Diagnosis of Lymphoedema

Lymphoedema is a condition often associated with cancer survivors, particularly those who have undergone surgery or radiation therapy, but it can also occur due to other chronic conditions or injuries. Characterized by the swelling of limbs due to the accumulation of lymphatic fluid, lymphoedema can significantly impact a person’s mobility, emotional well-being, and overall quality of life. Early diagnosis of lymphedema and management are key to preventing long-term complications, and at Melbourne Massage and Treatment in Fitzroy North, Giovanni, a skilled Myotherapist and Lymphoedema therapist, specializes in identifying and managing this condition using a combination of manual techniques and physical assessments.

In this blog, we’ll explore how lymphoedema is diagnosed, the challenges of identifying it early, and Giovanni’s approaches to detecting and managing the condition.

What is Lymphoedema?

Lymphoedema occurs when there is a disruption in the lymphatic system, leading to the accumulation of lymph fluid, a protein-rich fluid that sits beneath the skin and between the body’s tissue, which often causes swelling in the limbs or other areas of the body. This condition can develop due to a variety of factors, such as lymph node removal during surgery, radiation treatments, injury, or genetic predisposition. Early detection of lymphoedema is crucial to prevent the condition from worsening and causing complications like tissue fibrosis, infections, or reduced mobility.

Challenges in the Diagnosis of Lymphoedema

Lymphoedema can be difficult to diagnose, especially in its early stages. In its initial phase, symptoms such as heaviness, tightness, or mild swelling may seem subtle and easy to overlook. Patients might attribute these sensations to muscle strain or arthritis, delaying the diagnosis. Furthermore, swelling can fluctuate, making it even harder to identify at the outset.

By the time noticeable swelling occurs, the condition may have already advanced, complicating treatment and requiring more intensive management. This is why early detection is so important, as it allows for less invasive treatments and better long-term outcomes.

Giovanni’s Approach to Diagnosis of Lymphoedema

As a Myotherapist and Lymphoedema therapist at Melbourne Massage and Treatment, Giovanni uses manual techniques and physical assessments to diagnose lymphoedema. Although he does not use imaging technology or machines to detect the condition, Giovanni’s training and experience enable him to identify the signs and symptoms through careful observation, palpation, and physical examination. That said, if it is needed, Giovanni can write a referral doctor for your GP to indicate why he believes it is important for you to undertake a specific scan or some medical test.

1. History taking

The earlier approach to Lymphoedema diagnosis is an extended look at the medical history, where any past surgery, injury, accident or medications need to be outlined and taken into consideration.

2. Clinical Assessment

Following the history taken to diagnose lymphoedema is the clinical assessment. Giovanni conducts a thorough physical examination of the affected limb or area, paying close attention to key signs of lymphoedema, such as:

• Persistent swelling that doesn’t subside with rest
• Feeling of heaviness or tightness in the limb
• Changes in skin texture, such as hardening or thickening
• Reduced range of motion in the affected area

Along with your booking confirmation, you would also receive a form to fill in online, which would start paving the road to your diagnosis.

3. Tape Measurement Method

One of the simplest, yet effective, ways Giovanni diagnoses lymphoedema is by using tape measurements. This involves measuring the circumference of the affected limb at various points (e.g., wrist, forearm, upper arm) and comparing these measurements to the unaffected side. Over time, consistent and progressive changes in limb circumference can indicate the development of lymphoedema.

While this method is cost-effective and easy to perform, it may not detect early, subtle changes in limb volume. However, when paired with other assessments, it offers valuable information about the progression of the condition.

4. The Pitting Test

Giovanni often performs the pitting test, a hands-on method to assess fluid accumulation in the affected area. This simple test involves pressing down on the swollen area with his fingers. If an indentation (or “pit”) remains for several seconds after the pressure is released, it indicates the presence of excess fluid in the tissue, which is a hallmark of lymphoedema. The pitting test helps Giovanni evaluate the severity of fluid retention, but it is more subjective than advanced diagnostic tools.

