This page has been updated, please
see the page below for updated and complete information as of Jan. 14, 2012:
arm lymphedema is a
secondary condition caused by removal of lymph nodes for cancer biopsy
to thelymphatics from radiation. Other causes can include
infections, injury or trauma.
often overlooked and
seldom mention is that you can also have primary lymphedema
of the arm.
dynamics of arm lymphedema
are the same as leg lymphedema. A damaged lymphatic system is
remove lymph fluids adequately and the fluid begins to collect in the
interstitial tissues. This causes swelling of the affected
Factors for arm
Who is at risk for lymphedema?
Anyone who has one or more of the following factors can acquire
1.) Lymph node removal for
2.) Serious infections that
include lymphangitis, cellulitis or erysipelas.
3.) Deep invasive wounds that
might tear, cut or damage the lymphatics
4.) Radiation treatments,
especially ones that are focused in areas that might contain
"clusters" of lymph nodes
5.) Morbid obesity can cause
secondary lymphedema by "crushing" the lymphatics
6.) Serious burns, even
7.) Infection of the
microscopic parasite filarial larvae, though this is more common in
8.) For primary lymphedema
any person who has a family history of unknown swelling of a limb
Early Signs and
symptoms of arm Lymphedema
If you are an at
risk person for arm lymphedema there are early warning signs you should
of. If you experience any or several of these symptoms, you
immediately make your physcian aware of them.
Unexplained aching, hurting or pain in the arm
Experiencing "fleeting lymphedema." This is where the limb
swell, even slightly, then return to normal. This may be a
full blown arm lymphedema.
swelling of any area. Sometimes lymphedema may start as
swelling in one
area, for example the hand, or between the elbow and hand.
This is an
indication of early lymphatic malfunction.
4.) Any arm
inflammation, redness or infection.
5.) You may
experience a feeling of tightness, heaviness or weakness of the arm.
of arm lymphedema:
1. Infections such as cellulitis, lymphangitis, erysipelas.
This is due
not only to the large accumulation of fluid, but it is well documented
lymphodemous limbs are localized immuno-deficient.
2. Draining wounds that leak lymphorrea which is very caustic
surrounding skin tissue and acts as a port of entry for infections.
3. Increased pain as a result of the compression of nerves
by the development of fibrosis and increased build up of fluids.
4. Loss of Function due to the swelling and limb changes.
5. Depression - Psychological coping as a result of the
debilitating effect of lymphedema.
6. Deep venous thrombosis again as a result of the pressure
swelling and fibrosis against the vascular system. Also, can happen as
of cellulitis, lymphangitis and infections.
7. Sepsis, Gangrene are possibilities as a result of the
8. Possible amputation of the limb.
9. Pleural effusions may result if the lymphatics in the
abdomen or chest
are to overwhelmed to clear the lung cavity of fluids.
10. Skin complications such as splitting, plaques, susceptibility to
11. Chronic localized inflammations.
Angiosarcoma, a cancer of the soft tissues
Lymphangiosarcoma which is a rapidly progressive, non curable cancer of
Lymphoma, new research indicates a possibility of this with hereditary
lymphedema. I have been diagnosed with two forms of lymphoma.
of arm lymphedema
are three basic stages active of
lymphedema. The earlier lymphedema is recognized and diagnosed, the
easier it is
to successful treat it and to avoid many of the complications.
It is important as well to be aware that when you have lymphedema, even
limb there is always the possibility of another limb being affected at
later time. This "inactive" period referred to as the latency stage.
It is associated with hereditary forms of lymphedema.
Lymphatic transport capacity is reduced
No visible/palpable edema
Subjective complaints are possible
Accumulation of protein rich edema fluid
Reduces with elevation (no fibrosis)
Accumulation of protein rich edema fluid
Pitting becomes progressively more difficult
Connective tissue proliferation (fibrosis)
Accumulation of protein rich edema fluid
Fibrosis and sclerosis (severe induration)
Skin changes (papillomas, hyperkeratosis, etc.)
Treatment of Arm Lymphedema
treatment for arm lymphedema is much
the same as treatment for leg lymphedema. The preferred
decongestive therapy. However, with arm lymphedema, it has
been shown that
a treatment protocol including sequential pump therapy with
decongestive therapy has obtained the best results.
the course of treatment, the arm
will be wrapped in compression bandages after the treatment
completion of the treatment, compression sleeves and arm garments will
Blood Tests, Blood Pressure, I.V. or Injections into this Arm!
By Pat O'Connor, Lymphedema People
Nov 1, 2004
Perhaps the foremost rationale for NOT allowing the use of needles in
with lymphedema is the threat of infection. Every break of the skin
potential entry foci for bacteria. Because of the immunodeficient state
arm any infection can and often does escalate quickly into
These infections cause further damage to the lymphatics, thereby
severity of the lymphedema.
(which is the fluid in
the arm) is a protein-rich substance that provides excellent nutrition
bacteria that might gain a foot hold in the arm. Once an infection has
excess fluid and any fibrosis of the arm tissue makes it tremendously
difficult to eradicate the bacteria.
The doseage strength of any medicine injected into the arm will be
for two reasons. First, because of the fluid accumulation in
the arm it is
going to be immediately diluted. Following that, because of the
outflow of the arm, the medicine will have a more difficult time
remainder of the body system.
The first reason for not allowing an IV is simply the break in the skin
would be a continous opening until the removal of the IV. Beyond that
more important is the simple fact that lymphedema is caused by the
the arm to remove even the normal excess fluids of body dynamics. When
the fluids that are present in the administration of an IV, you
overload the arm. It simply is totally unable to rid itself
of that extra
fluid thereby causing a substantial increase in swelling.
Blood Pressure Tests
The danger of having a blood pressure test on
an at-risk arm or an
arm affected by lymphedema is that the squeeezing
involved can cause
possible further damage to already fragile lymphatics and blood
vessels. If this
occurs, it would cause worsening of the lymphedema.
are common sense approaches
that any physcian should be immediately aware of.
information, check out the Canadian Medical Association Journal at
Arm Exercises That Can Help Prevent/Manage Lymphedema
light exercise after breast cancer surgery and lymph node removal can
help reduce the chances of lymphedema, patients should discuss how and
begin arm exercises. Some patients find that taking painkillers
minutes prior to exercising helps alleviate discomfort, although all
should be approved by the patient’s physician.
following are suggestions
of exercises following breast cancer surgery from the Wessex
Cancer Trust, an independent charity that
provides information and
support to patients with cancer. Each exercise may be performed five
times in a
row, three times a day (morning, afternoon, evening) with the
palms up and elbows straight, stretch arms high above head, linking
- Bend elbows and clasp hands at the back of the neck. Push
elbows out as far as possible and then bring them together to touch in
front of the body. Repeat.
- Place hands behind the back and lace fingers together.
Slide hands as far as possible up the body toward the neck.
- Place hands on shoulders (on the same side of the body) and
move elbows up and then down toward the sides of the body.
