Edema

Question 1

History questions?

Answer 1

1. What is the client’s overall health?
2. Is the edema caused by a local or general infection?
3. Has the client had surgery that may disrupt the lymphatics?
4. Does the client have a peripheral nerve lesion that may cause edema?
5. Is the edema caused by position or by a rise in the temperature outside?
6. Has there been a history of recurrent edema?
7. How long has the edema been present for?
8. If the edema is caused by an injury, when did the injury occur?
9. Is there swelling or edema local or distal to the injury?
10. Did the client see any other health care practitioner?
11. If the edema is trauma related, is the client taking any medications?
12. Is the client taking any medication specifically for the edema?
13. Is the client using any elastic bandages or stockings to reduce the edema?
14. Does the edema interfere with ADL’s?
15. What aggravates or relieves the edema?

Question 2

CI

Answer 2

1. Avoid full body lymphatic drainage techniques or elevation of the limbs above the heart with chronic congestive heart failure.
2. Local or distal techniques are CI’d with edema that is due to thrombophlebitis or deep vein thrombosis.
3. Lymphatic drainage techniques are CI’d with untreated or metastasizing neoplasms, but edema that is a result of medical tx (lymph node removal, radiation), lymphatic drainage may proceed with a physician’s approval.
4. Local lymphatic drainage and hydrotherapy are CI’d if the edema results from bacterial, viral or fungal infection.
5. With chronic inflammation (sinusitis, bronchitis) lymph drainage should initially be performed for shorter periods of time and not on site.
6. Lymphatic obstruction due to parasites contraindicates lymphatic and Swedish techniques which increase circulation.
7. Lymphatic drainage is CI’d with toxoplasmosis, a lung infection associated with AIDS as it may cause a flare-up of the infection
8. Lymphatic drainage on low-protein edema (liver and kidney pathologies) will have no effect because the forces causing edema will overwhelm the effects of the techniques
9. On-site techniques are CI’d in the acute and early subacute stages of trauma, they are only used proximally
10. Distal to the lesion, circulatory techniques are CI’d in the acute and early subacute stage
11. Avoid using hot or warm hydrotherapy immediately proximal to the inflamed tissue in edemas arising from trauma
12. Do not disturb a hematoma

Question 3

ACUTE + EARLY SUB-ACUTE- Treatment goals + treatment ?

Answer 3

Treatment goals
1. Reduce the edema( if safe to do so) to prevent scar
2. Decrease pain or discomfort
3. Decrease sympathetic nerve system firing
4. Prevent adhesion formation where appropriate
Treatment
1. Cold hydrotherapy
2. Diaphragmatic breathing (throughout the treatment to facilitate lymphatic return)
3. Nodal pumping 10 times (elevate the limb before doing lymphatic drainage, can do once but repeat others)
4. Stationary circles
5. Effleurage and stroking proximal to the edema
6. Fee pain passive relaxed ROM of the proximal and distal joints

Question 4

Late subacute treatment goals + treatment ?

Answer 4

treatment goals
1. Reduce edema diminishes to improve tissue health
2. Increase proximal and distal ROM
treatment
1. Cold to warm hydrotherapy
2. Diaphragmatic breathing throughout the treatment
3.Drainage techniques (decrease)
4. The proximal limb lymphatic drainage techniques (elevate the limb before doing lymphatic drainage)
5. Local lymphatic techniques the edema site, covering the proximal border of the edema through the centre area to the distal border
6. Effleurage edema site distally
7. Mid to full-range passive relaxed ROM on the proximal and distal joints

Question 5

Chronic treatment goals and treatment?

Answer 5

Treatment
1. Hydrotherapy is dependent on the tissue health and the temperature of the tissue
2. Chronic edema that results from trauma (repeated ankle sprain) can be addressed using light fascial techniques on fascial restrictions. Petrissage techniques may be used on proximal areas if they are hypertonic. Once restrictions are reduced, lymphatic drainage techniques can be used
3. Chronic edema resulting from pregnancy, peripheral nerve lesions, prolonged sitting or standing or sodium retention is treated using Swedish massage techniques followed by lymphatic drainage
4. With lymphedema, deeper pressure Swedish techniques and frictions are avoided local to the edema
5. Lymphatic drainage is used to prepare the healthy, unaffected neighbouring watersheds to take an increased lymph load before draining the affected lymphedematous watersheds
6. Hot hydrotherapy is CI’d with lymphedema
7. With full limb lymphedema resulting from surgery, radiation, peripheral nerve lesions, spinal cord lesions where there is an interruption of the lymphatics or no muscular pump to promote lymph flow, the tissue feels waterlogged, soft, spongy and congested
8. Only unidirectional effleurage and stroking are used, starting on the contralateral quadrant

Question 6

Home care?

Answer 6

1. Hydrotherapy is chosen for the stage of healing
2. Self-massage is very helpful. Instruct client to elevate the affected area and do nodal pumping, light unidirectional effleurage and stroking
3. If edema is local and chronic and is due to proximal scarring and fascial restrictions, careful skin rolling over the scar tissue can be done prior to elevation and drainage
4. Diaphragmatic breathing
   Remedial exercise is dependent on the stage of healing and severity of the injury
5. In the acute and subacute stages, pain free active free ROM with the distal and proximal joints is encouraged
6. Clients with lymphedema should be encouraged to perform moderate active free ROM exercises without over exercising and may also be referred to a MLD specialist for treatment who is trained and certified in Vodder’s Manual Lymph Drainage and Combined Decongestive Therapy (MLD and CDT)

Question 7

Lymphatic drainage protocol?

Answer 7

With lymphatic facilitation techniques, only traumatic edemas should be treated

Question 8

Types of Edema ?

Answer 8

1. Circulatory Edema : dysfunction or disease in the cardiovascular . Lymphatic drainage techniques in these cases require considerable .
2. Lymphedema Edema :Dysfunction or failure in the lymphatic system (opposite of circulatory edema).
   - Primary lymphedema: congenital (bẩm sinh) or genetic defect in lymphatic development, evident in early childhood.
   - Secondary lymphedema: nodes or vessels of the lymphatic system are damaged or destroyed (common causes: surgery, radiation, infection, repeated compression)
3. Traumatic Edema: Localized and temporary swelling of tissue associated with soft tissue injury .
   - Primary: Amount of fluid actually spilled out of stretched and torn soft tissue
   - Secondary: Amount of fluid drawn into the area of damage due to increased interstitial oncotic pressure of that arm