Meet Our Team: Jessica Mitchell, PT, DPT, CLT, Doctor of Physical Therapy, Certified Lymphedema Therapist; Kelly Raquet, PT, DPT, CLT, Doctor of Physical Therapy, Certified Lymphedema Therapist; Samantha McGuire, PT, DPT, CLT, Doctor of Physical Therapy, Certified Lymphedema Therapist.
Lymphedema refers to swelling that generally occurs in one of your arms or legs. Sometimes both arms or both legs swell.
Lymphedema is most commonly caused by the removal of or damage to your lymph nodes as a part of cancer treatment. It results from a blockage in your lymphatic system, which is part of your immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling.
Jessica Mitchell, PT, DPT, CLT, Doctor of Physical Therapy, Certified Lymphedema Therapist
Signs and Symptoms
Jessica Mitchell, PT, DPT, CLT, Doctor of Physical Therapy, Certified Lymphedema Therapist
Lymphedema signs and symptoms, which occur in your affected arm or leg, include:
- Swelling of part or all of your arm or leg, including fingers or toes
- A feeling of heaviness or tightness
-
Restricted range of motion
- Aching or discomfort
-
Recurring infections
Hardening and thickening of the skin (fibrosis)
The swelling caused by lymphedema ranges from mild, hardly noticeable changes in the size of your arm or leg to extreme changes that make the limb hard to use. Lymphedema caused by cancer treatment may not occur until months or years after treatment.
What Causes Lymphedema?
Your lymphatic system is crucial to keeping your body healthy. It circulates protein-rich lymph fluid throughout your body, collecting bacteria, viruses and waste products. Your lymphatic system carries this fluid and harmful substances through your lymph vessels, which lead to lymph nodes. The wastes are then filtered out by lymphocytes — infection-fighting cells that live in your lymph nodes — and ultimately flushed from your body.
Lymphedema occurs when your lymph vessels are unable to adequately drain lymph fluid, usually from an arm or leg. Lymphedema can be either primary or secondary. This means it can occur on its own (primary lymphedema), or it can be caused by another disease or condition (secondary lymphedema). Secondary lymphedema is far more common than primary lymphedema.
Why are breast cancer survivors at risk for lymphedema?
Kelly Raquet, PT, DPT, CLT, Doctor of Physical Therapy, Certified Lymphedema Therapist
Causes include:
- Surgery. Removal of or injury to lymph nodes and lymph vessels may result in lymphedema. For example, lymph nodes may be removed to check for spread of breast cancer, and lymph nodes may be injured in surgery that involves blood vessels in your limbs.
- Radiation treatment for cancer. Radiation can cause scarring and inflammation of your lymph nodes or lymph vessels.
- Cancer. If cancer cells block lymphatic vessels, lymphedema may result. For instance, a tumor growing near a lymph node or lymph vessel could enlarge enough to block the flow of the lymph fluid.
- Infection. An infection of the lymph nodes or parasites can restrict the flow of lymph fluid. Infection-related lymphedema is most common in tropical and subtropical regions and is more likely to occur in developing countries.
Causes of primary lymphedema
Primary lymphedema is a rare, inherited condition caused by problems with the development of lymph vessels in your body.
Early-stage lymphedema can be treated with nonsurgical interventions, including physical therapy, medication, a healthy diet and manual compression. Treatment focuses on reducing the swelling and controlling the pain.
Samantha McGuire, PT, DPT, CLT, Doctor of Physical Therapy, Certified Lymphedema Therapist
Lymphedema treatments include:
- Exercises. Light exercises in which you move your affected limb may encourage lymph fluid drainage and help prepare you for everyday tasks, such as carrying groceries. Exercises shouldn't be strenuous or tire you but should focus on gentle contraction of the muscles in your arm or leg. A certified lymphedema therapist can teach you exercises that may help.
- Wrapping your arm or leg. Bandaging your entire limb encourages lymph fluid to flow back toward the trunk of your body. The bandage should be tightest around your fingers or toes and loosen as it moves up your arm or leg. A lymphedema therapist can show you how to wrap your limb.
- Massage. A special massage technique called manual lymph drainage may encourage the flow of lymph fluid out of your arm or leg. And various massage treatments may benefit people with active cancer. Be sure to work with someone specially trained in these techniques.
Avoid massage if you have a skin infection, blood clots or active disease in the involved lymph drainage areas.
- Pneumatic compression. A sleeve worn over your affected arm or leg connects to a pump that intermittently inflates the sleeve, putting pressure on your limb and moving lymph fluid away from your fingers or toes.
- Compression garments. Long sleeves or stockings made to compress your arm or leg encourage the flow of the lymph fluid out of your affected limb. Wear a compression garment when exercising the affected limb.
- Complete decongestive therapy (CDT). This approach involves combining therapies with lifestyle changes. Generally, CDT isn't recommended for people who have high blood pressure, diabetes, paralysis, heart failure, blood clots or acute infections.
- In cases of severe lymphedema, your doctor may consider surgery to remove excess tissue in your arm or leg to reduce swelling. There are also newer techniques for surgery that might be appropriate, such as lymphatic to venous anastomosis or lymph node transplants.
Unique ROSE (Restoring Optimal Strength and Energy) Program