- Place hands on shoulders and make circular movements with
the elbows. Circles should be as large as possible. Change directions
- After breast stitches have been removed, stand with one
foot in front of the other. Hold on to a chair or table. Lean forward
and swing the arm that was involved in the surgery backwards and
forwards, and then from side to side as far as it will go. Hold a small
weight to gain momentum. Increase movement until arm reaches shoulder
height. Keep elbows straight.
- Stand with one foot in front of one another. Hold onto a
chair or table for support. Lean forward and swing the arm on the side
of the surgery in circles, first clockwise and then counter-clockwise.
Keep elbows straight.
- Face toward a wall. Place hands on the wall and inch
fingers up the wall. Try to go higher each day until arms are fully
straight over head.
Lymphedema Arm Self Massage
You can do a simplified version of MLD yourself at home,
called simple lymphatic drainage (SLD). SLD is done by using your
fingers very gently to move the skin in a particular direction. If you
find that the skin is red when you have finished, then the movement is
too hard. It is often easier if your partner or a friend also learns
the technique, so that they can help you in any areas you cannot reach.
Your physiotherapist or nurse will be able to show you or your partner
the technique. The diagrams and explanations on the following pages
should also help.
Massage 1 - for both arm
and leg swelling
- Place your fingers, relaxed, on either side of your neck at
- Gently move the skin in a downwards direction, towards the
back of your neck.
- Repeat 10 times at position 1, 2 and 3.
- At position 4 (on the top of your shoulder) use a gentle
inward scooping movement down towards the top of your breast bone
(where the collarbones meet)
- Repeat 5 times.
Massage 2 - for swelling
of one arm
The aim of this massage is to stimulate the lymph channels on
the trunk to clear the way ahead so excess fluid can drain away.
The skin is always moved towards the non-swollen side. You
will find it easier to start with one hand, and then swap to the other
as you move across the body.
- Starting in the armpit on the non-swollen side (position
1), use light pressure to gently stretch the skin up into the armpit.
Your hand should be flat and not slide over the skin. Repeat 10 times.
- Next, at position 2, use a light push to stretch the skin
towards the non-swollen side, with a slow and gentle rhythm. Repeat 5
- Repeat the same movements at position 3.
- Swap hands, and repeat the movements 5 more times at
position 3 with your other hand, as this position is very important for
lymphatic drainage. This time, the movement with your fingers is a
slight pull to move the skin to the non-swollen armpit.
- Repeat movements 5 times at position 4, then 5.
Hand-held massagers can be useful for people who have
restricted movement of their hands, perhaps due to arthritis. They are
available at most large chemists and some electrical shops. As with all
SLD techniques, a light touch is necessary. Massagers should never be
used to press down on the skin. If you do this, you will obstruct your
lymphatic channels and so the massage will not help lymph drainage.
Hand-held massagers can be quite heavy to hold so try to hold it in the
non-swollen hand. You may need your partner or a friend to help you.
Talk to your doctor or lymphoedema specialist before using a
massager. It can be used to apply gentle pressure in the same sequence
of movements as the exercises on the previous pages. Here are some
guidelines for using a hand-held massager:
- Use it for at least 15 minutes a day.
- Use the lowest setting and a dimpled head.
- Do not use oils or creams with the massager.
- Do not use the heat setting. If possible, get a massager
without a heat pad, as these are lighter and easier to use.
- Use a gentle, circular movement, following the sequences of
movement described earlier.
- Avoid massaging abnormal or broken skin.
Before and after SLD, breathing exercises can help to
stimulate lymphatic drainage. Use the following simple exercises:
- Sit in a comfortable chair or lie on your bed with your
knees slightly bent. Rest your hands on your abdomen.
- Take deep breaths to relax.
- As you breathe in -- direct the air down to your abdomen,
which you will feel rising under your hands.
- Breathe out slowly by `sighing' the air out. While
breathing out let your abdomen relax in again.
Do the deep breathing exercises five times and then have a
short rest before getting up.
Cancer BACUP UK
"One of the truely
most comprehensive and best sites I have seen."
the arm and hand
Preventing Arm Swelling
after Breast Cancer Surgery
Peer Review Status: Internally Reviewed by
Cancer Center Staff
First Published: September 2003
Last Revised: November 2003
Swelling of the arm on the side of your breast cancer surgery
can be due to
the lymph nodes under the arm being disturbed by surgery and partial
also to radiation of the armpit.
After an injury anywhere in the body, lymph fluid will rush to
site to carry away bacteria and any foreign substances. If that injured
a hand or arm on the side of armpit surgery and radiation, the lymph
have a harder time being absorbed back normally because surgery has
of the channels that would have carried the fluid. Radiation has closed
some of those lymph channels also. Since surgery and radiation were
treatments, the focus now should be on preventing injury and stress to
affected hand, shoulder and arm to lessen the chance of lymph fluid
swelling of the arm. If you are a person who has had armpit surgery to
lymph nodes for cancer cells, or if you have received radiation to the
you may want to consider ways to prevent arm swelling.
- Treat even small injuries/hangnails with care. Wash the
injury with soap and water, apply antibiotic ointment, then cover with
- Keep skin of the hand and arm clean and moisturized. Apply
moisturizing lotion several times a day.
- Do not have blood drawn from the affected arm, unless
- Wear long oven mitts whenever putting hands in an oven.
Have someone else get dishes out of the oven when feasible.
- Carefully cook foods in oil to avoid splashing of hot
grease onto hands.
- Use rubber gloves when doing cleaning with harsh cleaners.
- Wear rubber gloves when doing dishes.
- Wear canvas gloves while gardening and doing yard work.
- Wear a thimble while sewing.
- Shave underarms with an electric razor. Avoid chemical hair
- Use insect repellant to protect against bug bites or bee
- Avoid sunburn by using sunscreen with SPF of at least 15.
Reapply sunscreen after swimming and as directed on the sunscreen
- Don't allow injections, vaccinations on the affected arm.
- Do not have manicures on the affected hand. Do not cut
cuticles or hangnails.
- Don't hold a cigarette in the affected hand.
- Avoid clothing with elastic sleeve bands or with tight
- Don't wear a watch or rings on affected arm.
- Avoid carrying a heavy purse or bag with the affected arm.
- Have blood pressure taken on the unaffected arm, if
- Underclothing, such as bras, should not leave pressure
- When traveling in a car or plane for long distances, keep
the affected arm above the level of the heart, if at all possible.
Avoid Muscle Strain
- Avoid heavy lifting if your muscles are not used to heavy
- Avoid vigorous, repetitive movements such as scrubbing,
- Sports such as tennis, racquetball and golf have the
potential to strain muscles because of sudden and forceful strokes.
- Begin any new exercise/activity involving the arms
gradually and with caution.
LYMPHEDEMA OF THE ARM AND
WHAT IS LYMPHEDEMA?
Lymph - obligatory load--
|an accumulation of lymph fluid
consists of lymph and other matter
consists of fluids (water) + plasma proteins (albumin) debris cells
(cells) + foreign matter + long chained fatty acids (fats)
2. WHAT CAUSES LYMPHEDEMA?
CAN LYMPHEDMA GET
The standard treatment for breast
cancer is the partial or
total resection (removal) of the breast with either a partial or total
and/or radiation of the underarm lymph nodes.
