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What is Lymphedema?Lymphedema, also known as lymphatic obstruction, is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system. In case you experience breathlessness with chest pain along with leg pain with coughing up blood then it can be due to pulmonary embolism. Pregnant women can develop this problem since it puts great pressure on the pelvic muscles and legs. In rare cases, the blood clot from the legs travel into the bloodstream reaching the lungs thus blocking the blood flow causing pulmonary embolism.
Your doctor will make a thorough physical examination and check for the symptoms of swelling of legs and tenderness on the affected area.
The aim of treatment is to reduce the symptoms and stopping the blood clot to grow bigger in size. Lymphedema : When there is excess of fluid accumulation in the lymph vessels it may cause swelling. Finally, it can be due to side effects of any drugs of calcium channel blockers and antidepressant medicines. Apart from swelling in the ankles or legs, there may be moderate to severe pain while walking or moving the legs. You can keep your legs in the elevated position (above the heart) for facilitating easy blood flow. In case of minor foot injury and sprain, you can use ice packs or wrap the foot with compressions. Your doctor will first identify the underlying cause of swelling in the feet before giving treatment. Doing exercise and physiotherapy can help the person to overcome various causes of swelling.
Second one is the chronic condition of knee swelling like that of arthritis, gout and infection inside. In very rare cases, the knee cap gets dislocated due to fatal fall pushing the cap to one side. As said earlier, your doctor will have to find out the root cause of swollen knee before starting any treatment.
Some doctors give aspiration therapy for swollen knee for draining out the synovial fluid inside.
In case if the swelling of knee is due to arthritis then you need to make lifestyle changes and dietary modifications for living with arthritis pain.
The lymphatic system returns the interstitial fluid to the thoracic duct and then to the bloodstream, where it is recirculated back to the tissues. For some people symptoms like leg pain, swelling in the leg, swelling in the ankle are observed. Individuals who are in bed rest in hospitals due to paralysis or any other medical condition have increased chance for developing blood clots in the calf muscles. In case you have sudden shortness of breath, chest pain, increased pulse rate and rapid heartbeat and profuse sweating you need to contact your doctor immediately.
Blood thinners like anticoagulants are prescribed for reducing the ability of blood to get clot. This medicine is given only on serious condition since it can cause life threatening adverse effects of bleeding. This happens when there is inadequate supply of blood that is moving upwards from the legs to the heart. For some people, swelling happens in the evening indicating retention of salt and heart failure.
Some people will be comfortable while sitting but feel intense pain while walking or moving their legs. There can be several reasons for swelling or inflammation of the knee and the pain associated with swollen knee can be mild to severe. Acute injury can occur to anyone during a fall thereby causing accumulation of blood inside the knee. Chronic injury does not happen all of a sudden; rather it takes enough time since it is a gradual process.
In case of infection due to wounds or surgery the fluid inside should be drained out from the space. In this category, the soft tissues present outside the knee joint gets inflamed and becomes swollen. There can be tumor on the knee joint and sometimes knee gets swollen due to deep vein thrombosis (marked by red color and tenderness) which is often seen after prolonged travel or bed rest. The affected knee becomes larger than the other one due to considerable amount of fluid inside.
Before going to hospital, you can apply ice on the swollen knee to reduce the blood flow and decreasing inflammation.
He may also give shots of cortisone for suppressing the immune system and for relieving the pain. Further your doctor will ask you to do regular exercises for reliving the pain and managing inflammation apart from taking medications. This condition occurs for people who are sitting for long time like traveling in car or due to certain medical conditions. In rare cases, DVT can develop complications like postphlebitic syndrome causing swelling of legs and skin discoloration. If the result of blood test indicates presence of D dimer then it is confirmed you have DVT.
It prevents further formation of blood clots and also restricts the size of existing blood clots. In case medicines are not responsive, then filters are inserted into the vein like vena cava in the abdomen which prevents blood clot to move towards your lungs.


You need to consult your doctor if there is excess of swelling with headaches, abdominal pain and nausea.
Sometimes, there may be injury in the ligaments which is holding the ankle when it is stretched beyond limit.
Certain allergic reactions, varicose veins and using contraceptive pills may also cause swollen feet. He will suggest you to wear support stockings if your problem is due to venous insufficiency.
The swelling can be acute or due to sudden injury and sometimes it can be gradual process due to accumulation of synovial fluid.
But due to some reasons, there may be excess of fluid accumulation inside the space causing swollen knee. Gout is yet another reason for causing swollen knee which builds crystals of uric acid inside the space.
