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Edema

EDEMA

What is Edema?

Local or Systemic swelling of our body 
Fluid retention in the interstitial tissue spaces...

Causes


1. Increased permeability of the capillaries

 2. Obstruction of the lymphatic flow
usually d/t...

 Infection
Parasites in the lymphatic system
Lymphadenectomy

 3. Increased capillary pressure or venous pressure
usually d/t...

 HT failure
Thrombophlebitis
Pregnancy
Allergic response ie hives

4. Decrease of plasma protein
accompanying LIV and KID dz
high flow low protein edema

Types of edema

1.Lymphedema

Systemic condition 
affects the entire body

Local lymphatic obstruction 
involves the whole limb distal to the edema site

2. Non-pitted edema
firm and discoloured
usually result from coagulation of serum protein in the interstitial spaces d/t local infection or trauma

3. Pitted edema (Boggy to touch)
usually found in chronic pathology

If you have patient with edema, what kind of question should you ask?

Overall health and surgery history
How did they get it?
Onset of edema?
Are they pregnant?
Have they had edema before?
Did they get checked by MD?
Hot to touch?
Redness?
Any OTC or Rx taking currently?
SE of medication?
Do they wear compression socks?
Provocative?
Palliative?

Where and what do you look for and palpate?

Where is it swollen? Any other area?
Colour
Temperature
Texture 
Tone
Tenderness

Contraindication to treatment?

Full body lymphatic drainage
Local or distal techniques (b/o thrombophlebitis or deep vein thrombosis. They could cause embolism!)
Hydrotherapy
Any infection, Fever
Acute TB
Associated with AIDs

What is the treatment goals?

Reduce edema
Improve ROM
Decrease pain if there is pain

 What are the steps of massage therapy?

 Acute (Wrist edema as an example)
Elevate the wrist

 Lymph drainage
Axilla >> Biceps >> Forearm 

Specific treatment for Acute Edema

Main goal is to reduce the swelling

Diaphragmatic breathing during treatment
to facilitate lymphatic return.

 Direction=proximal to distal

 Tech= Effleurage, stroking

 PROM of proximal and distal to the site of edema

Caution! Don't disturb hematoma if present
Maintain ROM

Specific treatment for Early subacute 

Main goal is to Reduce pain
Cool to cold hydrotherapy
Prevent adhesion formation where appropriate

 Lymphatic drainage from proximal to distal
Mid range PROM is used proximal and distal to the edema

 Contraindication: Local lymph drainage is still

Specific treatment for Late Subacute

Diaphragmatic breathing
Hydrotherapy: Cold/Warm contrast

As edema diminishes, duration of lymph drainage techniques decreases

If safe, increase PROM

Specific treatment for Chronic

Hydrotherapy - depending on tissue health and temperature

 Cold to touch = warm application to flush out the tissue
Warm to touch = cool application

 PROM to the joint proximal and distal to the edema

Home care

Buerger's exercise to promote circulation (raising leg)
AROM of upper limbs
Both are for decreasing the swelling

Frequency of the treatment

 Acute and Subacute
30 mins 3tx/week

 Chronic
45mins 1tx/week

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