PERCENT TO 50 PERCENT OF PATIENTS
ARM LYMPHEDEMA" OR "SECONDARY CHEST LYMPHEDEMA:"
The anatomy of the lymphatic
system provides an explanatiion
of what causes lymphedema following surgical treatment or radiation
The removal of the axillary or
underarm lymph nodes brings
about a disruption of the superficial and deeper lymph drainage
pathways of the
arm and the body quadrant on that side. This results in a
predisposition to or
the immediate formation of a condition of lymphedema on that side.
lymphedema of the arm or body
after mastectomy is not life-threate- ning, it is according to
"...often the source of considerable physical and mental discomfort and
occasionally even disabling."
If left untreated, lymphedema will
become worse with time.
There is a hardening of tissues as fibrosis or slerosis occurs.
lymphedema of the arm that remains untreated can turn into a form of
practice guidelines for
the care and treatment of breast cancer: 11. Lymphedema
- JANUARY 23, 2001
R. Harris, Maria
R. Hugi, Ivo A. Olivotto, Mark
Levine and The
Steering Committee for Clinical Practice Guidelines for the Care and
of Breast Cancer
Harris is Professor in the
School of Rehabilitation Sciences, Faculty of Medicine, University of
Columbia, Vancouver, BC; Dr. Hugi is with Providence Health Care,
Dr. Olivotto is Clinical Professor in the Division of Radiation
Cancer Agency-Vancouver Island Cancer Centre and the University of
Columbia, Victoria, BC; and Dr. Levine is with the Cancer Care Ontario
Regional Cancer Centre, and the Departments of Medicine and of Clinical
Epidemiology and Biostatistics, McMaster University, and is the Buffett
Chair in Breast Cancer Research, McMaster University, Hamilton, Ont.*The
steering committee is part of Health Canada's Canadian Breast Cancer
A list of committee members appears in Appendix
Objective: To provide information and
recommendations for women and
their physicians when making decisions about the management of
lymphedema related to breast cancer.
Options: Compression garments, pneumatic
compression pumps, massage
and physical therapies, other physical therapy modalities, pharmaceutical
Outcomes: Symptom control, quality of life,
Evidence: Systematic review of
English-language literature retrieved
primarily from MEDLINE (1966 to April 2000) and CANCERLIT
April 2000). Nonsystematic review of breast cancer literature
to October 2000.
Recommendations: · Pre- and postoperative
both arms are useful in the assessment and diagnosis of lymphedema.
measurements should be taken at 4 points: the metacarpal-phalangeal
joints, the wrists, 10 cm distal to the lateral
epicondyles and 15 cm
proximal to the lateral epicondyles. · Clinicians
symptoms of heaviness, tightness or swelling in
the affected arm. A
difference of more than 2.0 cm at any of the 4
measurement points may
warrant treatment of the lymphedema, provided
that tumour involvement
of the axilla or brachial plexus, infection and
thrombosis have been ruled out. · Practitioners
may want to
encourage long-term and consistent use of
compression garments by
women with lymphedema. · One randomized trial
has demonstrated a
trend in favour of pneumatic compression pumps compared with
treatment. Further randomized trials are required to determine
pneumatic compression provides additional benefit over compression
garments alone. · Complex physical therapy, also
decongestive physiotherapy, requires further evaluation
trials. In one randomized trial no difference
in outcomes was
detected between compression garments plus
manual lymph drainage
versus compression garments alone. · Clinical
encouraging patients to consider some practical
advice regarding skin
care, exercise and body weight. [A patient
version of these
guidelines appears in Appendix 2.]
Validation: An initial draft of this
document was developed by
a task force sponsored by the BC Cancer Agency. It was updated
revised substantially by a writing committee and then submitted
further review, revision and approval by the Steering Committee
Clinical Practice Guidelines for the Care and Treatment of
Sponsor: The steering committee was
convened by Health Canada.
Completion date: October 2000.
Lymphedema in women treated for breast cancer is an
protein-rich fluid in the arm that occurs when axillary lymphatic
from the arm is interrupted because of axillary lymph node
or axillary radiation, or both. Lymphedema remains a
with modern treatment modalities. Affected women can
swelling of the arm, tightness and heaviness in
the arm and recurrent
skin infections. Three stages of lymphedema have
Stage I presents with pitting and is considered
women with this stage have no increased arm
girth or heaviness and no
signs of pitting edema. As the edema
progresses, it becomes brawny,
fibrotic, nonpitting and irreversible (stage
II). In advanced
lymphedema (stage III), which rarely occurs
following breast cancer
treatments, cartilaginous hardening occurs,
outgrowths and hyperkeratosis of the skin. In
this guideline, we
provide an evidence-based approach to the
management of this
This guideline document is based on a systematic review of
literature retrieved from MEDLINE (1966 to April 2000) and
to April 2000). Medical subject headings used were "breast,"
neoplasms," "lymph node excision," "mastectomy" and
"lymphedema." Randomized controlled trials comparing
modalities would provide the strongest evidence for
treatments for lymphedema. However, given the lack of data from
studies, a broader strategy without limits set by methodological
search criteria was used. Review articles and textbook
also consulted, primarily to provide background
information and to
secure additional references. A nonsystematic
review of the breast
cancer literature to October 2000 also took
place. Rules of evidence
as described by Sackett4
were used for grading
the levels of experimental studies.
An initial draft of this guideline document was developed by
task force sponsored by the BC Cancer Agency that was convened
March 1997. The task force comprised physical therapists, breast
surgeons, radiation and medical oncologists, and breast cancer
patients living with lymphedema. The draft was reviewed by
practitioners and by representatives of the British Columbia
of Physicians and Surgeons, the Registered Nurses'
British Columbia, the College of Physical Therapists
Columbia and the British Columbia Council on
Guidelines. The Breast Tumour Group at the BC
Cancer Agency then
approved the guideline in October 1997. The
initial draft was updated
and revised substantially by a writing
committee and then submitted
for further review, revision and approval by
the Steering Committee
for Clinical Practice Guidelines for the Care
and Treatment of Breast
Cancer, sponsored by Health Canada
(INCLUDING EVIDENCE AND RATIONALE)
· Pre- and postoperative measurements of both arms
in the assessment and diagnosis of lymphedema. Circumferential
should be taken at 4 points: the metacarpal-phalangeal joints,
wrists, 10 cm distal to the lateral epicondyles and
15 cm proximal to
the lateral epicondyles.
There is no consistent operational definition of "clinically
lymphedema" in the literature. The lack of a consistent definition
leads to confusion regarding the incidence of lymphedema after
cancer treatment. The following criteria have been used
literature to measure lymphedema: absolute increase in
percentage increase in volume as determined by water
circumferential measurements and patient symptoms.5,6
Results of studies comparing differences in arm circumferences
volume differences are conflicting.7,8
In a recent study Megens8 reported
that both circumferential measurements and
volumetry in women with breast cancer had
excellent interrater and
test-retest reliability, although the 2 methods
had poor agreement
with each other.
