Fellows Course: Practical Lymphedema Diagnosis and Care Teams

Primary Versus Secondary Lymphedema and Phlebolymphedema

The presenter distinguished primary lymphedema from lymphatic malformation, appearing from birth through later adulthood, from secondary lymphedema caused by tumor surgery, radiation, or chronic venous insufficiency, noting phlebolymphedema reflects mixed venous and lymphatic disease.

Clinical Diagnosis Without Routine Imaging

Diagnosis relies largely on history and exam, including a positive Stemmer sign, an exaggerated dorsal skin crease, and progression starting at the foot or hand, since lymphangioscintigraphy and lymphangiography are rarely used and carry inflammatory risk to the lymphatics.

Complex Decongestive Therapy: Reduction and Maintenance

Standard treatment involves an intensive reduction phase of manual lymphatic drainage, multilayered compression bandaging, and skin care two to five times weekly for about four months, then a maintenance phase using compression garments, exercise, and weight loss.

Building a Care Team as a New Practitioner

She described building a team of physical therapists trained in lymphedema therapy, wound care, and vascular medicine colleagues early in practice, since undiagnosed leg swelling patients often land with vascular specialists and respond well to coordinated care.