph vessels without the valves that keep the lymph fluid from flowing backwards. A thing will make it difficult for the body to drain the lymph fluid from the limbs in a proper way.

Milroy disease:
Also called congenital lymphedema, this inherited condition causes a malformation of the lymph nodes, which leads to lymphedema.

Late-onset lymphedema:
Also called lymphedema tarda, this rare condition occurs after the age of 35.

CAUSES OF SECONDARY LYMPHEDEMA:
Lymphedema could be caused by any condition or procedure that damages the lymph nodes or lymph vessels, such as:

Infection:
Lymphedema could be caused by an infection that infiltrates the lymph vessels and lymph nodes, restricting the flow of the lymph fluid. In the tropical and subtropical regions of the globe, infection-related lymphedema is most common, and is more likely to occur in undeveloped countries. Parasites could also block lymph vessels and thus cause lymphedema.

Surgery:
In case someone’s lymph nodes and lymph vessels are removed or severed, surgery could cause lymphedema. For example, one or more lymph nodes in the armpit may be removed during surgery for breast cancer to look for evidence that the cancer has spread. In this case, lymphedema could result in the arm if the remaining lymph nodes and lymph vessels can't compensate for those that have been removed.

Radiation treatment for cancer:
The flow of the lymph could be restricted in case radiation treatment for cancer causes scarring and inflammation of the lymph nodes or lymph vessels.

Injury:
Lymphedema could result in case an injury damages the lymph nodes or lymph vessels.

Cancer:
Lymphedema could be caused in case cancer cells block lymphatic vessels. For example, a tumor near a lymph node or lymph vessel could obstruct the flow of the lymph fluid if it grows large enough.

Complications

Complications:

Some serious complications could be caused by lymphedema, including:

Lymphangiosarcoma:
If a severe case of lymphedema is left untreated, this rare form of soft tissue cancer could result. This condition starts at the lymph nodes and lymph vessels.

Infections:
Infections, such as cellulitis and lymphangitis are more likely to occur in the arm or leg that has been affected by lymphedema. An infection could enter through any injury to the arm or leg.

Elephantiasis:
In case a person has difficulty moving their arm or leg because it is hardened with thickened skin, elephantiasis occurs. Elephantiasis could cause chronic ulcers and repeated infections because it makes the skin on the arm or leg very weak.

Treatments:

Treatment for lymphedema will aim at reducing the swelling and controlling the pain. Some of those treatments may include:

Wrapping the Arm or Leg:
The lymph fluid could flow back out of the affected limb and toward the trunk of the body in case bandages are wrapped around the entire limb. A limphedema therapist could show how to wrap the limb. The bandages should be wrapped tightest around the fingers and toes, and loosened a little as they move up the arm or leg.

Exercise:
The lymph fluid could move out of the limb by light exercises that require the patient to move the affected arm or leg. The doctor or physical therapist could teach the patient exercises that help pump the lymph fluid out of the affected limb. These exercises should focus on gentle contraction of the muscles in the arm or leg; they shouldn't be strenuous or tiring.

Compression Garments:
To encourage the flow of the lymph fluid out of the affected limb, compression garments could be worn, such as long sleeves or stockings. To prevent the limb from swelling in the future, the patient may be recommended wearing compression garments after they’ve reduced swelling in the arm or leg via other measures. A person should get professional help to obtain a compression garment that fits correctly. In case they don't find any, they can have them custom-made.

Massage:
The flow of lymph fluid out of the arm or leg could be encouraged by a special massage technique called manual lymph drainage. To gently move the lymph fluid to healthy lymph nodes where it can drain, special hand strokes are involved in this technique. However, not everyone could use this technique. The patient should avoid massage on the areas of the body that have received radiation therapy. Additionally, in case someone has blood clots, a skin infection, congestive heart failure or an active cancer, they should avoid massage altogether.

Pneumatic Compression:
If someone chooses this treatment, they will wear a sleeve that is connected to a pump that intermittently inflates the sleeve and puts pressure on the affected limb. This inflated sleeve will reduce the swelling in the arm or leg by moving the lymph fluid away from the fingers or toes.
Someone may be recommended surgery to remove excess tissue in their arm or leg in case lymphedema is severe. However, surgery can't cure lymphedema; it can only reduce severe swelling because as mentioned before, lymphedema has no cure.

Prognosis:

Not Available

Expert's opinion

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