Circumferential measurements are widely used because tape
readily available and because volumetric measurement is logistically
difficult. One common approach involves measuring the
of both arms at points 13 to15 cm proximal and
10 cm distal to the
lateral epicondyle of the humerus.9
greater than 2.0 cm at any point are defined by some
whereas others classify this degree of
lymphedema as mild.11,12
Other methods for assessing lymphedema,
MRI, CT scanning and ultrasound, are being
evaluated in research
· Clinicians should elicit symptoms of heaviness,
swelling in the affected arm. A difference of greater than 2.0
any of the 4 measurement points may warrant treatment of
lymphedema, provided that tumour involvement of the axilla or
brachial plexus, infection and axillary vein thrombosis have
Given the variation of criteria used to define lymphedema and
variety of assessment techniques, it is not surprising to see
variation in the reported incidence of lymphedema following breast
cancer treatment. Lymphedema rates of 6% to 70% among patients
breast cancer have been reported.5,14,15,16,17,18
Petrek and Heelan19
reported on the
incidence of lymphedema after breast cancer
treatment in a review of
7 studies published since 1990. These studies
were all retrospective,
differed in patient populations, used different
criteria to measure
lymphedema and had varying degrees of
follow-up. The incidence of
lymphedema ranged from 2% to 24%.
Transient lymphedema occurs in a number of patients following
dissection. In a study involving 282 women who underwent breast-conserving
surgery including axillary dissection, Werner and
reported that transient edema occurred in 21 (7%)
of the women and
persistent edema in 24 (12%). The median time
to development of
persistent edema was 14 months (range 2-92
Irradiation of the axilla increases the risk of lymphedema.
randomized controlled trial conducted in British Columbia, chemotherapy
alone was compared with chemotherapy plus regional radiation
in women with node-positive breast cancer after
The reported rate of lymphedema
was 9.1% among the irradiated subjects and 3.2% among those
received chemotherapy alone. Although the risk of lymphedema
with irradiation of the axilla, this risk is also influenced
extent of axillary dissection.21,22,23,24
Other factors that have been implicated in the development
extensive axillary disease22
and recurrent cancer in the axillary lymph
Chronic and severe lymphedema may very rarely give rise to
The incidence of this complication is rarely reported among
patients; in unselected patients the risk is less than
In a population-based Swedish study involving 122 991
for breast cancer between 1958 and 1992, angiosarcoma developed
only 35 women.26
However, 26 (74%) of the 35
women had lymphedema.
Before any type of lymphedema treatment is started, tumour
the axilla or brachial plexus, infection and axillary vein thrombosis
should be looked for and treated if present. The systematic
literature on the management of lymphedema was
limited by the lack of
prospective randomized trials evaluating different
· Practitioners may want to encourage long-term and
of compression garments by women with lymphedema.
Graded compression garments that deliver pressures of 20 to
Hg are the mainstay of lymphedema therapy and can be used as
Some clinicians recommend the use of a
compression garment for up to
24 hours per day, while others recommend its
use only during waking
hours or exercise.9,12,29,30,31,32
Compression garments may also protect the extremity from
as burns, lacerations and insect bites.
Collins and colleagues33
used CT scanning to
assess the effect of compression garment
therapy in 27 women with
unilateral lymphedema. They found significant
decreases in the
cross-sectional area of subcutaneous
compartments: the mean decrease
was 9% in the proximal portion and 26% in the
distal portion of the
limb (level V evidence).
In one of the few randomized controlled trials of lymphedema,
use of a compression sleeve plus electrically stimulated lymphatic
drainage was compared with the use of a compression sleeve
Both modalities reduced limb girth by 17%, which suggested
compression sleeve therapy alone is effective (level
Good compression garments can be custom-made or prefabricated,
ideally they should be fitted by trained personnel.12,34
Some sleeves start at the wrist and end at the upper arm.
the shoulder and fasten with a strap around the upper
compression gauntlet, especially one incorporating the
wrist, can be
used if the hand is swollen.1
should be replaced every 4 to 6 months, or when they begin
Patients may be noncompliant with using compression garments
the garments are unsightly, uncomfortable, difficult to
put on and
Customized, lightweight and
colourful garments may be an option for comfort
· One randomized trial has demonstrated a trend in
pneumatic compression pumps compared with no treatment. Further
trials are required to determine whether pneumatic compression
provides additional benefit over compression garments alone.
There has been only one randomized trial that has evaluated
compression pumps for the treatment of lymphedema. Dini
assigned 80 women with
postmastectomy lymphedema to either
compression or no treatment. Women in the
treatment group underwent a
2-week cycle of 5 pump sessions per week, each
session lasting 2
hours, followed by a 5-week break, and then
another 2-week treatment
cycle. Although the mean decrease in arm
circumference in the
treatment group was nearly 4 times that in the
control group (1.9 cm
v. 0.5 cm), the post-test differences between
the 2 groups failed
to reach statistical significance (p =
0.084), possibly because
of the small sample and the large variability in both the
measurements and the circumferential changes within each group
The experience with lymphedema pumps has also been reported
number of level V studies.36,37,38,39,40,41,42
The results have been mixed. These studies were
limited by their
small samples, mixed populations (arm and leg
edema), lack of control
groups and lack of outcome measures that
assessed symptoms such as
pain and heaviness. In one study pneumatic compression
reduction in lymphedema volume that was 18% greater than the
produced by elastic compression;41
study no difference was detected between
elastic compression and
No comparative studies have been published to determine the
effective pumping time, pressure levels or kind of pump. There
but not unanimous agreement,43
that sequential, multichambered pumps are more
monochambered pumps. The former produce a
linear pressure wave from
distal to proximal portions of the limb that
reduces the tendency of
fluid to collect in the hand. There are several commercially
pumps, ranging in complexity and cost. Most pumps used
clinics and consumers are complex and cost several
thousand dollars. Pump
therapy is contraindicated in the presence of
active infection or
deep vein thrombosis in the limb.
· Complex physical therapy, also called complex
requires further evaluation in randomized trials. In
trial no difference in outcomes was detected between
garments plus manual lymph drainage versus compression
Complex physical therapy, also called complex decongestive
is a treatment regimen that includes meticulous skin
lymph drainage, bandaging, exercises and support garments. Manual
lymph drainage is a massage technique that involves the skin
only and follows the anatomic lymphatic pathways of
the body. A
session of manual lymph drainage starts centrally in
the neck and
trunk to clear out the main lymphatic pathways, thereby
drainage from the arm.45,46,47
A recently published randomized trial involving 42 women with
stage I or II lymphedema compared standard therapy alone with
standard therapy plus manual lymph drainage and training in
self-massage (level I evidence).48
therapy included use of a custom-made
garment worn during the day, instruction in
education in skin care, and information and
lymphedema. Both groups obtained a significant
reduction in limb
volume, a decrease in discomfort and increased
joint mobility over
time. However, no significant differences in
objective measures of
change in arm volume or subjective measures of symptoms
lymphedema were found between the 2 groups.