5. Stemmer’s Sign – Tissue assessment

Giovanni also uses palpation (manual examination through touch) to assess the affected area’s tissue texture and consistency. In the early stages of lymphoedema, the tissue may feel soft and puffy, but as the condition progresses, it can become firmer, and in some cases, the skin may develop a thicker, fibrous texture. These changes are essential indicators of lymphoedema and are crucial for determining the stage of the condition. In addition to this, the Stemmer’s Sign is a test that consists of picking what we would expect to be wrinkled skin, like the one just before the toe/tarsal joint. A positive test would result in the impossibility of pinching any skin due to the swelling in the area.

6. Lymphoscintigraphy

A lymphoscintigraphy is a scan that is part of nuclear medicine tests, and it is specifically used to detect any interruption within the lymphatic system.
The test is done in the specific clinic, and no recovery is needed for it. The procedure consists of injecting a radioactive liquid either in the feet or hands and with a specific camera, detecting the movement of the liquid within the body. We would expect the liquid to move within a certain timing and pathway along the lymphatic system. If that doesn’t happen, this test can give a good understanding if anything is not functioning with teh lymphatic system.

Why Early Detection is Crucial?

The earlier lymphoedema is detected, the easier it is to manage. Early-stage lymphoedema is often easier to treat with less invasive interventions, such as manual lymphatic drainage (MLD), compression therapy (CDT), specific exercises, and skin care. These treatments can help reduce swelling, prevent the condition from worsening, and improve the patient’s overall quality of life.

Timely management can also help avoid complications like cellulitis (infection), fibrosis (thickening of tissue), and mobility limitations. In some cases, lymphoedema can become disabling if left untreated. Early intervention significantly reduces the risk of these complications, helping patients maintain greater independence and mobility.

Differential Diagnosis

As mentioned in another blog, there are two major types of Lymphoedema: primary and secondary. That said, swelling in the limbs could be due to other pathologies, such as:

• Varicose vein
• Vein insufficiency
• High blood pressure medications
• Lipedema
• Deep vein thrombosis (DVT)
• Cardiac disease
• Renal disease
• Metabolic disease
• Myxoedema (hypothyroidism)

All the presentations listed above are serious conditions to consider, and this is why a detailed clinical history and the communication between Giovanni and your GP are important.

Giovanni’s Treatment Approach

As a Myotherapist and Lymphoedema therapist, Giovanni uses a holistic approach to managing lymphoedema. Alongside the diagnostic process, he works with clients to develop a tailored treatment plan that may include:

• Manual Lymphatic Drainage (MLD): A gentle massage technique designed to encourage lymph flow and reduce swelling.
• Combined Decongestive Therapy (CDT): The use of bandages, garments, or sleeves to assist in managing swelling and fluid retention.
• Exercise: Targeted movements to improve lymphatic flow and prevent fluid buildup.
• Skin Care: Techniques to protect the skin from damage and reduce the risk of infection.

Giovanni’s comprehensive, hands-on approach helps clients manage lymphoedema effectively and improve their overall quality of life.

Conclusion: The Importance for Early Diagnosis of Lymphoedema and its Management at Melbourne Massage and Treatment

At Melbourne Massage and Treatment in Fitzroy North, we specialize in diagnosing and treating lymphoedema through a combination of physical assessments, manual techniques, and personalized care plans. Giovanni’s expertise as a Myotherapist and Lymphoedema therapist ensures that each client receives the highest level of care tailored to their individual needs. Early detection and treatment of lymphoedema can make all the difference in preventing complications and improving long-term outcomes.

If you’re concerned about lymphoedema or believe you may be at risk, don’t wait for symptoms to worsen. Contact us today to book a 15-minute free online appointment with Giovanni for a thorough evaluation and a customized treatment plan.