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Assessing and Treating Lymphedema

June 8, 2009
by Gail Pekelis, MA, PT, CLT

Lymphedema, as previously stated, is a swelling of a body part from the abnormal accumulation of protein rich edema fluid in the affected area.  In post breast cancer, lymphedema can develop in the affected arm.  If lymph nodes are removed, there is an increased risk of developing lymphedema.
This 2nd article on lymphedema will present current assessment and treatment options for lymphedema.

Lymphedema assessment may be accomplished by physical reassures and imaging techniques.  Four physical measures of lymphedema are available, including circumferential measurements at various standard points along the affected arm, volumetric measures using limb submersion in fluid, skin/soft tissue tonometry in which soft-tissue compression is quantified and most recently, measuring affected arm tissue impedance.


Both the circumferential measurements and the bioimpediance tool for assessment will be discussed since they are most clinically available for post mastectomy patients.


 The traditional method for measuring lymphedema is the tape measured arm circumference at standard distances and points on the affected arm.  Ideally, measurements should be taken pre-surgically for a baseline measurement of both affected and unaffected sides; and then taken routinely during treatment of lymphedema to measure the decrease in arm girth, as well as to determine the need for a compression sleeve or compression bandage wrapping.


Impedimed's L-Dex is a relatively new technology that measures changes in extracellular fluid in the affected arm.  As extracellular fluid accumulates the L-Dex value increases on the scale.  The L-Dex values for a normal patient without lymphedema will fall in the range of -10 to +10.  The presence or absence of lymphedema is assessed by comparing the patient's L-Dex test to this range and to past L-Dex tests. This scale is one tool to assist in the clinical assessment of lymphedema by a medical provider. It is not intended to diagnose lymphedema.


It is imperative to treat lymphedema signs and symptoms once it has been assessed.  All too often it goes unrecognized and untreated.  Detection and recognition of early signs of lymphedema is important.  As data suggests that the sooner the treatment is started, the less amount of treatment is required to prevent further progression and the better the ultimate result.


The lymphedema treatments lie between the combinations of many approaches:


-      Manual Lymphatic Drainage (MLD)

-      Compression garments

-     Therapeutic exercises

-      Self-care management

-      Elevation

-     Complete Decongestive therapy (CDT)


MLD is a delicate massage technique that stimulates lymph vessels, directing and channeling fluid toward adjacent functioning lymph nodes.  CDT has been widely available in Europe for many years.  This therapeutic approach takes into account the fact that lymphedema exists in the entire body quadrant, with the most distressing effects in the affected hand and/or arm.  It includes skin care, MLD, low-stretch multilayer compression bandaging (followed by a fitted compression garment when edema is reduced) and therapeutic exercises.


Lymphedema is an important health problem for many women who have been treated for breast cancer.  It is important that women are aware of their lymphedema symptoms and seek out clinician for assessment and treatment of this condition.


Please feel free to address any questions to Gail Pekelis at


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