In a cohort study involving 35 women, compression bandaging
manual lymph drainage was compared with compression bandaging
(level III evidence).49
There was a trend in
mean volume reduction and a statistically
between the 2 groups in the percentage
reduction in volume in favour
of the combined treatment. Symptoms did not differ
between the 2 groups. A number of case series have
reported on the
use of these modalities. Some reported alleviation
(level V evidence).50,51,52,53,54,55,56,57
However, interpretation of the results is limited by the
the studies. In another trial, manual lymph drainage plus compression
garment use was compared with sequential pneumatic compression
compression garment use; no difference was detected
treatment groups (level II evidence).58
another study, involving 6 months of compression garment use
women, no additional benefit was shown by adding electrically
stimulated lymphatic drainage or pneumatic pump therapy
Other physical therapy modalities, such as laser treatment,
stimulation, transcutaneous electrical nerve stimulation (TENS),
cryotherapy, microwave therapy and thermal therapy, have
for lymphedema in breast cancer patients (level V
However, these modalities need further, rigorous
recommendations can be made.
A 1993 Italian study compared ultrasonography and pump therapy
a monochambered pump.63
There was no
significant reduction in lymphedema with either
therapy. In fact,
therapeutic ultrasound to areas of potential
metastatic disease is
contraindicated. A randomized study involving
71 mice showed enhanced
tumour growth when high-intensity, continuous
ultrasound was applied
directly over the tumour.64
Low-intensity, continuous ultrasound and pulsed
increased tumour weight and volume, although
not as significantly as
ultrasound should not be used over areas of active or
breast cancer metastases, such as the hips, lumbar area,
wall or axillae.
Pain and discomfort associated with lymphedema are common66,67
and should be managed primarily by controlling the
pain can be managed with non-narcotic and narcotic analgesics,
the use of adjuvant analgesics (e.g., tricyclic antidepressants,
corticosteroids, anticonvulsants or local anesthetics) when
Aggravating conditions, such as
infection and recurrence of cancer in the
axillary lymph nodes or
brachial plexus, should be looked for and
Because of the psychological morbidity associated with
issues should be promptly recognized and addressed. Women
lymphedema have been shown to have greater psychiatric morbidity
greater functional disability.69,70,71,72
diuretics and benzopyrones
Surgery (e.g., microsurgical lymphovenous anastomoses, creation
a myocutaneous flap with latissimus dorsi muscle, omental transposition,
grafting of lymphatic vessels with tubes or threads) has
disappointing, inconsistent results and should be
Diuretics, which have been recommended in the
past, may temporarily
mobilize water, but the increased interstitial
exerted by the high protein concentration of
lymph fluid will cause
rapid recurrence of edema.3
The diuretic effect
in the rest of the body may cause adverse side effects, such
hypotension, dehydration and electrolyte imbalance.
Benzopyrones were promoted for use in lymphedema because they
felt to stimulate macrophage-induced proteolysis.79,80
Subsequently, a large randomized, placebo-controlled trial
a benzopyrone, in 140 women failed to show any benefit (level
These products are no longer
· Clinical experience supports encouraging patients
some practical advice regarding skin care, exercise and
The following suggestions make clinical sense to the authors
this guideline, even though the evidence that supports the suggestions
is limited and primarily anecdotal.
· Scrupulous skin care should be encouraged. Women should
cuts, pin pricks, hangnails, insect bites, contact allergens
irritants, pet scratches and burns to the affected extremity.
possible patients should avoid medical procedures such as
vaccination, blood drawing, intravenous access, blood pressure
acupuncture, venography and lymphangiography in the
· Lymphedema may be exacerbated if women use saunas,
or hot tubs, spend time in hot climates or travel. Many
report worsening of their lymphedema during flight,12,82
which suggests that patients who use compression sleeves
use them during air travel.
· Exercise involving the affected arm may be beneficial
controlling lymphedema. Although some clinicians have recommended
of rowing, tennis, golf, skiing, squash, racquetball or
repetitive movements against resistance, there is
evidence to suggest that these activities promote or
lymphedema. No exacerbation of existing lymphedema or
new cases of lymphedema occurred in 20 women with
breast cancer who
competed in the strenuous sport of dragon boat
Some experts have recommended that women with lymphedema
compression sleeve during arm exercises.30
· Maintenance of ideal body weight should be encouraged.
is a contributing factor for the development of lymphedema10,21
and may limit the effectiveness of compression pumps or
· Skin infection, which is often streptococcal, or on
occasions staphylococcal, should be promptly treated with antibiotics
such as a penicillin, a cephalosporin or a macrolide.83,84,85,86,87
For recurrent infections, prophylaxis with oral antibiotics
monthly injections of penicillin should be considered.87
It may be prudent to provide the patient who has recurrent
with an emergency home supply of an antistreptococcal
be taken at the first sign of infection. A patient travelling
remote area should be encouraged to take along a supply of
The management of lymphedema in breast cancer patients is based
on results from case studies, clinical experience and
information. The natural history and most effective therapies
lymphedema are poorly understood and need further study.
assessment requires agreement on a standardized and
Randomized controlled trials
to answer these questions should be encouraged and funded whenever
patient version of these guidelines
appears in Appendix 2.
article has been peer reviewed.
There are 4 principal authors of this guideline article.
The Steering Committee for Clinical Practice Guidelines for
and Management of Breast Cancer provided scientific and
comments, which led to multiple revisions of the manuscript.
interests: None declared.
requests to: Dr. Mark Levine, c/o Ms. Humaira Khan,
of Health Sciences, McMaster University Health Sciences Centre,
2C6, 1200 Main St. W, Hamilton ON L8N 3Z5; fax 905 577-0017
associated with the development of
arm lymphedema following breast cancer treatment: a match pair
Johansson K, Ohlsson K, Ingvar C, Albertsson M, Ekdahl C.
Department of Physical Therapy, Lund University, Sweden.
We examined factors that may influence the development of arm
following breast cancer treatment including the specific mode of
patient occupation and life style. Medical record data and a
used to collect information after surgery concerning such issues as
infection, adjuvant treatment, vessel string (phlebitis), body mass
smoking habits and stress. Occupational workload was assessed after
whereas housework, exercise, hobbies and body weight were assessed both
and after surgery. Seventy-one breast cancer treated women with arm
lasting more than 6 months but less than 2 years were matched to women
treated for breast cancer but without arm lymphedema (controls). The
factors included axillary node status, time after axillary dissection,
In the lymphedema group, there was a higher body mass index at time of
(p=0.03) as well at time of study (p=0.04). No differences were found
occupational workload (n=38) or housework, but the lymphedema group
their spare time activities including exercise after surgery compared
controls (p<0.01). In conclusion, women treated for breast
axillary node dissection with or without adjuvant radiotherapy could
their level of physical activity and occupational workload after
without an added risk of developing arm lymphedema. On the other hand,
BMI before and after operation increases the lymphedema risk.
PMID: 12081053 [PubMed - indexed for MEDLINE]
compression bandaging with or
without manual lymph drainage treatment in patients with postoperative
Johansson K, Albertsson M, Ingvar C, Ekdahl C.
Department of Physical Therapy, Lund University Hospital, Sweden.
