EDEMA.
DEFINITION
– Edema is an abnormal and excessive accumulation of fluid within interstitial space or cavities.
• Types
(A) Depending upon the extent
(1) Localized edema :
– Localized to an organ or limb
– For e.g., Inflammatory, lymphatic, toxic.
(2) Genralized edema :
– It is systemic in distribution .
– For e.g., Cardiac , renal, nurtitional.
(B ) Depending upon nature of fluid
– Exudative
– Trasudative
(C) depending upon depth of fluid displacement
✓ Pitting edema :
– Pressure by fingers produces a depression.
– E.g, edema in Subcutaneous
✓ Non-pitting edema :
– There is no depression on pressure
– E.g, Myxoedema, elephantiasis etc.
(D) Others
– pulmonary edema
– cerebral edema
• Signs and symptoms
✓ swelling
✓ warmth
✓ redness
✓ Pain and tenderness
✓ Pitting or non-pitting edema
✓ Loss of skin crease or texture
✓ Rashes , itching.
• Assessment and PT management
(A) Data Base :
– Name
– Age
– Sex
– Occupation
(B) Subjective assessment
– Chief complaint
– History :
√ Onset
√ Duration
√ Intensity
√ Cause
– Any surgical or medical history
– Family history
(C) Objective assessment
(1) On Observation :
√ Built of patient
√ Attitude of limbs
√ swelling
√ Any surgical notes
√ side, site of edema
√ trophical changes
√ Peripheral pulsations
√ Temparature
(2) On examination :
√ edema
√ MMT of muscle
√ ROM of joints
√ Limb and muscle girth measurements
√ Volumetric measurements
• Levels of limb measurements
(a) Upper limb
– Axilla
– 8cm proximal to Olecranon process
– 11cm distal to Olecranon
– Wrist level of thumb.
(b) For lower limb :
– Groin
– 15cm above patella
– 15cm below patella
– Ankle ( malleoli)
– Middle of metatarsals.
Both affected and unaffected limbs must be measured.
•PT management
(1) Elevation of affected limb
(2) Application of anti – embolic stockings and pressure bandage , lymphedema sleeves .
(3) Faradism under pressure If the joints are unable to move due to severe accumulation of fluid and pain
(4) Pneumatic compression machine
– Intermittent mode
– Sequential mode
It helps to give compression to the limb from distal to proximal
(5) Soft tissue manipulation
– Massage
– Kneading , stroking, efflurage
– ultrasound
– Pulsed electromagnetic energy
(6) Exercises
– Distal joint mobilization
– Active movements of involved joints in elevated position
– It Helps in mobilization of fluid from the subcutaneous tissues
– It can be done 4-5 times /day.
– Ankle – toe movements
(7) Advice to the patients
– Prevent prologed standing or walking or in dependent position.
– Keep the affected limb in elevated position
– Prevent any injury over affected limb due to high chances of infection
– Do not take hot baths
– Do not wear tight bands , ankles , rings or jewellery on swollen limb
– Wear appropriate foot wear with elastic stockings.
