Lymphedema

Lymph

Lymphedema is the accumulation of fluid that causes swelling in the arms and/or legs. This fluid, called edema, occurs when venous or lymphatic vessels, or both, are impaired.

Those patients who undergo surgical removal of a breast tumor and the adjacent lymph nodes and vessels may develop lymphedema. This "fluid build up" may occur immediately in the post surgical period or several years later. Patients who have radiation therapy in the treatment of various cancers may also experience lymphedema due to damage to the lymph nodes.

For additional information, visit the National Lymphedema Network.

Prevention Methods

A. Postural Awareness

• Sit upright - maintain low back curve.
• Let arms swing naturally during walking.
• Use of arm for daily activities, i.e. grooming, light household chores.

B. Skin Care

• Inspect arm daily for skin tears, swelling or infection (signs of infection - redness, swelling, warmth, pain, fever, red streaks and/or drainage).
• Avoid injury to arm: skin tears, insect bites, burns (use potholders), cuticle tears, cuts and abrasions.

C. Protective Measures

• Oven mitts, rubber gloves when washing dishes, use garden gloves while performing yard work, avoid sunburns, use of moisturizers to prevent dry, cracked skin.
• Use an electric razor.
• Return to sports gradually.

During the first 30 days postoperatively and while receiving radiation treatment (if indicated by your physician), follow these additional precautions:

D. Avoid Binding the Affected Arm

• NO BLOOD PRESSURE readings on the affected arm.
• No tight jewelry or watches, they must be loose enough to move around the wrist completely.
• No jackets or clothing that are tight at the wrist or arm.
• Carry purse, bookbag or tote bag on non-involved shoulder.

E. Exercising For Prevention

Perform the following exercises regularly to maintain your strength, mobility, and flexibility. If you begin to notice any signs or symptoms of lymphedema, seek medical advice for treatment. Check with your doctor, nurse or physical therapist before you begin these exercises.

F. Post-Operative Care

• The 3 goals for post-operative rehabilitation are prevention of physical disability, restoration of cosmetic appearance, and psychosocial and vocational re-adjustment.
• The aim is to improve shoulder muscle strength and mobility, minimize arm swelling, and facilitate resumption of all functional activities.
• Depending on the extensiveness of the surgery, the degree of rehabilitation and recovery will vary. Your physician or physical therapist will prescribe an individualized exercise plan based on your needs.

Helpful Guidelines

• If you are experiencing pain, discontinue exercises and notify your doctor or nurse.
• If your arm becomes swollen or very tender after these exercises, contact your doctor, nurse, or physical therapist.
• If possible, do exercises in front of a mirror to keep your correct posture and motion.
• Be sure to breathe during your exercises as you may not realize you are holding your breath.
• Perform all exercises in pain-free ranges.
• Use slow, smooth movements

If you have had recent surgery, seek advice from your doctor or physical therapist for an individualized exercise program. These exercises are not designed for patients who have had breast reconstruction. If you have had reconstruction you will be given a different set of exercises.

ROM (Range of Motion)

Do each exercise for 10 repetitions. Perform 2 sets. Rest 30 seconds between each set.

Flexibility

Hold each stretch for 30 seconds. Repeat 3 times. Rest 30 seconds between each repetition.

Strengthening and Conditioning

Do each exercise for 10 repetitions. Perform 2 sets. Rest 1 minute between each set. Use a light, comfortable weight, such as a soup can, for resistance.