Not all swelling is lymphedema. Therefore, in clinical practice it is important to understand the difference between edema and lymphedema.   Edema is the abnormal pooling of fluid in the tissues or accumulation of excess interstitial fluids. It can be generalized (throughout the entire body), or localized (occurring in a specific region or body part). Edema is caused by an underlying medical condition including, but not limited to: blockage of a vein, congestive heart failure, kidney failure, liver cirrhosis, inflammatory reactions, burns, draining wounds, excessive bleeding, malnutrition, and allergic reactions. The most common form of edema is inflammatory edema and can be seen in healthy individuals. This type of localized edema is often an immediate result of trauma or injury to the tissues such as sprained muscles, torn ligaments, and abrasions. Joint swelling secondary to arthritis is another common type of localized edema.   Treatment of edema is directed at correcting or curing the underlying condition since once the condition resolves, the edema dissipates. If it does not dissipate, it can be treated with diuretics and/or decongestive massage therapy. If vascular edema is present, compression stockings may be worn.   Lymphedema is a potentially serious condition caused by a blockage or dysfunction of lymph vessels or nodes, giving forth excess protein-rich fluid, which begins to accumulate, causing chronic swelling in the arms, legs, or other parts of the body. Initially, lymphedema causes uncomfortable swelling. If left unchecked, it can lead to major swelling that can lead to serious infections and, in extremely severe cases, soft tissue cancer. Lymphedema is often associated with, but not excluding, orthopedic, systemic disorders and lymphatic disorders. Lymphedema can affect infants, children, and adults of all ages. There are two types of lymphedema, primary and secondary.   Primary Lymphedema While sometimes hereditary, primary lymphedema often occurs without an obvious cause. This condition may be present at birth, or may develop later in life. Primary lymphedema is more common in women and most often occurs in the lower extremities.   Secondary Lymphedema The most common cause of secondary lymphedema is Chronic Venous Insufficiency (CVI). Secondary lymphedema is also caused by damages to the lymphatic system by infections, radiation, surgery, lymph node removal, orthopedic surgeries and any trauma to the lymph system.   Symptoms of Lymphedema

• Swelling in a limb, face, head, neck, trunk, genitalia
• Heaviness or discomfort in the affected area, often resulting in loss of mobility due to decreased range of motion, strength, endurance
• Repeated infections in a limb (e.g. cellulitis)
• Lymph fluid weeping through the skin
• Thickened skin or fibrosis as well as pitting edema
• Unnecessary discomfort and complications when left untreated
• Chronic wounds
• Swelling in a limb following orthopedic surgery which does not resolve in an appropriate amount of time

If a patient experiences unexplained swelling, it is crucial to work with the physician to find the underlying cause so that a comprehensive plan can be developed to reduce the symptoms and minimize functional deficits.

For more in-depth information on lymphedema treatment options, refer to the Functional Pathways Lymphedema Management Program.

Melissa Ward Director of Clinical Services