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Swollen lymph node in upper arm: Swollen lymph nodes – Symptoms and causes

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A rare involvement of epitrochlear lymph nodes in mantle cell lymphoma

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A rare involvement of epitrochlear lymph nodes in mantle cell lymphoma

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  1. Mohan Kumar,
  2. Gaurav Prakash,
  3. Kundan Mishra,
  4. Savita Kumari
  1. Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Mohan Kumar, monu8501{at}gmail.com

http://dx.doi.org/10.1136/bcr-2018-224665

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  • malignant and benign haematology
  • dermatology

Description

A 60-year-old man presented with bilateral groin swelling for 1 year. Sequentially, he developed similar swellings in the cervical and axillary regions. He noted multiple nodular swellings arranged on the medial aspect of both arms in a linear fashion. At this moment, he reported to our hospital. He had generalised lymphadenopathy and the most characteristic finding was enlarged, bilateral, firm, epitrochlear lymph nodes (figure 1). No finding of local temperature rise, redness or infection was found. He also had hepatosplenomegaly. An excisional biopsy revealed mantle cell lymphoma. Bone marrow aspiration done for staging showed infiltration by mantle cells.

Figure 1

Clinical photograph showing bilateral epitrochlear lymphadenopathy.

Epitrochlear lymph nodes are present on the medial aspect of the arm, about 1–2 cm above the elbow joint anterior to the medial intermuscular septum between the biceps and triceps. 1 Their enlargement is usually a part of generalised lymphadenopathy and sometimes because of pathologies in the hand and forearm. One study from the University of Edinburgh showed no palpable lymph nodes in 140 healthy individuals but nodes were palpable in 27% of 184 patients who were diagnosed with disease causing generalised lymphadenopathy.2 Enlargement of epitrochlear lymph nodes is almost always pathological. Isolated enlargement of epitrochlear lymph nodes has also been reported.3 They can be enlarged in infectious conditions like HIV, leishmaniasis, syphilis, leprosy, cat scratch disease, tuberculosis, filariasis and inflammatory conditions like rheumatoid arthritis when the disease is active in the hands. Their enlargement is much more common in chronic lymphoproliferative disorders than in aggressive lymphomas.

Learning points

  • This case highlights the importance of clinical examination of the sites we usually miss during our routine clinics.

  • It is an easily accessible site for biopsy.

  • Although a less common clinical finding, enlarged epitrochlear lymph nodes can provide clues for evaluation of generalised lymphadenopathy and febrile illnesses.

References

    1. Fujiwara M,
    2. Suzuki A,
    3. Mizukami T, et al

    . Mid-arm lymph nodes dissection for melanoma. J Plast Reconstr Aesthet Surg 2010;63:1561–4.doi:10.1016/j.bjps.2010.02.015

    1. Selby CD,
    2. Marcus HS,
    3. Toghill PJ

    . Enlarged epitrochlear lymph nodes: an old physical sign revisited. J R Coll Physicians Lond 1992;26:159–61.

    1. Yardimci VH,
    2. Yardimci AH

    . An unusual first manifestation of hodgkin lymphoma: epitrochlear lymph node involvement-a case report and brief review of literature. J Investig Med High Impact Case Rep 2017;5:232470961770670.doi:10.1177/2324709617706709

View Abstract

Footnotes

  • Contributors MKH, GP, KM and SK were involved in the management of the patient. MKH and KM wrote the manuscript which was vetted by all.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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Lymphoma Symptoms | The University of Kansas Cancer Center

The majority of cases of  lymphoma cannot be prevented because the exact cause remains unknown. Lymphoma may be triggered by an infection or exposure to radiation. However, there are common risk factors that may be associated with developing the disease, as well as common lymphoma symptoms many people experience.

Lymphoma Symptoms

The most common early sign of lymphoma is a painless enlarged lymph node(s) in the neck or upper chest. Sometimes you can feel the swollen lymph node(s) in your armpit, stomach area or groin.

