Lymphedema is a chronic condition that is gaining more and more importance in scientific circles due to the application of increasingly effective treatments. It is, in fact, turning out to be no longer a condition without an answer, but an area open to both different treatment possibilities and significant future developments.
Lymphedema is an edema, that is to say a build-up of liquid or swelling, with a high interstitial protein concentration. It is the result of a reduction in the transport capacity of lymphatic circulation.
The increase in protein concentration differentiates it from all other edemas and is responsible for symptoms and signs that allow the classification of primary and secondary lymphedema.
Primary lymphedema refers to lymphedema evident already in the first months of life, in childhood or at a young age. It normally appears as a result of structural alterations of the lymphatic system already present at birth.
Secondary lymphedema refers to lymphedema that manifests itself following events such as the removal of lymph nodes following cancer surgery, the degeneration of lymph nodes following radiotherapy, due to trauma and parasitosis (including filariasis).
Diagnosing lymphedema is an essential procedure to establish the most suitable therapy to carry out.
Lymphedema is mainly clinically diagnosed through direct medical examination of the affected limb, although it can be done by instrumental examinations in order to confirm the suspected diagnosis.
The main aid to diagnosing this condition is that it typically affects a single limb. This means it is easier to recognise and distinguish it from other conditions.
Differential diagnosis, i.e. the one that attempts to exclude from various similar conditions those that do not include the set of symptoms found during the examinations, must be performed in the presence of edema related to congestive heart failure, renal failure and hepatic failure. In fact, these three conditions often have edema among their symptoms.
Generally, edema is defined as a build-up of fluid that occurs in the body’s interstitial spaces.
There are many types of edema. From those defined as “physiological” to “pathological”, typical of a dysfunction often caused by organ disease.
Physiological edema, such as hydrostatic edema, premenstrual edema and gravid edema, are characterised by transient dysfunction often due to overload.
In the case of pathological edema, however, organ disease is often recognised. These include renal edema, cardiac edema and hepatic edema. In other cases (mixedema, rheumatic edema, phlebedema, lipedema, lymphedema), there is a specific disease or condition in progress.
Anatomy-physiology of the lymphatic system
Our body contains two major systems designed to transport blood: the arterial system and the venous system. The two systems converge on the periphery, where arterial, venous and interstitium capillaries meet.
Arterial blood arrives along the capillaries carrying nutrients to the tissues, while the venous system begins to collect the waste substances.
The interstitium is composed of a network of cells and fibres and is the place where interstitium fluid flows, composed of water, proteins, mineral salts and cells of various types including viruses and bacteria.
The lymphatic system is a drainage system working in tandem with the venous system and its main task is to drain the interstitial fluids present in the peripheral connective tissue. If there is an increase in the production of interstitial fluid, the lymphatic system will maintain its equilibrium.
It is precisely when this does not happen that we have the condition known as “edema”.
Lymphedema produces telltale symptoms including chronic swelling of the limbs, and a feeling of heaviness, tightness and soreness of the affected limb.
It is a condition that manifests itself asymmetrically. That is to say it only affects one arm or one leg. Even in the rare cases in which it can affect both limbs, one limb tends to be more swollen than the other.
The swelling may be slight or severe, to the point where it can degenerate in certain cases into elephantiasis, a disease characterised by an abnormal thickening of the skin and the underlying connective tissue.
These are not the only symptoms that a patient with lymphedema can display.
Almost all the other symptoms concern the skin. The skin, in addition to thickening, actually becomes more fragile and more prone to infections. Moreover, a variation in colour can be clearly noted, with the skin appearing more shiny and discoloured.
In some cases, the subject affected, in addition to the weight and constriction of the limb, may experience tight and itchy skin.
This is why lymphedema may be a bothersome but not painful condition.
Some of the causes of lymphedema include:
- Infectious cellulitis: an inflammation of the skin and subcutaneous tissue caused by a bacterial infection
- Diabetes: an accumulation of sugar in the blood
- Erysipelas: an acute skin infection involving the lymphatic vessels, especially of the legs, arms and face
- Obesity: a condition caused by excess body fat
- Turner’s syndrome: a syndrome characterised by the absence of one of the two X chromosomes in women
- Phlebothrombosis: also known as deep vein thrombosis, caused by the obstruction of a vein by a blood clot, without previous inflammation of the wall
- Burns: involving damage to the skin and underlying tissue
Physical therapy involves the execution of physiotherapy exercises for the treatment and rehabilitation of the hand, hip, knee, foot and limbs in general.
There are many possible therapies for treating lymphedema. These include:
- Manual lymphatic drainage
- Respiratory physiotherapy
- Hydrokinetic therapy
- Altering the diet
- Drug therapy
- Physical therapy (for example, electrostimulation)
- Derivative microsurgery
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