ktph powerpoint template. recovery after breast... · bandaging • reduction phase • high...
TRANSCRIPT
Senior Physiotherapist
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Limited shoulder movements/stiffness
Lymphoedema • Chest complications • Cording (axillary web
syndrome) • Decreased exercise tolerance • Psychological issues/Self-
image issues • Infections
Post-op Complications
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• Fear • Pain • Position during operation
Why shoulder limitations?
Pendulum Shoulder Rotation
Physiotherapy for the shoulder
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Shoulder flexion Wall Climbing
Physiotherapy for the shoulder
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Posterior Capsule
stretch
Hand behind back
stretch
Physiotherapy for the shoulder
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• Joint mobilisation • Soft tissue mobilisation • Progress of home exercises
• Stretching • Strengthening
Physiotherapy for the shoulder
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• The result of accumulation of fluid and other elements (e.g. protein) in the tissue spaces due to imbalance between interstitial fluid production and transport
• Damage to lymphatic vessels and/or lymph nodes • Can impact greatly on patient’s physical and
psychosocial health • Progressive, chronic condition • May be alleviated by appropriate management
Lymphoedema
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• Combination of 1. Education 2. Exercise 3. Manual lymphatic drainage (MLD) 4. Compression
Lymphoedema Management
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1. Education
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• Feeling of ‘heaviness/tightness/fullness’ • Aching • Tight sleeves/clothing/jewellery • Changes in density/appearance of skin • Limited movements of the affected arm • Observable swelling
Early Signs of Lymphoedema
(Lymphoedema Framework 2006)
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• Avoid • Tight bras, fitting clothing and jewellery • Exposure to extreme cold or heat • ‘Trauma’ to the limb
• Have a balanced diet • Maintain optimal body weight • Wear compression garments (if prescribed) • Wear well fitting compression garments with flying • Undertake exercise/movement and limb elevation (Lymphoedema Framework 2006)
Advice for ‘At Risk’ Limb
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• Lifting advice • 2-4 weeks (sentinel lymph node surgery) • 2-3 months (axillary clearance)
• Skin care • Skin and nails • Moisturize skin • Minimize the risk of cuts/bruises/burns • Immediate medical care if infected • Use high factor sunscreen and insect
repellent/mosquito nets (Lymphoedema Framework 2006)
Advice for ‘At Risk’ Limb
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2. Exercise
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• Avoid inactivity • Positive impact on body weight, overall fitness,
muscle strength, flexibility and quality of life (Courneya,
2012)
• Resistance exercises increase lymphatic flow • Significant reduction in lymphoedema with a 8 week
exercise programme (Guatam, 2011)
• Early physiotherapy with education after surgery for breast cancer associated with a lower risk of secondary lymphoedema (Lacomba, 2010)
• No increase in risk of lymphoedema with weight lifting exercises (Schmitz, 2010)
Exercise
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• Resistance training • Supervised programme • At least 16 weeks and start with very low
resistance • Monitor arm/shoulder symptoms • Beware of risk of fracture
(ACSM, 2010)
Exercise
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3. Manual Lymphatic Drainage
(MLD)
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• Slow and rhythmic • Light, circular superficial tissue stretching • Absolute contraindications
• Acute bacterial infection • Acute venous disorders • Sickness with associated fever • Congestive heart failure (Pritschow & Schuchhardt 2010)
• Safe and well tolerated • May offer additional benefit when added to
intensive compression bandaging (Ezzo et al 2015)
Manual lymphatic drainage (MLD)
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4.Compression
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• Can be applied via • Multi-layer inelastic
bandaging • Reduction phase • High working pressure • Lower resting pressure • Low compliance rate
Compression
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• Can be applied via • Compression hosiery
• Long term/maintenance phase
• Flat knit vs circular knit • Custom made garments
often flat knit • Can better
accommodate shape distortion
• Replaced approximately every 6 months
(Lymphedema Framework 2006)
Compression
23 Solarismed.com
Compression