We examined the effects of low stretch compression bandaging (CB) alone
combination with manual lymph drainage (MLD) in 38 female patients with
lymphedema after treatment for breast cancer. After CB therapy for 2
I), the patients were allocated to either CB or CB + MLD for 1 week
Arm volume and subjective assessments of pain, heaviness and tension
measured. The mean lymphedema volume reduction for the total group
during Part I
was 188 ml (p < 0.001), a mean reduction of 26% (p <
0.001). During Part
II the volume reduction in the CB + MLD group was 47 ml (p <
0.001) and in CB
group 20 ml. These differences were not significant (p = 0.07). A
reduction of 11% (p < 0.001) in the CB + MLD group and 4% in the
CB group was
significantly different (p = 0.04). In both the CB and the CB + MLD
decrease of feeling of heaviness (p < 0.006 and p <
and tension (p < 0.001 for both) in the arm was found, but only
the CB + MLD
group showed decreased pain (p < 0.03). Low stretch compression
an effective treatment giving volume reduction of slight or moderate
lymphedema in women treated for breast cancer. Manual lymph drainage
- Clinical Trial
- Controlled Clinical Trial
lymph node biopsy lowers the rate of
lymphedema when compared with standard axillary lymph node dissection.
Golshan M, Martin WJ, Dowlatshahi K.
Department of Surgery, Rush University, Rush Presbyterian St. Luke's
Center, Chicago, Illinois, USA.
Arm edema occurs in 20 to 30 per cent of patients who undergo axillary
node dissection (ALND) for carcinoma of the breast. Sentinel lymph node
in lieu of ALND for staging of breast cancer significantly lowers this
morbidity. We hypothesized that SLNB would have a lower lymphedema rate
conventional axillary dissection. Patients who underwent SLNB were
those who underwent level I and II axillary node dissection. A total of
patients were evaluated with 77 patients who underwent SLNB and 48
underwent ALND. The arm circumference 10 cm above and 10 cm below the
process was measured on both arms. In this series a difference in arm
circumference greater than 3 cm between the operated and nonoperated
defined as significant for lymphedema. Lymphedema was seen in two of 77
patients in the SLNB group as compared with 13 of 48 (27%) ALND
the above data patients who underwent sentinel lymph node biopsy show a
significantly lower rate of lymphedema than those who had axillary
dissection. This has an important impact on long-term postoperative
of patients with breast cancer.
PMID: 12678476 [PubMed - indexed for MEDLINE]
upper extremity exercise on
secondary lymphedema in breast cancer patients: a pilot study.
McKenzie DC, Kalda AL.
Division of Sports Medicine and School of Human Kinetics, University of
Columbia, Vancouver, British Columbia, Canada. firstname.lastname@example.org
PURPOSE: To examine the effect of a progressive upper-body exercise
lymphedema secondary to breast cancer treatment. METHODS: Fourteen
survivors with unilateral upper extremity lymphedema were randomly
an exercise (n = 7) or control group (n = 7). The exercise group
progressive, 8-week upper-body exercise program consisting of
training plus aerobic exercise using a Monark Rehab Trainer arm
Lymphedema was assessed by arm circumference and measurement of arm
water displacement. Patients were evaluated on five occasions over the
experimental period. The Medical Outcomes Trust Short-Form 36 Survey
was used to
measure quality of life before and after the intervention. Significance
at alpha < or = 0.01. RESULTS: No changes were found in arm
arm volume as a result of the exercise program. Three of the
domains showed trends toward increases in the exercise group: physical
functioning (P =.050), general health (P =.048), and vitality (P
health increased, although not significantly, for all subjects (P
volume measured by water displacement was correlated with calculated
(r =.973, P <.001), although the exercise and control group
significantly different (P <.001). CONCLUSIONS: Participation in
upper-body exercise program caused no changes in arm circumference or
in women with lymphedema after breast cancer, and they may have
increase in quality of life. Additional studies should be done in this
determine the optimum training program.
- Clinical Trial
- Randomized Controlled Trial
PMID: 12560436 [PubMed - indexed for MEDLINE]
A new method for
treatment of chronic lymphedema of the arm
after a radical mastectomy.
OF PLASTIC AND
Professor Henry Svensson,
Unit: Håkan Brorson,
+46 40 33 10 00 Fax:
+46 40 33 62 71
Lymph is produced as the result of
hydrostatic filtration of
blood in the smaller blood vessels. Normally lymph is removed from the
extracellular space via small lymph vessels and is then carried to the
glands. From these glands the lymph finally empties into the blood
At the time of a radical mastectomy, the axillary lymph glands are
prevent any spread of the cancer. Many of these patients develop
the arm due to the impaired lymph drainage, which is further
post-operative irradiation. The accumulating lymph and the thickened
subcutaneous fat leads to chronic lymphedema. After some time
fibrosis can develop. Common symptoms of chronic lymphedema are pain, a
of heaviness and decreased mobility of the arm.
Conservative therapies (manual lymph therapy according to Foldi,
garments), if used early, can remove the edema, but in long-standing
is not always possible. To date there has not been a surgical procedure
completely removes the edema after breast cancer treatment. At the
Plastic and Reconstructive Surgery, Malmˆ University Hospital, Malmˆ,
a new and unique method of complete removal of cronic lymphedema has
developed using a special liposuction technique. The edema and the
subcutaneous fat are removed via some 30 small incisions along the arm.
results in disappearance of pain and feeling of heaviness as well as an
increased mobility of the arm.
A prerequisite to the success after the operation is a vigilant use of
custom-made compression garment. This garment has to be used at all
lymphedema inevitably recurs.
We have operated on 85 patients to date using this technique. The mean
the lymphoedema was 1.9 liters. The edema reduction is complete, and no
recurrence of the edema has been seen at 10 years follow-up.
References:Brorson H, Svensson H. Complete
lymphoedema of the arm by liposuction after breast cancer. Scand J
Surg Hand Surg 1997; 31: 137-143.
Brorson H, Svensson H. Skin blood flow of the lymphedematous arm before
after liposuction. Lymphology 1997; 30: 165-172.
Brorson H, Svensson H. Liposuction reduces arm lymphedema without
altering the already impaired lymph transport. Lymphology 1998;
Brorson H, Svensson H. Liposuction combined with controlled compression
reduces arm lymphedema significantly better than controlled compression
alone. Plast Reconstr Surg 1998; 102: 1058-1067.
Thesis: Brorson, H. Liposuction and controlled compression therapy in
treatment of arm lymphedema following breast cancer
Brorson H. Liposuction gives complete reduction of chronic large arm
after breast cancer. Acta Oncologica 2000; 39: 407-420.
Brorson H. Fettabsaugung des Lymphödems am Arm. Handchir Mikrochir
2003; 35: 225-232.
of lymphedema of
the upper limb after treatment of breast cancer. Risk factors. Apropos
Ferrandez JC, Serin D, Bouges S.
Unite de reeducation main-membre superieur et unite de reeducation
Lymphoedema of the upper limb after breast cancer treated with axillary
clearance is a well known sequels. But its real rate is not precise.
retrospective study of 683 patients approaches this reality. When
criteria are selected with centimetric measures, its general rate is
out of them have a difference smaller than 3 cm. We noticed three
kinds of lymphoedemas which occur on the arm, the forearm or the
limb. Their volumes are different, the more voluminous ones occur when
limb is touched completely (P = 0.0001). The different factors which
the risk of lymphoedema are described. The role of the infection is
1.7). The rate is independent of the surgery, of the importance of
clearance and of the shoulder joint function. The lymphoedema size is
important when it occurs secondary to mastectomy then conservative
= 0.0078). Parietal fibrosis increases lymphoedema risk to 54% (P =
lymphoedemas are more voluminous (P = 0.009).