Hodgkin lymphoma starts in the lymph nodes of the neck and spreads in an orderly fashion from the neck area down to the rest of the body. Signs of lymphoma can include:

  • Enlarged lymph node in the neck, shoulder or chest (most common symptom)
  • Enlarged liver or pain on the upper left side of the abdomen
  • Enlarged spleen or pain on the upper right side of the abdomen
  • Fever not caused by another health problem
  • Itchy skin
  • Lower back pain
  • Night sweats
  • Pain in the involved (swollen) nodes after drinking alcohol
  • Reddened patches on the skin
  • Unexplained weight loss

Non-Hodgkin lymphoma (NHL) symptoms can include:

  • Cough or shortness of breath
  • Enlarged lymph nodes in the neck, underarm or groin (most common symptom)
  • Extreme fatigue
  • Fever not caused by another health problem
  • Itchy skin
  • Night sweats
  • Pain in the belly or back
  • Reddened patches on the skin
  • Unexplained weight loss

These symptoms may come from many different illnesses. Your doctor must perform a biopsy to confirm a lymphoma diagnosis.

Lymphoma risk factors

Risk factors for Hodgkin lymphoma include:

  • Age: The disease peaks at ages 15-40 and at 55 and older.
  • Exposure to environmental poisons, such as Agent Orange
  • Family history of the disease, although lymphoma has only a slight genetic link
  • Gender: Hodgkin lymphoma is more common in males than females.
  • History of infectious mononucleosis or Epstein-Barr virus
  • Prolonged use of human growth hormone
  • Weakened immune system, including infection with HIV

Non-Hodgkin lymphoma has many of the same risk factors:

  • Age: The likelihood of getting NHL increases as you get older.
  • Bacterial infection: Infection with Helicobacter pylori increases the risk of lymphoma involving the stomach.
  • Gender: NHL is more common in males than females.
  • Daily life: Exposure to farming chemicals or fertilizers, chemicals used to dissolve rubbers or glues, chemicals used to make rubber products, asbestos and arsenic increases the risk of developing NHL.
  • Weakened immune system: NHL is most common among those who have an impaired immune system or a severe autoimmune disease, including those who take medicines to suppress the immune system following an organ transplant.
  • Viral infection: Infection with Epstein-Barr virus or human immunodeficiency virus (HIV) increases the risk of developing NHL.

 



A care team to count on

When Richard “Smokey” Dyer was diagnosed with non-Hodgkin lymphoma, he relied on his work experience, family and cancer care team.

Smokey’s story

A new chance at life

Thanks to CAR T-cell therapy, Brad Zackert beat non-Hodgkin lymphoma and is in complete remission. Now, he’s getting back to what matters most.

Brad’s story


Related links

Lymphadenitis – treatment of inflammation of the lymph nodes in adults, what to do if the submandibular lymph node is inflamed

Lymphadenitis is an inflammation of the lymph nodes. This condition indicates the infection of the human body with pathogenic microflora – a viral or bacterial infection. Inflammation of the lymph nodes is an SOS signal of the immune system, indicating the development of an infectious disease. The task of such a phenomenon is to prevent the spread of viruses, bacteria and other foreign agents throughout the body. In medicine, there is another term – lymphadenopathy (enlarged lymph nodes of any etiology).

Lymphadenitis rarely acts as an independent disease. In the vast majority of cases, inflammation of the lymph nodes occurs against the background of another disease, often infectious. Pathology requires timely medical attention. If the diagnosis is not treated, the quality of life of a sick person is greatly reduced, and serious complications can develop due to prolonged inflammation of the lymph nodes.

Enroll

Why does lymphadenitis occur? What are the symptoms of swollen lymph nodes? What are the main causes of the development of the disease in adults and children? How to treat the disease to avoid complications? You will find answers to these and other questions in our article.

What is the lymphatic system for?

The lymphatic system is an integral part of the immune system. It performs a number of important functions, but the main one is to protect the body from diseases and inflammation. If the lymphatic system fails, a person will not live a day.

It consists of:

  • lymphatic capillaries
  • lymphatic vessels
  • lymphatic trunks and ducts
  • lymph nodes

The lymphatic system slowly circulates lymph – a clear liquid with a large number of immune cells. The task of the lymph is to find and evacuate excess proteins, water, salts, toxic substances from the tissues of the body, directing them for subsequent disposal.

Every day we come into contact with viruses, bacteria and other pathogens. When the infection enters the body, it travels to the lymph and at some point reaches the lymph nodes. Lymph nodes look like small round or oval formations with a diameter of a few millimeters to a couple of centimeters. There are about 500 of them in the human body. Nodes that collect lymph for a specific area of ​​​​the body are called regional (regional). The location of the lymph nodes (regions) determines their names: submandibular, cervical, occipital, inguinal, pelvic, axillary, etc.

