Utilization of a home exercise program with self-manual lymph drainage for a patient with

upper extremity lymphedema

Marissa M. Hansen, SPT; Eric Shamus, PhD, DPT, CSCS; Russell Hogg, PhD
Department of Rehabilitation Sciences

Interventions: Outcomes:
Case Presentation:
•Initial Visit •Presented with decreased edema of the trunk and left upper
•Background & Purpose •Evaluation & patient education on lymphedema and upcoming treatment extremity
•Visits 2 to 4 •Active and passive ranges of motion brought into functional
•This case presentation describes the physical
therapist examination, evaluation, and •Focus on decreased left upper extremity volume ranges
•Manual lymph drainage applied to left upper extremity and trunk •The patient reported a return to all functional activities,
interventions for a patient with left upper
extremity lymphedema •Self-manual lymph drainage emphasized due to decreased frequency of without pain or difficulty overhead
visits •The patient had about a 9% reduction in volume, according to
•Case Description •Multi-layer compression bandaging, therapeutic exercise, and skin care the Matthews & Smith Formula
•Visit 5 •(Note: This formula has not been validated for measuring a
•55 year old female
•Left upper extremity lymphedema after •First visit after breast reconstruction so patient was re-measured decrease in volume, but gives an overall view of reduction of
surgery and chemotherapy for breast cancer •Deemed appropriate for compression garment; instructed in garment care, lymphedema when combined with girth measurements)
•breast cancer in late 2013, bilateral fit, donning, and doffing
Initial & Final Circumferential Measurements
mastectomy in January 2014 •Visits 6 to 9 Location Distance from Left Upper Left Change
•Single lymph node removed; tested •Continued focus on decreasing limb size Anatomical Extremity Upper (cm)
negative for cancer •Increased emphasis on self-manual lymph drainage and at-home Landmark Initial (cm) Extremity

•Presented swelling in left upper management/maintenance of symptoms Final (cm)

extremity •Importance of skin care again emphasized

Metacarpals On metacarpals 18.4 17.2 1.2
•Decreased range of motion •Additional exercise progressions given
Wrist At the styloid process 16.2 14.9 1.3
•Inability to complete functional tasks, •Final measurements taken at visit 9 Distal 8cm superior to 20.1 17.5 2.6
•Pain Forearm styloid process
Before and After Photos
•Decreased active and passive left shoulder Proximal 16cm superior to 25.8 22.7 3.1
Forearm styloid process
flexion and abduction
Elbow Taken at the elbow 26.7 24.7 2.0
•Difficulty reaching overhead crease
Distal Upper 8cm superior to the 30.5 28.5 2.0
•Interventions Arm elbow crease
•Patient received Complete Decongestive Axilla On the humerus, 37.7 34.3 3.4
Therapy 2-3 times/week for a total of 9 even with the
superior aspect of
visits
the axilla
Total: 175.4cm 159.8cm 15.6cm
•Outcomes
Conclusion & Discussion:
•Limb circumferences were at or below
•Most studies recommend a frequency of 5x/week during the
the size of the contralateral control limb
Plan of Care: initial stage of treatment
•Range of motion was increased back to
•Complete Decongestive Therapy (CDT) is the gold-standard treatment •This was unattainable due to various factors
functional limits, and the patient was
•Manual lymph drainage, Compression Bandaging, Therapeutic Exercise, •This case study proves reductions in volume and
able to resume all functional activities
circumference are still possible with suboptimal frequencies.
•This case presentation demonstrates the and Skin Care & Skin Care Education
•Research recommends 5x/week The increased emphasis on the home program and self-care was
effectiveness of a home exercise program
•This patient only able to attend 2-3x/week due to the breast reconstruction in the middle of her treatments,
with a focus on self-manual lymph drainage
likely lengthening the duration of treatment