Role of Pneumatic Compression Pumps:
preliminary results from a current study
Andrzej Szuba, researcher
with the Stanford/Aurora
Centre for Lymphatic and Venous Disorders, Stanford University School
Medicine, Stanford, CA U.S.A. has made a number of presentations
this centre's experiences in using pneumatic extremity pumps on
Sept. 14-17, 2000 The Role
of Pneumatic Compression
Pumps, a presentation at the 4th National Lymphedema Network Conference
Orlando, Florida. Szuba suggested that intermittent penumatic
single or multi-compression with single or multi-chamber pumps
removed access fluid from the extremity. He reported that they were
two studies on the application of pneumatic compression in combination
decongestive lymphatic therapy (DLT) in patients with arm lymphedema
to breast cancer therapy.
Preliminary results of the
first study involving 22
women showed an average arm volume reduction of 51% in the group using
compression pump with DLT vs.35% volume reduction in the group treated
alone. The second study of 23 which assessed the usefulness of daily
compression for maintenance of arm volume by patients with post
edema also found beneficial effects.
Sept. 2002 at the
Internation Congress of Lymphology,
Genoa, Italy, Szuba, R. Achalu and S.G. Rockson reported on their
research in this area.
They investigated the
safety and efficacy of adjunctive
intermittent pneumatic compression (IPC) for the acute decongestive
post-mastectomy lymphedema. 23 patients were randomized into two
first which received decongestive lymphatic therapy (DLT) which
lymph drainage, bandaging and exercise daily and IP; and the second
received IPC 30 minutes daily at 40-50 mm. In group 1, 11 patients
25% acute arm volume reduction; in group II 12 patients received a mean
of 45.3% mean volume reduction.
These preliminary results
appear to show positive
affects for some patients which use this form of treatment.
INTERMITTENT PNEUMATIC COMPRESSION AS
ADJUNCTIVE MAINTENANCE THERAPY IN POSTMASTECTORMY LYMPHEDEMA
A. Szuba, R. Achalu, S.G. Rockson
Stanford Center for Lymphatic and Venous Disorders,
Stanford Univerity School of Medicine, Stanford, CA USA
We studied the safety and efficacy of intermittent
therapy as an adjunct to standard decongestive lymphatic therapy in
with stable post-mastectomy arm lymphedema.
Study design: Randomized, cross-over, 2 month study with 6 month
Patients and methods: 29 patients with postmastectomy arm lymphedema
evidence of active cancer were enrolled. Patients were randomized into
Patients assigned to Group I were asked to continue their routine
therapy with use of a Class II compression garment and self–applied
lymphatic drainage (MLD); patients assigned to Group II were asked to
intermittent pneumatic compression (IPC) pump for 1 hour daily
addition to conventional therapy (garments + MLD). All patients crossed
the alternate therapy after one month. Patients who elected to continue
use of the pump were evaluated after 6 months. Clinical evaluation was
at the beginning of
the study, after the first and the second month and after six month
The evaluation included tank volumetry, skin tonometry, and measurement
Results: 27 patients completed the study. Two patients voluntarily
|There was a mean volume
reduction of 89.5 ml during the month with IPC and volume increase of
32.7 ml during the month of routine maintenance therapy.
The difference was statistically significant (p<0.05).
There was no
difference in tonometry results. Of the 21 patients who completed
chronic use of
IPC, 19 were available for analysis. After 6 months, there was a
volume reduction of 29.1 ml (not statistically significant). No adverse
of IPC were observed.
Intermittent pneumatic compression is safe and well tolerated and may
offer additional benefit for patients with postmastectomy lymphedema.
Liposuction in arm lymphedema
The Lymphedema Unit, Department of Plastic and Reconstructive Surgery,
University, Malmo University Hospital, Malmo, Sweden.
Breast cancer is the most common disease in women, and up to 38%
lymphedema of the arm following mastectomy, standard axillary node
and postoperative irradiation. Limb reductions have been reported
various conservative therapies such as manual lymph and pressure
patients with long-standing pronounced lymphedema do not respond to
conservative treatments because slow or absent lymph flow causes the
of excess subcutaneous adipose tissue. Previous surgical regimes
bridging procedures, total excision with skin grafting or reduction
seldom achieved acceptable cosmetic and functional results.
reconstruction involving lympho-venous shunts or transplantation of
vessels has also been investigated. Although attractive in concept, the
failure of microsurgery to provide complete reduction is due to the
of newly formed subcutaneous adipose tissue, which is not removed in
with chronic non-pitting lymphedema. Liposuction removes the
adipose tissue and is a prerequisite to achieve complete reduction. The
equilibrium is maintained through constant (24-hour) use of compression
postoperatively. Long-term follow up (7 years) does not show any
|Horse chestnut seed
extract for the treatment of arm lymphedema.
P. R. Hutson, R. R. Love, J. F. Cleary, S. A. Anderson, L. Vanummersen,
S. L. Morgan-Meadows, E. A. Doran;
UW School of Pharmacy, Madison, WI; UW Comprehensive Cancer Center,
Madison, WI; UW Dept Biostat Med Informatics, Madison, WI
Abstract: Background: Lymphedema of the arm occurs frequently as a
consequence of surgical and radiation damage to the major lymphatics
during lymph node dissection (LND) and adjuvant treatment of breast
Usual lymphedema treatments are massage, compression sleeves and wraps;
there are no drug treatments currently available in the USA.
This is an interim report of our use of Horse chestnut seed extract
(HCSE) for the treatment of arm lymphedema in breast cancer survivors.
HCSE is widely used in Europe for venous and lymphatic disorders, and
is postulated to act by decreasing capillary and interstitial
Methods: In this double-blind, randomized, and placebo-controlled
study, eligible subjects with stable arm lymphedema receive placebo or
HCSE (50mg escins) twice daily PO for three months, followed by a 1
Eligible subjects have affected : unaffected arm edema ratios of ¡Ý 1.1
to 1 by bioelectric impedance, and significant response was empirically
set as a 15% decrease in arm ratios.
Arm edema is measured concurrently with serial tape measurements, water
displacement, and bioelectric impedance. Subjective assessments include
the FACT-B QOL instrument and a 16-item experimental lymphedema
Results: 25 subjects (of 68 sought) are evaluable at 3 months. 24
patients are at intermediate assessment points and accrual continues.
One patient developed progression of known breast cancer metastases;
one developed minor, reversible dizziness and tolerated 50% dose
There are no statistically significant differences in the amount of
lymphedema at 3 months by any of the measurement techniques. Small
changes in arm volume are not reflected by correlative changes in the
scores of the QOL instruments.
Conclusions: HCSE at doses commonly used for treating CVI or varicose
veins is well tolerated in breast cancer survivors with lymphedema.
This interim analysis does not demonstrate significant objective or
subjective benefit of HCSE in reducing arm lymphedema. QOL
questionnaires need improvement to identify issues that more
specifically reflect the impact of lymphedema.