They work as natural, natural filters: they pass lymph through themselves, but they trap infection, toxins, and mutated cells inside themselves. Inside the lymph nodes, lymphocytes are formed – immune cells. Lymphocytes of one type produce antibodies, the second type destroy pathogens, atypical cells and promote healing.

If there are too many pathogens, and the lymph nodes cannot cope with the load, lymphadenopathy occurs – the process of enlargement of the lymph nodes. If the lymph node becomes inflamed, lymphadenitis develops.

How does the mechanism of lymphadenitis start?

The barrier function of the lymph nodes creates the prerequisites for the occurrence of lymphadenitis in adults and children. If an infection or toxins enter the body, some of them with the lymph flow, blood flow from neighboring organs and tissues still end up in the region of the lymph nodes. Once in the lymph nodes, the pathogenic flora and foreign particles begin to contact the lymphocytes that produce antibodies. A large number of other leukocytes rush into the lymph node with the blood flow, which are trying to cope with the pathogenic microflora, to prevent it from spreading throughout the body. If the pathogens are strong enough and the immune cells don’t have the resources to do their job, inflammation kicks in.

The influx of a large number of leukocytes into the area of ​​​​inflammation leads to the growth of lymphoid tissue, so the size of the inflamed lymph node increases. Often the enlarged lymph node becomes sensitive, and pain is felt when it is touched. This is what the development of lymphadenitis looks like.

Lymphadenitis is equally common in women and men, in an adult and in a child, since every person faces infectious diseases throughout his life. In adult men, lymphadenitis is often the result of diseases of the ENT organs and sexually transmitted diseases. In women, inflammation occurs for the same reasons. Women who have a baby are often diagnosed with acute purulent mastitis – a specific form of the disease. It develops after childbirth due to an unbalanced lactation process and improper hygiene during breastfeeding and proceeds with severe pain in the chest area. Inflammation and enlargement of the lymph nodes in childhood often occur against the background of ENT diseases. Almost every child manages to get sick with tonsillitis, otitis media, sinusitis and typically “children’s” contagious diseases – measles, scarlet fever, “mumps”. Lymphadenitis in children is usually mild. If the main diagnosis is treated in time and correctly, the inflammatory process subsides, and the size of the lymph nodes decreases. But in any case, an increase in the lymph nodes in a child is a good reason to show it to the attending physician to determine the cause of the disease and prescribe an effective treatment if necessary.

Classification of lymphadenitis

Lymphadenitis can manifest itself in different ways depending on the cause of its appearance, on the nature of the inflammatory process and the area where the inflamed node is located.

By etiology

Depending on the origin of inflammation, lymphadenitis can be primary and secondary. The primary form is not common. It accounts for about 5% of all cases. In this case, the inflammatory process starts immediately in the lymph node, that is, there is no primary focus of infection in the body. Usually this condition is easy. But in some cases, diagnosis and treatment by a doctor may be necessary: ​​with the opening of the lymph node and the appointment of antibiotic therapy to prevent the spread of pathogenic microflora to other organs.

The secondary form is the most common. In this case, lymphadenitis develops as a result of an already existing focus of infection, which can be located anywhere: in the ENT organs, on the skin, in the oral cavity, genitals, etc. When a primary infection occurs, viruses or bacteria enter the lymph flow, and some of them settle in the lymph nodes closest to the inflamed organ. As a result, they increase in size and begin to hurt.

downstream inflammation

According to the nature of the course of the inflammatory process, there are two types of the disease – acute and chronic.

Symptoms of reactive (acute) lymphadenitis are pronounced. The disease develops rapidly. The acute form of the disease often progresses in three stages:

  1. At the first (catarrhal) stage, the lymph node enlarges, the skin over it turns red, becomes hot. When touched, pain is felt. The patient may complain of the following symptoms: chills, fever, body aches, lethargy.
  2. The second (hyperplastic) stage is characterized by an increase in the number of lymphocytes in the inflamed node.
  3. The third stage is purulent. The lymph node is filled with pus. This process proceeds with high body temperature and acute pain in the affected area. The patient tries to touch this place as little as possible in order to avoid pain. The result of this stage of the disease may be the formation of a purulent pocket (abscess) or diffuse purulent inflammation of the fiber (phlegmon). As a rule, the treatment in this case is surgical: the doctor opens the inflamed lymph node and prescribes antibiotic therapy. If you do not consult a doctor in time for diagnosis and treatment, pathogenic contents can spread throughout the body and cause sepsis, a life-threatening condition.