Bursitis and haematoma are examples of such condition in which there is extensive fluid accumulation on the top of kneecap.
In case of mild to moderate pain without injury you can use knee braces for reducing the pain and swelling. In rare cases, deep vein thrombosis can become life threatening when the blood clot break loses and reaches the lungs causing pulmonary embolism (block in normal blood flow). Anesthesia given during surgery can cause dilation of veins increasing the risk of blood clotting. Taking hormone therapy for long time and using oral contraceptive pills gives increased risk for getting DVT.
Heparin injection is given for few days and followed as oral pills like Coumadin or xarelto. Venous insufficiency occurs when there is any problem in the valves thus leaking the blood down into the vessels of the lower legs. Inadequate secretion of albumin can cause liver disease which can create swelling in the ankles. If swelling is due to edema, you will be put on diuretic drugs for increasing the output of urine. This type of acute accident can cause the knee to develop swelling within minutes because of the fluid pressure inside. Uric acid is produced during digestion for transporting waste products from the body and people who suffer from gout will have large amount of uric acid inside the knee space causing inflammation and pain. Fluid will get collected due to contusion on the knee or due to forceful injury like a fall.
Taking bed rest for long, undergoing surgery on knee or hip, fracture in the pelvic bone and obesity can cause DVT. Before the doctor begins treatment, he should find out what exactly is the cause of swollen knee.
Sometimes, meniscus tear or sprain on the knee can cause fluid (not blood) to collect inside the joint space.
Conditions like arthritis do not develop overnight since it is a process but it takes sufficient time for healing.
Powerful anti-inflammatory medicines called steroids are sometimes used and may quickly reverse the lung inflammation. Outlook (Prognosis) Acute episodes usually go away within 48 - 72 hours after the medication has been discontinued, but chronic syndromes may take longer to resolve.
Certain types of autoimmune disorders, cancer, smoking, and using oral contraceptive pills for long can cause this problem.
Do not exceed the dosage of any medicine given for DVT since it can land you up in serious condition. But this type of injury takes enough time (delayed swelling) and sometimes days to develop inflammation. In case the swollen knee is without fracture the affected person can move his knee with difficulty. Here the amount of synovial fluid gets collected inside may vary significantly however this type of tear or sprain does not produce any tense moments like that of blood accumulation due to rapid injury. The seriousness of the disease depends on what exactly caused swelling and accordingly the treatment is given. Usually upon waking in the morning, the limb or affected area is normal or almost normal in size. Fibrosis found in Stage 2 Lymphedema marks the beginning of the hardening of the limbs and increasing size.
Stage 3 (lymphostatic elephantiasis): At this stage, the swelling is irreversible and usually the limb(s) or affected area is very large. This remains controversial, however, since the risks may outweigh the benefits, and the further damage done to the lymphatic system may in fact make the lymphedema worse. This provides a clear technique which can be employed by clinical and laboratory assessments to more accurately diagnose and prescribe therapy for lymphedema.
Physicians and researchers can utilize additional laboratory assessments such as bioimpedance, MRI, or CT to build on the findings of a clinical assessment (physical evaluation). From this results of therapy can be accurately determined and reported in documentation as well as research.
For example, pleural effusion is an uncommon complication of rheumatoid arthritis and systemic lupus erythematosis (SLE). The difference in circumference is less than 4 centimeters, and other tissue changes are not yet present.
Grade 2 (moderate edema): Lymphedema involves an entire limb or corresponding quadrant of the trunk. For example, cirrhosis of the liver and some kidney diseases may cause a low level of blood protein which allows a pleural effusion to develop.
Grade 3a (severe edema): Lymphedema is present in one limb and its associated trunk quadrant.


Grade 3b (massive edema): The same symptoms as Stage 3a except that two or more extremities are affected.
In this stage of lymphedema, the affected extremities are huge due to almost complete blockage of the lymph channels. As a whole range of conditions can cause a pleural effusion, there is a large range of other symptoms that may occur, depending on the underlying cause. One example is you may have a cough and a fever if the cause is lung infection (pneumonia).
In many patients with cancer this condition does not develop until months or even years after therapy has concluded.
Lymphedema may also be associated with accidents or certain diseases or problems that may inhibit the lymphatic system from functioning properly.
In tropical areas of the world, a common cause of secondary lymphedema is filariasis, a parasitic infection. Lymphedema may be present at birth, develop at the onset of puberty (praecox), or not become apparent for many years into adulthood (tarda). Some cases of lymphedema may be associated with other vascular abnormalities.Lymphedema affects both men and women.
