The Stages of Lymphoedema

Stage 0

Latent or subclinical lymphoedema. There are no visible signs of lymphoedema despite the lymphatic system not working to “normal” capacity. You may feel it is slightly different, heavier, tight, tired or tingley.

Stage 1

Swelling is evident and pitting may occur as protein-rich fluid is accumulating in affected areas. This swelling normally resolves overnight or with elevation.

Stage 2

The affected limb may pitt less as fatty or fibrous tissue is being laid down. The swelling now does not resolve overnight or with elevation. Other tissue changes such as inflammation, hardening or thickening can occur.

 Stage 3

Swelling is significant and the affected area can become quite large. Skin can become hard, dry and thick.

Early detection and measurement of Lymphoedema – Bioimpedance Spectroscopy

Bioimpedance Spectroscopy is a non invasive measurement tool used in the clinical assessment of those with lymphoedema or those at risk of lymphoedema.

 How it works:

  • bioimpedance uses an electrical signal which measures the extracellular fluid level in the arm or leg and,
  • the speed in which the fluid travels from one arm to the other or one leg to the other

Lymphoedema is characterised by an increase of extracellular fluid in the affected area which results in a higher reading on bioimpedance – this is called a Lymphoedema Index Measure or LDEX.

What can you do with this information?

Bioimpedance is particularly important for the early detection of even pre-clinical levels of lymphoedema (Stage 0). This is before visual signs of lymphoedema are noticeable such as pitting, changes in circumferential measurement, or changes in fit of clothing or jewelry.

Early intervention would be implemented at this stage which may prevent progression of stages of lymphoedema. This would be a valuable measurement for those undergoing treatment or following treatment for breast cancer.

When will your physiotherapist perform a LDEX measurement?

Pre op assessment: measure your “base line” before surgery. This is great information to have and will help with monitoring for lymphoedema following breast cancer surgery.

Post op assessment: measures any change in fluid in the weeks or months following surgery.

Follow up: your therapist may perform follow up LDEX measurements to help determine if your current treatment is effective. Changes can be made to treatment based on the LDEX and other objective and subjective measures to help better control lymphoedema.

 

 

About the Author



Ashley has completed Level 1 course for the treatment and management of lymphoedema through Lymphoedema Training and Education in 2014 and has completed Level 2 Lymphoedema training including the treatment of complex lymphoedema patients through Lymphoedema Education Solutions in 2016. Ashley is also a member of the Australasian Lymphology Association and on the National Lymphoedema Practitioner Register.


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