The symptoms of chronic lymphadenitis are not as intense as the symptoms of the acute form. But inflammation in the chronic form takes a protracted character. For weeks, or even months, the inflammation is in the catarrhal stage and does not become purulent. Signs of the disease: moderate enlargement of the lymph nodes, the absence of severe pain on palpation of the lesion, body temperature is kept at around 37.5 ° C. In parallel with this condition, symptoms of the underlying disease appear. It happens that a person simply complains of feeling unwell and cannot understand the reason. For diagnosis, you must definitely contact a specialist. Chronic lymphadenitis allows the doctor to identify a prolonged inflammatory process in the body. This form of the disease can be confused with other diagnoses in which the lymph nodes are constantly enlarged – blood diseases, oncology. Therefore, a thorough, competent diagnosis is necessary.

Distribution

If the lymph nodes of one anatomical zone (for example, the head and neck) are affected, the patient is diagnosed with regional lymphadenitis. If lymph nodes of different groups are involved in the inflammation (for example, the face and limbs), it is called generalized.

By the nature of the inflammatory process

This classification divides the inflammatory process into serous and purulent.

The serous form of the disease is the initial stage, which lasts from several hours to several days in acute, and up to several months in chronic inflammation. With serous lymphadenitis, the lymph node becomes larger and begins to hurt. Body temperature during this period may not rise. If you consult a doctor in time, diagnose and start treatment, you can cope with the disease with the help of conservative, non-surgical measures.

The main symptom of purulent lymphadenitis is the presence of purulent masses inside the lymph node. Symptoms of inflammation are very intense: it is impossible to touch the affected area due to acute pain. The skin in this place is red, hot. Sometimes an abscess “shines” through them. Body temperature rises. Chills appear. The body “breaks”. The patient complains of severe weakness. Pus can flow out, or it can enter the bloodstream and spread the infection throughout the body. In the latter case, blood poisoning can occur, followed by death.

Friends! Timely and proper treatment will ensure you a speedy recovery!

By type of infection

Depending on the type of pathogenic microflora that provoked inflammation, lymphadenitis is divided into nonspecific and specific.

Nonspecific forms of the disease are caused by various pathogens – bacteria, viruses, fungal flora. But the mechanism of triggering the inflammatory process and the symptoms are similar.

Specific lymphadenitis develops when certain pathogens enter the lymph node – the causative agents of tuberculosis, plague, brucellosis, actinomycosis, etc. The symptoms of each specific type of infection will vary.

One of the varieties of specific lymphadenitis is granulomatous lymphadenitis, the causative agent of which is the causative agents of tuberculosis, syphilis, gonorrhea. A distinctive feature of this form is the presence of small nodules – granulomas in the lymph node.

When infected with Koch’s bacillus (the causative agent of tuberculosis), such specific inflammation as caseous lymphadenitis can develop, when necrotic foci appear in the lymph node. This form of the disease occurs against the background of tuberculosis.

At the location of the inflammatory process

Submandibular

The most common localization of inflammation. The lymph nodes of this group are located in the lower jaw in the amount of 8-10 pieces. Lymph flows here from the facial tissues (eyelids, cheeks, nose), oral cavity, teeth, gums, submandibular and sublingual salivary glands.

It most often occurs in childhood, since it is during this period that a person is faced with respiratory tract infections and diseases of the oral cavity. This form of the disease often occurs against a background of tonsillitis (acute inflammation of the palatine tonsils), rhinopharyngitis (a combination of inflammation of the nasal mucosa – rhinitis and the mucous membrane of the posterior pharyngeal wall – pharyngitis), gingivitis, stomatitis, caries, mumps, measles, diphtheria, whooping cough, facial injuries, herpes, infections of the skin on the face. Sometimes this group of nodes becomes inflamed when the child’s teeth erupt.

Usually enough quality treatment of the underlying disease to eliminate the symptoms of lymphadenitis. But if the inflammation has become purulent, surgery will be required to cleanse the lymph node from pus.