In women, it is most prevalent in the upper limbs after breast cancer surgery and lymph node dissection, occurring in the arm on the side of the body in which the surgery is performed. It may also occur in the lower limbs or groin after surgery for colon, ovarian or uterine cancer in which removal of lymph nodes is required. For breast cancer survivors, wearing a prescribed and properly-fitted low-compression sleeve and gauntlet may help decrease swelling during flight.Some cases of lower-limb lymphedema have been associated with the use of Tamoxifen, due to the blood clots and deep vein thrombosis (DVT) that can be caused by this medication. Unfortunately, there is no generally accepted worldwide criterion of difference definitively diagnostic although a volume of difference of 200 ml between limbs or a 4 cm (at a single measurement site or set intervals along the limb) is often used. Recently the technique of bioimpedance measurement (a method that measures the amount of fluid in a limb) has been shown to have greater sensitivity than these existing methods and holds promise as a simple diagnostic and screening tool. Impedance analysers specifically designed for this purpose are now commercially available.Similarly assessment and monitoring of lymphedema progression or its response to treatment is usually based on the changes in volume, circumference or impedance over time. Most people with lymphedema follow a daily regimen of treatment as suggested by their physician or certified lymphedema therapist.
The most common treatments for lymphedema are a combination of direct lymphatic massage, compression garments or bandaging and the use of intermittent sequential gradient pumps.
It is sometimes used in people with effusions due to cancer when other treatment options have failed. Complex decongestive physiotherapy is an empiric system of lymphatic massage, skin care, and compressive garments. Depending on the therapist's discretion, a compression garment may be custom-fit or purchased in over-the-counter, standard sizes. Compression garments are meant to be worn every day to maintain edema reduction and must be replaced on a regular basis.Bandaging or WrappingCompression bandaging, also called wrapping, is the application of several layers of padding and short-stretch bandages to the involved areas. Short-stretch bandages are preferred over long-stretch bandages (such as those normally used to treat sprains), as the long-stretch bandages cannot produce the higher tension necessary to safely reduce lymphedema and may in fact end up producing a tourniquet effect.
During activity, whether exercise or daily activities, the short-stretch bandages enhance the pumping action of the lymph vessels by providing increased resistance for them to push against. This encourages lymphatic flow and helps to soften fluid-swollen areas.A new adjunct treatment is being taught to therapists using a special type of tape called Elastic therapeutic tape.
It is used to help soften edemas.Sequential Gradient Pump TherapySequential Gradient Pump Therapy has been utilized for over 30 years throughout the world.
Compression pump technology utilizes a multi-chambered pneumatic sleeve with overlapping cells, to gently move the lymph fluid. These compression devices are recognized treatments and approved by Medicare and most insurance plans in the USA.
Patients may often receive treatment on a pump for 10-15 minutes before an MLD (Manual Lymphatic Drainage) session to help break up fibrotic (hard) tissue.
By softening or breaking up the fibrosis, the MLD Therapist may be more effective with the given treatment. Many patients may benefit from a pump without ever going to MLD sessions, as they are very beneficial, but not a requirement. However, after completion of the appropriate number of MLD sessions, many patients will benefit from a home use of a sequential pump. The technique was pioneered by Emil Vodder in the 1930s for the treatment of chronic sinusitis and other immune disorders. Initially, CDT involves frequent visits to a certified therapist with a doctor's prescription. Once the lymphedema is reduced, increased patient participation is required for ongoing care, along with the use of elastic compression garments and non-elastic directional flow foam garments.Manual manipulation of the lymphatic ducts consists of gentle, rhythmic massaging of the skin to stimulate the flow of lymph and its return to the blood circulation system.
In the blooda€™s passage through the kidneys, the excess fluid is filtered out and eliminated from the body through urination. The treatment is very gentle and a typical session will involve drainage of the neck, trunk, and involved extremity (in that order), lasting approximately 40 to 60 minutes. CDT is generally effective on non-fibrotic lymphedema and less effective on more fibrotic legs, although it has been shown to help break up fibrotic tissue.Surgical techniquesSurgical techniques for correcting lymphedema may be excisional or physiological. Modified Liposuction has been developed in Sweden in recent years to remove adipose tissue associated with longstanding lymphedema, primarily in the upper region. Early prevention and disease regression in breast cancerIn 2008 an NIH study revealed that early diagnosis of lymphedema in breast cancer patients (called stage 0 in the article) associated with an early intervention, a compression sleeve and gauntlet for 1 month, led to a return to pre operative baseline status. In a 5 year follow up patients remained at their pre operative baseline, suggesting that pre clinical detection of lymphedema can halt if not reverse it progression.



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