Funded by the Susan G. Komen Breast Cancer Research Foundation (BCTR
Abstract No: 8095
Nicole L. Gergich MPT,
Lymphedema Specialist, Penn Therapy and Fitness
Posting Date: May 6, 2001
Last Modified: January 3, 2002
| Why Should I
One very important component of a comprehensive
treatment plan for cancer-related lymphedema is exercise. A program
consisting of flexibility, strengthening and aerobic exercise is
beneficial in reducing lymphedema when administered under the correct
conditions. Exercise also allows cancer survivors a more active role in
their own lymphedema management. Recent studies have shown no
significant increase in the incidence of lymphedema after breast
cancer, between women participating in an exercise program when
compared to women who did not exercise.
What Type of Exercises are Helpful To Someone
Flexibility exercises help to maintain joint range of
motion and allow for elongation or stretching of tissues. Flexibility
exercises also help to prevent joint stiffness and postural changes
after cancer surgeries or treatments. Muscle tightness may further
Strengthening exercises are also important in reducing
lymphedema when done at low intensity levels with the extremity wrapped
(see below). These exercises often help increase lymphatic and venous
flow, aiding in the removal of fluid from the involved extremity.
Aerobic exercise enhances the lymphatic and venous flow,
further reducing swelling in the extremity. Aerobic exercise also
combats fatigue, which plagues so many people during and after cancer
Finally, deep abdominal breathing or diaphragmatic
breathing is important with all exercise, but especially so in people
with lymphedema. When deep breathing is carried out, the pressure
inside the chest and abdomen is altered and creates a pumping activity
within the lymphatic system. The central thoracic duct, which carries
lymph fluid from the abdomen and legs, travels through the chest
cavity. Pumping action around the duct helps to increase lymphatic flow
throughout the body. Deep breathing is also important to deliver
adequate oxygen supplies to the working muscles so that they may work
Exercises should be initiated by a physical or
occupational therapist that specializes in lymphedema treatment. As
with all exercise, you should discuss beginning a program with your
How Much Weight Can I Lift?
There has been little research to date regarding the
intensity of exercise in people with lymphedema and what is a safe
level. Previously, intensive exercise was viewed as contraindicated, or
not advisable. Currently, exercise and progressive weight lifting
activities are used to assist in the removal of lymphedema from the
affected areas. Therapists can guide clients in a weight lifting
program that is tailored to their present fitness levels. How much you
can lift depends on the stage of treatment and most importantly, you
previous and present fitness levels. It is important to continuously
monitor the limb for swelling or redness, which can be an indication
that the exercise was too intense. A weight lifting program
should be initiated by a therapist who specializes in the treatment of
Should I Wrap My Arm With Exercise?
It is recommended that the affected limb (arm or leg) be
wrapped with compression bandages during exercise to aide the muscle
pump force on the venous and lymphatic systems. Wrapping also prevents
further fluid from accumulating in the extremity. The bandages used for
lymphedema treatment are short-stretch bandages. The short stretch
bandages used in lymphedema treatment do not stretch much when applied
to the arm or leg. When you exercise the wrapped limb, the muscles and
the bandages place a force on the lymphatics that help move fluid out
of the arm. ACE bandages stretch too much and are ineffective in the
treatment of lymphedema. Do NOT USE Ace wraps when wrapping for
What Exercises Can I do After Breast Surgery?
Following a mastectomy it is important to maintain range
of motion or flexibility in the shoulder. Frequently, women decrease
the use of the shoulder and arm on the side of the body where surgery
was performed due to pain or fear of hurting the incision. Protecting
the arm may lead to stiffness and tightness in the shoulder which can
make it difficult to move the arm. This is often followed by a loss of
muscle strength and stability around the shoulder. Since the shoulder
and neck are closely related, it is also important to maintain neck
mobility to prevent further complications. Ask your doctor or physical
therapist if you have questions about which shoulder exercises are
right for you. If you have recently undergone a mastectomy accompanied
by a breast reconstruction REFER TO YOUR SURGEON FOR INFORMATION
REGARDING SHOULDER EXERCISE. It is important to discuss
beginning an exercise program with your physician.
Vascular Web - MD
illustration will give you an idea on the
correct way to wrap your arm. You can also
find sleeves and garments at the
suppliers listed below.
Lymphedema Arm Sleeves
Gauntlets, and Gloves
Designed to treat primary or secondary lymphedema
of the hand and arm. Arm sleeves are an effective treatment
for primary lymphedema patients, as well as those experiencing
lymphedema following mastectomy, radiotherapy, cellulitis, trauma or
UE-P-AH arm sleeve and UE-P-AH with JoVi Jacket
Made-to-Order shoulder extention contours over the rotator cuff with a
Jacket to match. (order UE-P-AH) Available with elastic cross strap.
products page for more information.
of arm wraps,
compression garments and sleeves
Measure-Up™ Arm Sleeve
Press "Lymphedema" Garments
us as we work for lymphedema patients everywehere:
Dedicated to be an advocacy group for lymphedema patients.
education, legal reform, changing insurance practices, promoting
reaching for a cure.
/ Advocates for Lymphedema
For information about
For information about
Lymphedema Treatment Options
The time has come for families, parents, caregivers to have a support
their own. Support group for parents, families and caregivers of
lymphedema. Sharing information on coping, diagnosis, treatment and
Sponsored by Lymphedema People.
No matter how you spell it, this is another very little understood and
frustrating conditions out there. This will be a support group for
suffering with lipedema/lipodema. A place for information, sharing
exploring treatment options and coping.
Come join, be a part of the family!
If you are a man with
lymphedema; a man with a loved
one with lymphedema who you are trying to help and understand come join
discover what it is to be the master instead of the sufferer of
Support group for parents, patients, children who suffer from all forms
lymphangiectasia. This condition is caused by dilation of the
lymphatics. It can
affect the intestinal tract, lungs and other critical body areas.
Disorders Support Group @ Yahoo Groups
While we have a number of support groups for lymphedema... there is
there for other lymphatic disorders. Because we have one of the most
comprehensive information sites on all lymphatic disorders, I thought
it is time that one be offered.
Information and support for rare and unusual disorders affecting the
system. Includes lymphangiomas, lymphatic malformations,
hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of
available through sister site Lymphedema People.
For our Google fans, we have just created this online support group in
Group email: All-About-Lymphedema@googlegroups.com
If you an AOL fan and looking for a
support group in AOL
Groups, come and join us there.
our home page we have 18
categories with 218 articles
lymphedema, edema, and
Lymphedema and Edema Related Conditions
Hereditary Conditions of the Lymphatics
Related Medical Conditions
Complications of Lymphedema
Lymphedema Treatment Options
Complete Listings of Therapists and Links
Cellulitis and Related Infections
Wound Information, Care, Treatment
Skin Care, Conditions and Complications
Exercise, Diets, Nutrition
Miscellaneous Interesting Articles section
Resources, Organizations, Support Groups
Advocacy and Lobbying Resources
Resources for the Medical Community
Home Page: Lymphedema People
Reviewed Jan. 14, 2012