Works simultaneously with the venous system for fluid return
Removes plasma proteins
Filters antigens, bacteria, and waste products
Produces white blood cells, specifically lymphocytes
All white blood cells originate in the bone marrow; organs within the lymphatic system, like the thymus, spleen, and lymph nodes, are crucial for their development and function.
Lymph nodes
A series of sinuses that filter antigens and bacteria. The plasma that seeps out of blood capillaries into the surrounding tissues forms lymph fluid.
* Key to immunological response
Total in the body = 600, with 300 in the head/neck
Two primary lymphatic ducts of the body
Right lymphatic duct
Thoracic duct
Lymph fluid composition
Transparent, yellowish fluid containing water, proteins, lipids, minerals, and hormones
The human body produces 2.4 L of lymph fluid daily.
25 L cycles through the heart
Pathology
Lymphedema
Excessive accumulation of lymph fluid due to dysfunction in the lymphatic system, leading to increased edema
Skin changes – 'peau d’orange’- a medical term describing a characteristic appearance of the skin (skin of an orange)
Related impairments
Functional deficits
Loss of mobility
Difficulty wearing normal clothing
Psychological issues
Stages of lymphedema
Stage 1
Latent, subclinical condition
Swelling not evident despite impaired lymph system
Stage 2
Completely and spontaneously reversible
Soft, pitting edema
Little to no fibrosis
Skin easily pinched and moved
Stemmer sign present
Stage 3
Spontaneously irreversible
Tissues are usually fibrotic
Pitting requires strong pressure or no pitting
Can usually be reversed with treatment
Stemmer sign present
Stage 4 — Elephantiasis
Irreversible
No pitting, significant fibrosis
Hardening of the skin
Stages of lymphedema
Goals of manual lymph drainage
Peristalsis of lymph fluid
Breakdown of fibrotic tissues
Increase lymph volume in lymph vessels
Decrease congestion in the interstitium
Basic principles
Treatment always begins proximally to clear proximal lymph nodes before moving to affected lymphotomes (a specific region of the skin that drains lymph to a particular group of lymph nodes).
Massage is directed towards the cleared lymph node
Pressure is very light
Contraindications
Bacterial infection
Acute congestive heart failure
Acute deep vein thrombosis
Acute renal disease
Acute pulmonary edema
Malignancy
Arterial disease
Sensation deficits
Low blood counts
Areas of inflammation
Open wounds
Bandaging techniques
Compression garments
Maintains the reduction gained during therapy
Transition to garments when reduction plateaus
Garments for daytime wear, options for nighttime
Insurance coverage varies greatly
Therapeutic exercise
Exercises facilitate muscle pumping
Should be done with compression
Progress from proximally to distally
Very low resistance
Patient education
Home exercise
Self-massage
Skin care
Precautions
Compression garments
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