Managing arm or breast swelling

Introduction

In order to understand lymphoedema you need to know a little bit about the lymphatic system. The lymphatic system is a network of vessels (tubes) and nodes (glands) that cover the body and drain fluid from the tissues into the blood stream. The lymph vessels collect extra fluid, protein and waste material from the body tissues and transport it through the lymph nodes back into the blood. The lymph nodes filter the fluid of any unwanted material and make special cells that help the body fight infection.

What is lymphoedema?

Lymphoedema is a swelling in the tissues below the skin that occurs when the lymphatic fluid cannot drain away. Lymphoedema can occur in the arm or trunk on the affected side of your body. This can happen if the lymphatic system is damaged or blocked. Similarly, if lymph nodes are removed as part of cancer surgery this can also block the normal drainage pathway. Lymphatic vessels and nodes can also be damaged by the caner and any scarring that follows after surgery or radiotherapy. If lymphoedema fluid is dammed behind the blockage and builds up in the surrounding tissues this can result in tissue swelling.

Other causes that may interrupt or damage the Lymphatic system include:

• Surgery
• Infection
• Severe injury
• Burns
• A congenital or hereditary abnormality.

NOT ALL LYMPHOEDEMA IS CANCER RELATED

Taking care of your skin

Good skin care plays a vital part in the treatment of swollen or at risk areas. Stretched skin can become dry and cracked and any break or injury to the skin is a potential entry for bacteria which thrive in the warm, protein-rich fluid of the swelling.

Prevention of infection in the skin tissues is of great importance. Not only is an infection unpleasant and painful, but it may also cause the swelling to get worse.

Any infection should be treated promptly within a two week course of antibiotics. So if you think you may be developing an infection see your doctor immediately. If you do have an infection, discontinue the use of any hosiery until pain and swelling resolves and stop massage or exercise until it is better.

Some people who suffer repeated infections may be prescribed a small but continuous course of antibiotics over a long period of time as a preventative treatment. If infection tends to be a problem, it may be advisable to take an emergency supply of antibiotics with you, especially if you are going on holiday, just in case they are needed. Your doctor or lymphoedema nurse will advise you.

You may here the term acute inflammatory episode (AIE) or cellulitis. These are commonly used words which refer to an infection of the skin tissues.

Hints for positioning movement

• Do not carry heavy bags on your affected side g. shopping etc.
• Carry your handbag on the other shoulder or in the other hand
• Go easy on heavy housework and gardening
• Avoid using your arm in one position for a long time on the affected side
• Avoid over exertion, do not strain and do not be over vigorous
• When sitting, rest your swollen limb fully supported on cushions on the chair arm and try to keep it fairly straight
• When walking try not to let your arm hang by your side. Try to exercise your arm a little as you go along e.g. hand pumping, elbow bending or try rolling a small pebble or marble in your pocket
• Some people find they get relief by resting their limb on a pillow in bed, this may be worth a try if you find it difficult to get comfortable
• Swimming is a useful exercise and will be especially beneficial if you wear your hosiery (an old one is a good idea as the chlorine can damage the fabric)

Exercises – see leaflet for diagrams

Exercise is important for helping to drain fluid since muscles help to pump lymph out of the limb. Very vigorous exercise, however, causes an increased blood supply consequently forming more fluid in the tissues. Try to do gentle regular exercise rather than intensive bursts, normally twice a day is ideal. Do the exercises slowly, rhythmically and gently.

Remember to wear your hosiery when you are exercising.

The following exercises are designed to help keep your shoulder joint mobile and prevent stiffness and to stimulate drainage in the swollen area by working the muscles. Try about 10 repetitions of each exercise:

1. Place hands behind neck then slowly bring hands down in front of the body then behind the waist.
2. Place hands on top of head then slowly bring down to touch shoulders.
3. Lie or stand for this one – Clasp hands together and lift arms straight up as far as possible.
4. Slowly and firmly spread the fingers, hold for a count of 2 and then relax.
5. Slowly and firmly flex the wrist, bringing the hand back as far as it will go, then slowly flex the wrist the opposite way pointing the fingers towards the floor.
6. Slowly and firmly bend and straighten the arm supporting the elbow if necessary.