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1

Physical therapy of lymphedema in experience from the German school

100%

Mrozińska M.

Physiotherapy

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2009

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vol. 17

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issue 3

62-68

PL

Obrzęk chłonny jest schorzeniem, z którym coraz częściej spotykają się w swojej praktyce zawodowej zarówno lekarze, jak i fizjoterapeuci. Wynika to z faktu powszechności tej choroby - wg WHO jedna na 20 osób na świecie cierpi z tej przyczyny, oraz z rosnącej liczby czynników etiologicznych, szczególnie chorób nowotworowych mających w powikłaniach obrzęk limfatyczny. Rodzi się zatem potrzeba poznawania mechanizmów powstawania, objawów, a przede wszystkim metod leczenia obrzęków, które umożliwiłyby konkretną i efektywną pomoc chorym. Wyzwania te jako pierwsi podjęli lekarze i fizjoterapeuci niemieccy opracowując kompleksową fizykalną terapię obrzęków. Lata udoskonalania metody pozwoliły na sprecyzowanie skutecznego sposobu leczenia tego schorzenia, zagwarantowały rzeszę wysoko wyspecjalizowanych terapeutów oraz refundowanie tej terapii przez system opieki zdrowotnej.

EN

Lymphoedema is a chronic condition becoming more commonly encountered by both physicians and physiotherapists. It results from the fact that lymphoedema is now more and more widespread - according to the WHO it affects 1 in 20 people in the world. The increasing number of etiological factors, and especially neoplastic disease are also responsible for increasing the prevalence of lymphoedema. Therefore it is very important to study pathophysiology of lymphoedema and to develop more effective methods of treatment. Introduction of modern complex physical therapy of lymphoedema we owe to German physicians who were the first to develop and apply this method to lymphoedema therapy. Over years the CPT method was perfected, great numbers of therapists were trained in CPT and the method was recognized and reimbursed by the German healthcare system.

2

The usefulness of lymphoscintigraphy in the assessment of physiotherapeutic methods in the management of lymphoedema

100%

Tomczak H., Nyka W.

Medical Rehabilitation

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2006

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vol. 10(4)

25-30

EN

Lymphoedema is the progressive accumulation of protein-rich fluid in the tissue, resulting froman anatomic or functional obstruction of the lymphatic system. Worldwide about 10 million people have lymphoedema secondary to breast and pelvic cancer therapy, recurrent infections, injuries or vascular surgery. The disease is frequently misdiagnosed treated too late or not treated at all. At the initial medical evaluation of patients with suspected extremity lymphoedema, it is highly desirable for physicians to define the abnormality; to determine whether the suspected abnormality is, in fact, a lymphatic one. The disease is often possible to be diagnosed by its characteristic clinical presentation, yet, in some cases, ancillary tests might be necessary to establish the diagnosis. The presentation overviews the problem of clinical basis, diagnosis and therapy of lymphoedema. Regarding diagnostics the measurement of circumference and volume of the limb are presented, as well as diagnostic imaging modalities. These include direct and indirect lymphography, MRI, CT, ultrasound imaging and lymphoscintigraphy, which are currently considered to be a leading technique in the primary diagnosis of lymphoedema and its follow-up. The paper presents the usefulness of lymphoscintigraphy in: - diagnosis of lymphatic oedema; - assessment of the efficacy of therapeutic methods; - prediction of the outcome of therapy; - assessment of the risk of development of lymphoedema. The role of lymphoscintigraphy in the management of lymphoedema will be probably growing for a few reasons: - the higher incidence of breast cancer and longer survival of patients; - the need of early diagnostic methods, evaluation of lymphoedema over a period of time, development of new therapeutic techniques and finding methods to assess objectively the effect of therapy.

3

Lymphedema of upper limb after radical treatment of breast cancer patients: current management principles

84%

Kołodziejski L. S., Łobaziewicz W., Ochałek K., Niedbała E.

Medical Rehabilitation

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2009

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vol. 13(2)

23-31

EN

Upper limb lymphedema (ULL) is the most severe late complication following radical treatment of breast cancer (BC). It can be caused by both cancer recurrence and previous therapy (lymphadenectomy, axillary radiotherapy). In BC survivors, ULL- inducing factors include: previous irradiation treatment, infections within the upper limb or the scar, high BMI. Diagnosis of ULL makes use of measurements of the circumference and volume of the limb, imaging, measuring electrical impedance of tissues and lymphoscintigraphy which determines the type and severity of lymph flow disturbances. ULL has a chronic and progressive nature leading to physical, psychic and social disability and, on rare occasions, to secondary neoplasms of the lymphatic system. Therapeutic management involves: patients’ education, complex physical therapy (manual lymphatic drainage, compression therapy), reduction and drainage surgery (microsurgery) as well as liposuction. The most effective conservative procedures include complex physical therapy and particularly manual lymphatic drainage with compression therapy. Failure of conservative therapy indicates the need for surgery. Liposuction is a currently preferred surgical procedure because of its simplicity and a low percentage of complications. Surgery should be complemented by constant compression therapy. Due to low efficiency of all the methods applied, ULL prevention is of paramount importance. It should consist in rationalising indications for oncological treatment (lymphadenectomy, radiation therapy).

4

Problems associated with physiotherapeutic management of patients after breast cancer surgery

84%

Kołodziejski L., Niedbała E.

Medical Rehabilitation

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2008

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vol. 12(2)

24-30

EN

Breast cancer (BC) is the most frequent malignant neoplasm in women in Poland and its treatment majorly depends on the degree of disease progression. Surgery is the main radical therapy of BC. In most cases, this therapy involves mastectomy with excision of the lymphatic system of the axilla. Breast-saving treatment is used in patients at early stages of breast cancer. This treatment involves excision of the primary tumour within the broders of the unchanged tissue and of the axillary lymphatic system followed by breast irradiation. The majority of early and late complications of surgery are due to the axillary lymphadenopathy, the sequel of surgical therapy. Early inpatient rehabilitation is initiated on the day of the surgery and aims at prevention of the following states: hypo-ventilation and inflammatory pulmonary complications, thrombo-embolioc complications, early post-operation oedema, restrictions in movements in the shoulder joint and acute psychotic syndromes. It also prepares the patient for every-day activities, anti-oedema preventive care and teaches performance of physical exercises. Late rehabilitation conducted at home, as outpatient care or during balneological treatment is a continuation of the early rehabilitation. It involves improvement of shoulder functioning, prevention of incorrect posture, anti-oedema care and providing psychological support. Regular motor exercises improve functioning of the extremity ipsilateral to the side of breast surgery, prevent incorrect posture and the associated ailments. The majority of problems are associated with the therapy of late lymphoedema of the upper limb. Physiotherapeutic management results in measurable effects: amelioration of spontaneous lymph outflow, reduction of oedema size, improvement in limb agility reduction of ailments; it is, however, not always sufficient. Effectiveness of various management approaches is still a subject of discussion.

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Physical therapy of lymphedema in experience from the German school

The usefulness of lymphoscintigraphy in the assessment of physiotherapeutic methods in the management of lymphoedema

Lymphedema of upper limb after radical treatment of breast cancer patients: current management principles

Problems associated with physiotherapeutic management of patients after breast cancer surgery