Symptoms of this type of disease are: swollen lymph nodes, pain on palpation and fever of the inflamed area, redness and swelling of the skin, suppuration of the lymph node (with purulent inflammation). If the pathogenic flora spreads beyond the node, the patient’s temperature rises to 38-40 ° C, body aches appear, headaches and weakness occur.

Neck

Another common form of the disease. The cervical lymph nodes filter the lymph that flows from the head and neck. This means that almost all ENT diseases can be complicated by cervical lymphadenitis.

Cervical lymphadenitis can develop against the background of the following ENT diagnoses and conditions:

  • Rhinitis – inflammation of the nasal mucosa
  • Acute and chronic tonsillitis – an inflammatory process in the throat, occurring in the palatine tonsils. Acute tonsillitis is often called angina. The cause of tonsillitis is infection of the palatine tonsils.
  • Pharyngitis is an infectious inflammatory process affecting the posterior wall of the pharynx. Often pharyngitis is paired with tonsillitis. In this case, the patient is diagnosed with tonsillopharyngitis.
  • Otitis is an inflammatory process that affects one or another part of the hearing organ – the outer, middle and inner ear.
  • Sinusitis is an inflammatory process of the paranasal sinuses. There are four types of sinuses, therefore, there are also types of diagnosis: sinusitis (inflammation of the maxillary sinuses), frontal sinusitis, ethmoiditis (cells of the ethmoid labyrinth), sphenoiditis (sphenoid sinus).

The disease can also occur against the background of mononucleosis, infectious inflammation of the thyroid gland, rubella, influenza, adenovirus.

Symptoms of cervical lymphadenitis: enlargement of the cervical lymph nodes, their soreness, swelling of the skin in the area of ​​​​inflammation, difficulty with turning and tilting the head – every movement is accompanied by acute pain. With purulent inflammation, the skin turns red, an abscess is visible through it; the temperature rises to 40°C. The patient suffers from severe weakness and headaches.

Axillary

A rarer form of the disease, but most often acquires a purulent character. Lymph from the arms, upper abdomen, chest and mammary glands is sent to the axillary lymph nodes.

The cause of axillary lymphadenitis is purulent diseases of the skin of the hands, infected wounds on the upper limbs, abdomen, chest, mastitis, boils and carbuncles, which are formed directly in the armpit.

Symptoms of the disease: an increase in axillary lymph nodes (usually one becomes inflamed, in more rare cases several), with suppuration, the skin over the node becomes red and swollen. Hand movements are difficult – when touching the lymph node, severe pain is felt. The sensitivity of the hand may disappear for a while, tingling under the arm, goose bumps.

Behind the ear

Next to the hearing organs are the parotid lymph nodes. They run along the tragus in a vertical direction from the side of the cheek.

Most often, inflammation of this group of lymph nodes is observed in children and adolescents, whose immunity is not yet sufficiently developed and cannot always cope with pathogens. But adults are also prone to behind-the-ear lymphadenitis.

The causes of this form of the disease are:

  • colds and infectious diseases of the upper respiratory tract
  • inflammation of the ENT organs (for example, otitis media, tonsillitis, rhinitis, etc.) yschey on the face
  • oncology
  • other causes: tuberculosis, HIV, diseases of the blood, lymphatic, endocrine systems

Symptoms of behind-the-ear lymphadenitis are a sharp, throbbing pain in the area of ​​the lymph node; the skin at the site of inflammation is red, hot; high body temperature.

The purulent process in this zone is a danger to humans. The proximity of the focus of infection to the brain can provoke complications, slow down the recovery process, and in the most severe cases, in the absence or untimely treatment, result in death.

Occipital

There are usually up to three lymph nodes at the back of the head. They are small in size and in a healthy state are not noticeable. Lymph flows to them through the vessels of the occipital part of the head.

The reasons for the development of this form of the disease can be:

  • tonsillitis
  • chronic otitis
  • infectious diseases: measles, rubella, tuberculosis
  • caries
  • oncology

The inflammation begins with discomfort in the back of the neck. Then the occipital node becomes larger, the skin above it swells. This process is accompanied by the appearance of pain when you touch the affected area. At the peak of inflammation, large bumps appear on the back of the head, which cannot be overlooked. Possible local increase in temperature.

There are other, less common forms of lymphadenitis: inguinal, posterior cervical, mesenteric (inflammation of the lymph nodes of the mesentery of the intestine), abdominal cavity, lower extremities, mammary glands, etc.

