The lymph system is a network of lymph vessels, tissues, and organs that carry lymph throughout the body.
The parts of the lymph system that play a direct part in lymphedema include the following:
- Lymph: A clear fluid that contains lymphocytes (white blood cells) that fight infection and the growth of tumors. Lymph also contains plasma, the watery part of the blood that carries the blood cells.
- Lymph Vessels: A network of thin tubes that helps lymph flow through the body and returns it to the bloodstream.
- Lymph Nodes:Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.
The spleen, thymus, tonsils, and bone marrow are also part of the lymph system but do not play a direct part in lymphedema.
What Causes Lymphedema ?
Primary Lymphedema Causes
Primary lymphedema is an abnormality of an individual's lymphatic system and is likely present at birth, although symptoms may not become apparent until later in life. Depending upon the age at which symptoms develop, three forms of primary lymphedema have been described. Most primary lymphedema occurs without any known family history of the condition.
- Congenital Lymphedema is evident at birth, is more common in females, and accounts for 10%-25% of all cases of primary lymphedema. A subgroup of people with congenital lymphedema has a genetic inheritance (in medical genetics termed "familial sex-linked pattern"), which is termed Milroy disease.
- Lymphedema Praecox is the most common form of primary lymphedema, making up 65%-80% of cases. It is defined as lymphedema that becomes apparent after birth and before age 35 years and symptoms most often develop during puberty. Lymphedema praecox is four times more common in females as in males.
- Primary lymphedema that becomes evident after 35 years of age is known as Meige Disease. It is less common than congenital lymphedema and lymphedema praecox and accounts for 10% of cases of primary lymphedema.
Symptoms Of Lymphedema
Lymphedema of the lower extremities begins with mild swelling of the foot and gradually extends to the entire limb. The edema is usually painless and initially may be pitting (compressible). Over time the skin over the edema becomes brawny and non-pitting. There may also be pain from the swelling. There is no evidence of ulceration or varicose veins.
Diagnosis of Lymphedema
The diagnosis is often made clinically. Lymphangiography using an injection into the lymphatic channels in the web spaces between the toes or fingers is rarely performed because the material used to outline the channels can cause more damage to the lymphatics and make the problem worse. Radioactive isotope studies (lymphosynctigraphy) utilize a radioactive isotope injection into a vein and carries far less risk to damaging the lymphatic channel and can provide the same information about the anatomy.
Treatments And Drugs
There's no cure for lymphedema. Treatment focuses on reducing the swelling and controlling the pain. Lymphedema treatments include:
- Exercises : Light exercises that require you to move your affected arm or leg may encourage movement of the lymph fluid out of your limb. These exercises shouldn't be strenuous or make you tired. Instead, they should focus on gentle contraction of the muscles in your arm or leg. Your doctor or a physical therapist can teach you exercises that may help.
- Wrapping your arm or leg : Bandages wrapped around your entire limb encourage lymph fluid to flow back out of your affected limb and toward the trunk of your body. When bandaging your arm or leg, start by making the bandage tightest around your fingers and toes. Wrap the bandage more loosely as you move 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. Manual lymph drainage involves special hand strokes on your affected limb to gently move lymph fluid to healthy lymph nodes, where it can drain. Massage isn't for everyone. Avoid massage if you have a skin infection, active cancer, blood clots or congestive heart failure. Also avoid massage on areas of your body that have received radiation therapy.
- Pneumatic compression : If you receive pneumatic compression, you'll wear a sleeve over your affected arm or leg. The sleeve is connected to a pump that intermittently inflates the sleeve, putting pressure on your limb. The inflated sleeve gently moves lymph fluid away from your fingers or toes, reducing the swelling in your arm or leg.
- Compression garments : Compression garments include long sleeves or stockings made to compress your arm or leg to encourage the flow of the lymph fluid out of your affected limb. Once you've reduced swelling in your arm or leg through other measures, your doctor may suggest you wear compression garments to prevent your limb from swelling in the future. Obtain a correct fit for your compression garment by getting professional help — ask your doctor where you can buy compression garments in your community. Some people will require custom-made compression garments.
When several of these treatments are combined, this therapy may be referred to as complete decongestant therapy (CDT). CDT generally 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. While this reduces severe swelling, surgery can't cure lymphedema.
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