At WVU Medicine Rehabilitation Services, lymphedema therapists conduct evaluations and treat patients for lymphedema.

We also use lymphedema treatments for other types of edema including:

  • Chronic venous insufficiency (CVI)
  • Vascular issues – deep vein thrombosis (DVT)
  • Dynamic edema from cardiac issues
  • Infections such as cellulitis

What is Lymphedema?

The lymphatic system is a network of vessels and ducts that return water, proteins, fats, bacteria/viruses, and wastes from your cells to the lymph nodes where they are filtered and sent to be removed from your body. The system is crucial to keeping your body healthy.

Lymphedema is a chronic condition where swelling occurs in body tissue. The swelling occurs when the lymphatic system has been blocked, damaged, or is underdeveloped and prevents the lymph fluid from draining properly. It often occurs in the arms or legs but can also occur in the chest, trunk, and head/neck.

Left untreated, swelling may increase and worsen, skin may become unhealthy, infections can occur, and wounds may have difficulty healing, and decreased movement and functional use may result.

The most common causes are: cancer, lymph vessel blockage, and removal or damage from cancer treatments, such as radiation and surgery. Other causes may be trauma/injuries, surgeries, recurrent infections, and chronic venous insufficiency.

 

Types of lymphedema

Primary – the lymph vessels are often absent, smaller, or dysfunctional; occurs without any obvious causes; may be present at birth or occur later in life. It is more common in legs.

Secondary – often caused by surgical removal of lymph nodes in cancer treatment; can also be caused by infections, radiation treatment, trauma, scar tissue, and medical conditions, such as chronic venous insufficiency. The major causes are from cancer and its treatment, such as the removal of axillary lymph nodes and radiation to treat breast cancer. As many as 15-30% of breast cancer patients are at risk for developing lymphedema.

Symptoms of lymphedema

  • Noticeable swelling of a body part – often an arm, leg, or chest/trunk area
  • Condition worsens over time
  • Heaviness, denseness, or aching in the swollen body part
  • Decreased movement or range of motion in the body part
  • A feeling of “fullness” in the swollen body part
  • Thickening and hardening of the skin
  • Leakage of fluid from swollen body part
  • In some cases, massive swelling and skin changes called elephantitis.

 

Treatment

Lymphedema can be treated very successfully by a qualified lymphedema therapist. The standard treatment is called combined decongestive therapy (CDT) and consists of:

Manual lymph drainage (MLD) – a light massage technique that stimulates the lymph system and helps the flow of lymph fluid from congested areas to healthy areas that can pick up extra fluid. MLD also helps soften hardened skin and increases the health of the skin and tissue.

Compression bandages- low-stretch bandages are applied to the affected area to provide a gradient compression that encourages fluid out of the area to decrease the swelling. The bandages must be worn at all times (except for bathing) in the treatment phase to be effective in decreasing the swelling. After the body part is down to normal or close to normal size, the patient can be fitted with appropriate compression garments that replace the bandages, support the body part, and prevent swelling from returning.

Exercise/breathing programs – the patient is encouraged to perform gentle exercises and deep breathing techniques to help stimulate low lymph flow and maintain/increase range of motion and functional movement.

Skin care – good skin care practices are very important to maintain healthy skin and prevent infections

Management – skills are learned through treatment to help patients manage and keep lymphedema under control in a home program with the use of compression stockings/garments, skin care, exercises, and task modification.

Prevention and keeping lymphedema under control

General Guidelines

  • Avoid extreme temperature changes, such as hot bath/showers, hot tubs, saunas, sunburns, and traveling to hot/cold climates. Use sunscreen, even under compression garments.
  • Avoid skin infections. Possible sources of infections include: insect bites, pet scratches, cuts, punctures, and manicures/pedicures.
  • Avoid injections, blood draws, or a blood pressure check in the affected limb.
  • Avoid putting extra pressure or stress on the affected area. Use caution when lifting heavy objects. Do not wear tight clothing or jewelry. Wear gloves when doing housework or gardening.
  • Avoid salty, fried foods. Maintain a healthy weight.
  • Keep skin clean and dry. Use hypoallergenic soap and deodorant. Use care when cutting fingernails/toenails.
  • Get regular exercise.  Ask your therapist for recommendations.
  • Seek medical treatment for swelling or signs of infection.
  • Wear compression garments or bandages as directed. This may include when traveling by airplane.

Visit these websites to learn more about lymphedema:-