The Education on chronic lymphoedema of the upper limb

Lymphoedema, or lymphedema, is a chronic medical condition accumulating lymph fluid in certain body parts. It occurs when there is a disruption or damage to the lymphatic system, responsible for maintaining fluid balance and filtering toxins from the body.

The lymphatic system consists of a network of vessels, nodes, and organs that carry lymph fluid throughout the body. Lymphoedema typically develops when the lymphatic vessels cannot properly transport lymph fluid, leading to its accumulation in the affected area. This often results in persistent swelling, usually in the arms or legs, although it can also affect other body parts.

The primary causes of lymphoedema include congenital malformations of the lymphatic system, surgery or radiation therapy that involves removing or damaging lymph nodes, and certain infections. Secondary lymphoedema can also occur due to various underlying conditions such as cancer, obesity, or chronic venous insufficiency.

 The incidence of lymphedema secondary to breast cancer varies between 12.5% ​​and 49%, less frequently affecting women with negative sentinel lymph nodes 2,3,4.

Symptoms of lymphoedema after breast cancer:

• Swelling: Persistent swelling in the affected arm, hand, fingers, chest, or underarm area. The swelling may be mild initially and gradually progress over time.

• Heaviness or tightness: A feeling of heaviness or tightness in the affected limb or surrounding area.

• Limited range of motion: Difficulty moving the arm or affected area due to stiffness or decreased flexibility.

• Aching or discomfort: A dull ache or pain in the affected limb or nearby regions may worsen with physical activity or prolonged use.

• Skin changes: The skin in the affected area may become tight, thickened, or hardened. It may appear red, inflamed, or develop a leathery texture.

• Infections: Increased susceptibility to diseases, such as cellulitis, in the affected limb due to compromised lymphatic function.

• Lymphatic fluid leakage: In some cases, lymphatic fluid may leak through the skin, resulting in lymphorrhea. This may cause a weeping or oozing of fluid from the affected area.

• Relevant issues: Difficulty fitting into clothing or jewellery that previously fit comfortably due to swelling.

All these symptoms can have a significant impact on the patient’s quality of life, social and work relationships. For this reason, it is advisable to identify the pathology early, setting up an adequate rehabilitation path with an integrated approach called Complete Physical Therapy (or Complete Decongestive Physiotherapy – CDP). Women undergoing surgery for breast cancer should therefore be informed of the possible onset of lymphoedema and the precautions to be taken to reduce the likelihood of this occurring.

Rehabilitation treatment and elastic compression aids

If signs of possible lymphoedema are found, the patient will have to visit a vascular surgeon, who will confirm the diagnosis and then refer the patient to a physiotherapist, who will evaluate the lymphedematous limb and prepare, if necessary, an Individual Rehabilitation Plan (PRI). This document specifies all the treatments and procedures the patient will undergo to prevent the worsening of the lymphedema and improve the functionality of the upper limb during the activities of daily living (ADL – Activities of daily living). 

As a healthcare professional, it is important to seek the correct medical compression garments for your patients. Solidea has a wide range of medical compression wear such as our Micromassage Armbands and  Arm Care CCL.1 armbands.

The rehabilitation treatment includes manual lymphatic drainage performed by a physiotherapist with specific skills in this area, sequential pressure therapy, skin care of the lymphoedematous limb and possibly the making of an elastic compression bandage to perform specific exercises with the limb bandaged. With the decongestant treatment, it is desirable to obtain an improvement in the functionality of the limb and a reduction in the volume of the same.

To ensure that these results persist over time, it is necessary to prescribe an elastic-compressive brace: a containment sheath that causes compression on the limb, preventing a further increase in volume. The compression exerted by the sheath on the limb must be defined by the doctor, depending on the severity of the lymphoedema and the patient’s condition: from one 1st compression class (18-21 mmHg)(Class 1 (Mild): This is the lowest level of compression. Class 1 compression garments exert gentle pressure on the affected area. They are often used for mild cases of lymphoedema or as a preventive measure to reduce the risk of swelling in at-risk individuals.) up to a 4th compression class (49 mmHg)(Class 4 (Extra High): Class 4 compression garments provide the highest level of compression. They exert intense pressure and are typically reserved for specialised medical conditions under healthcare professionals’ guidance.). At the end of the complete decongestant therapy, the patient should wear the elastic compression bracelets throughout the day, removing them in the evening before bed 5.

The educational activity before and after the intervention

Patient awareness of the possibility of secondary lymphoedema after breast cancer surgery is paramount to ensure early diagnosis and treatment. For this reason, educational and awareness-raising activities must occur in the immediate postoperative period, during the days of hospitalisation after surgery. 

Patients are informed of all the necessary precautions for the prevention of lymphedema or infectious episodes (the so-called lymphangitis), for the care of the skin of the upper limbs, for setting an adequate diet and for identifying the early stage of lymphoedematous problems.

The educational activity continues during the daily rehabilitation sessions if treatment becomes necessary. On these occasions, it is required to accurately illustrate to the patient the meaning and purpose of the decongestant treatment, highlighting the importance of subsequent regular use of elastic compression aids to maintain the results achieved. It is also important to encourage women undergoing treatment to meet other patients who regularly use adjustable compression bracelets so that they can share their experience in the daily management of the brace. 

Prescribing an elastic compression brace can be difficult for the patient, but meeting other women who have used it regularly daily can help improve its acceptance. Since lymphedema is a chronic disease, it is important that the rehabilitation team takes care of the patient and follows her regularly, becoming a constant point of reference for any concerns and needs regarding the disease.
Recommend only the best compression aids to your patients prone to lymphoedema after breast cancer with Solidea’s Micromassage Armbands and Arm Care CCL.1 product.