If the diagnosis could not establish the cause of the lesion of the lymph nodes, such lymphadenitis is called unspecified.

Diagnostics

Diagnosis of lymphadenitis with its characteristic clinical picture is usually not difficult. It is more difficult to determine the root cause – the underlying disease, against which the lymph nodes became inflamed.

Diagnostic measures include:

  • patient history taking, questioning of complaints
  • direct examination of the patient
  • laboratory tests: blood, urine test
  • ultrasound examination of the area of ​​inflammation
  • x-ray oncology, specific and chronic lymphadenitis, in the absence of the effect of the treatment).

If you are sick, you should first consult a therapist. Depending on the localization of the inflammatory process and the primary focus of infection, the doctor will refer the patient to a related specialist: an otorhinolaryngologist, dentist, phthisiatrician, urologist, dermatologist, surgeon, etc.

How to treat?

Only the doctor chooses the tactics of treatment. Self-medication is unacceptable, especially if the inflammatory process occurs in the skull next to the brain.

Mild forms of the disease are treated conservatively. The patient may be prescribed:

  • antibacterials
  • non-steroidal antivirals
  • antivirals
  • antihistamines
  • tuberculosis medicines
  • antifungals
  • physiotherapy

If the inflammatory process has become purulent, surgical treatment may be necessary: ​​the surgeon opens the lymph node and evacuates its purulent contents. This measure prevents the infection from spreading to the surrounding tissues and bloodstream.

A big mistake is to treat lymphadenitis on your own or with traditional medicine.

You can not warm the inflamed lymph node or do a warm compress to relieve unpleasant symptoms. After all, with some diagnoses and conditions, heating is contraindicated, for example, with oncological diseases, signs of intoxication, specific lymphadenitis.

You can not try to open a festering node on your own – this can cause blood poisoning.

Doing nothing and waiting for the disease to go away on its own is also not worth it. Be sure to consult a doctor at the first sign of illness. Only the timely help of a doctor will help to cope with the disease and avoid complications. Timely diagnosed lymphadenitis responds well to therapy, and the prognosis for the patient is very favorable.

Prevention of the disease is aimed at the timely treatment of infectious diseases, including chronic foci of infection in the body, regular visits to an ENT doctor, dentist and other specialized specialists, strengthening immunity

Hand edema after breast surgery

What is lymphostasis (hand edema after surgery) and what causes it

Lymphostasis (lymphedema) is a delay (stagnation) of lymphatic fluid (lymph) in the tissues. Normally, it is formed in our tissues and flows through the lymphatic vessels through the lymph nodes.

From the arm and from the mammary gland, lymph flows through the axillary lymph nodes towards the chest, where it enters the bloodstream.

Immediately after the operation (after removal of the nodes), through the damaged lymphatic vessels, the lymph flows under the skin in the area of ​​the operation and then flows out through the drainage. In the process of wound healing, scarring of the injured lymphatic vessels occurs and the amount of lymph gradually decreases. When its amount becomes scarce (less than 50 ml per day), the drainage is removed. But the lymph does not disappear – it finds its way through other lymphatic vessels that were not injured during the operation.

If these remaining vessels are sufficient for the outflow of all lymph, then edema (lymphedema) does not develop. If there are few of them left, then edema may appear, and the severity of this edema depends primarily on the number of these remaining vessels.

The number of remaining lymphatic vessels depends on the individual characteristics of the patient: some “reserve” ways of lymphatic drainage are many (hand edema does not develop), while others have few (they develop edema).

Radiation therapy affects the capacity of the lymphatic vessels remaining after the operation: after irradiation, the frequency of edema increases. This is due to the fact that the lymphatic pathways remaining after radiation exposure can be scarred, and therefore their throughput decreases. This is less common when your radiologist:

  • operates on modern equipment (only 30% of such linear accelerators operate in St. Petersburg today),
  • has the skills and desire for individual work with the patient: able to do more for him than regulated by his duties (satisfied with the payment of his labor).

Swelling of the hand after surgery, how to treat it and what it depends on:

  • Physical activity
    During physical activity, more lymph is formed, and a larger volume of lymph just physically sometimes cannot flow through the remaining lymphatic vessels. Therefore, if after any load on the arm you notice the appearance of edema – henceforth try to avoid such a load.

