How do I know if I have Lymphedema?

By Sandra MacDonald, RMT

Last Updated: Aug 2, 2006
Articles & News : Articles : Lymphedema

Email this article
Printer friendly page

What is lymphedema? How do I know if I have it? As a massage therapist who specializes in complete decongestive therapy these are questions that I often get.

Lymphedema is long-term swelling in an area(s) of the body. It is caused by a problem with the lymph system’s ability to remove all the fluid from the tissue spaces. Other types of edema may be caused by injury, as in an ankle sprain, or other conditions, such as pregnancy. In both these cases the swelling is usually temporary and does not directly involve a dysfunction of the lymphatics.

Lymphoedema may be primary or secondary. Primary lymphoedema is caused by problems with the development of the lymph system. There may be an insufficient number of nodes or vessels, or they may have formed poorly and not function well. Primary lymphoedema may be present at birth (congenital), arise in puberty (praecox) or middle age (tarda).

Secondary lymphoedema occurs when a normally healthy lymphatic system is damaged and cannot remove its share of the fluid from the tissue spaces. The

causes are numerous. In Canada, we often associate lymphoedema with removal of lymph nodes during cancer surgery. Other causes may be trauma where the lymphatics are damaged, parasites, or lack of movement. Lympheodema caused by immobility is usually seen in the legs of the elderly, or individuals with circulatory problems.

Lymph vessels start in the capillary beds and are responsible to carry that portion of the tissue fluid that does not return directly to the bloodstream. The lymph fluid then moves through a chain of vessels to the lymph nodes that are clustered primarily in the groin, axilla (arm pit), abdomen, and neck. It finally feeds back into the blood stream just near the jugular veins of the neck.

Damage to or removal of the lymph nodes will affect the drainage area of all the vessels that travel to that node. This can lead to large areas being affected.

Decreased drainage of an area leads to a gradual accumulation of fluid. As the condition progresses a feeling of heaviness may result as well as a reduction in cellular oxygen and nutrient exchange contributes to muscle fatigue. A build-up of tissue fluid will lead to an increased protein concentration in the tissues that contributes to a chronic inflammation that, in turn, stimulates the formation of fibrotic tissue. Fibrotic tissue causes the edema to become quite firm to the touch. Inflammation also leads to blood vessel dilation and the limb may feel hot. Fibrosis, increased protein concentration and heat can create a prime environment for bacterial growth and decreased tissue health that may compromise immune function and lead to infection.

There are different stages of progression of lymphoedema and not everyone who develops lymphoedema will progress through all stages.

• Stage 0 - In this stage there is the presence of heaviness, discomfort and the limb tires on activity. There are no visible changes in the shape of the limb.
• Stage 1 - There is a noticable swelling of the limb, and will pit (pressure applied to the skin will leave a divot that lingers after the pressure is removed). The swelling will ease, but not disappear, if the limb is elevated.
• Stage 2 - The limb has significant changes in shape and the swelling is firm with the presence of fibrous tissue and does not pit. There is little change in swelling on elevation or overnight.
• Stage 3 -  (Elephantiasis) There are gross changes to the skin with visible size increases as well as hardening of the skin. This does not occur in the upper limb.

To diagnose lymphoedema the most important factors are history and observation. It can be difficult if more than one condition exists concurrently. With a breast cancer surgery and lymph node dissection the stage is set. Symptoms that may arise are:

• A feeling of tightness or heaviness of the area
• Bursting sensation
• Change in sensation, pins and needles, or shooting pain
• Decreased mobility due to fullness of area
• Arm may be warmer than usual due to low grade inflammation
• Presence of swelling, can be seen in hand, forearm or chest or involve the entire arm
• Weakness of the involved limb
• Dryness of skin
• Slowed healing rates

Once the lymphatics have been damaged the potential exists for lymphoedema to arise at any time, even years after the surgery. It can arise gradually with a steady increase over time or suddenly if as a response to other insult such as a sunburn,

bruise or insect bite. It may persist for months, weeks or years. Overall the occurrence after breast cancer surgery is between 20-30% and risk varies due to a number of factors including: the type of surgery, number of node removed, or radiation therapy. There is treatment available known as complete decongestive therapy. While the condition is chronic it can be well managed and the sooner symptoms are addressed the less likely it is that the stages will progress.

---

Sandra MacDonald has been working with lymphoedema since 1995.  She trained in Canada and Austria with the Dr. Vodder School of Manual Lymph Drainage. Sandra works with Physiotherapy Atlantic at Suite 440, 5991 Spring Garden Rd. Halifax, Nova Scotia.  Phone:  (902) 421-7549.

Have comments about this article? We'd love to hear from you. Please email us at abcn@abcn.ca!