  • Overweight
    obese people are more likely to have edema, and the edema disappears with weight loss. Limit yourself in carbohydrates ( sweets, sugar, potatoes, flour), start walking if you can no longer run due to weight.
  • Treatment of diabetes and hypertension
    See HERE for the principles of diabetes care. You must understand that today there are not enough funds allocated to provide you with modern medicines and consumables for the proper treatment of your diabetes and hypertension. Doctors are also not paid for their work, so that they can do it for you according to modern standards.
  • Selenium deficiency
    Selenium preparations (pine nuts) are prescribed for all patients with hand edema.
  • Prevention of erysipelas
    Erysipelas provokes lymphostasis: each episode increases edema. To prevent erysipelas (if it has already occurred against the background of lymphostasis), patients with arm edema are prescribed antibiotics prophylactically for 2-3 years (Penicillin 1. 5 million x 3 times a day or Bicillin). Some believe that antibiotics are needed only when the first signs of erysipelas appear (they are not prescribed prophylactically).
Before any stage of treatment, ICJ-fluorescence is performed – to assess the condition of the lymphatic collectors (to compare with the results after treatment, correctly determine the bandage zone, select the site for transplanting a node or applying a lympho-venous anastomosis – according to the reflux zone). Lymphoscintigraphy is not a standard for such diagnostics.
  • Compression
    98% use class 2 compression underwear. Measurements during selection must be taken with the maximum tension of the measuring tape! When the sleeve is correctly put on, the indicator – at the top of it (on an elastic band) – a vertical rectangle – should become a square. If the square has become a horizontal rectangle – you need to lower the sleeve down – then it has been pulled up.

This underwear is not easy to put on by hand without a special device – a special frame is used for this.

If the edema is very pronounced – in addition to the sleeve, bandaging is applied (tight bandaging over the sleeve).

Traditional bandaging does not use fixing hooks – they can injure the skin and provoke erysipelas. The bandages are fixed with a plaster. The bandage is worn up to 23 hours a day, and if the bandages weaken, they are re-bandaged 2 times a day. The treatment course of bandaging takes 3-4 weeks.

Just sitting in a brace is not enough. It is necessary to move in the bandage in order to expel the lymph: active physical activity is required – gymnastics, dancing, exercise equipment, qigong gymnastics.

Analogue of bandaging – compression underwear Circaid from Medi.

  • Lymph node transplantation and lympho-venous anastomoses

Before node transplantation, ICJ helps to determine the level of transplantation (by the reflux zone): in the armpit, or elbow area; in the groin or under the knee (with swelling on the leg). For transplantation, a lymph node is removed from another area of ​​the patient’s body (for example, in the groin) and transplanted with surrounding tissues into the armpit (with swelling of the arm), while under a microscope, very small vessels of the lymph node are sutured with vessels in a new place. A lymph node transplanted in this way with its surrounding tissues collects lymph and pumps it into the bloodstream through the vessels. The therapeutic effect of such an operation is observed up to 2 years. The cost of a lymph node transplant operation is from 10,000 €. In Russia, this is done by altruists (as long as they have a desire to do this work unpaid by the state).

There is also a variant of the operation, when an enlarged lymphatic vessel is found in the zone of lymphostasis (on the forearm or in the elbow bend) and it is sutured to a vein in this place so that the lymph is discharged into the bloodstream. The effect of such an operation alone is extremely unstable, but in combination with lymph node transplantation, it can reach up to 5-6 years.

  • Liposuction for lymphostasis
    is used only in severe forms of it, but after the operation it requires a course of bandaging up to 3-4 weeks, with an ultrasound assessment of the presence of lymph streaks in the operation area. After liposuction, excision of excess skin is required.

How to reduce the risk of hand swelling during breast surgery

The likelihood of edema is affected by the volume of tissues removed during surgery: if all axillary lymph nodes are not removed, then the likelihood of edema will be less. However, if tumor metastases remain in the non-removed lymph nodes, they will threaten the patient’s life with the return of the disease. There is a technique for biopsy of the sentinel lymph node, which in some cases allows you to reasonably refuse to remove all lymph nodes during surgery.

Sometimes swelling of the arm after surgery is a manifestation of the progression of oncological disease (the remaining lymphatic tracts are compressed by non-removed lymph nodes containing tumor metastases). Ultrasound, CT, MRI or PET of the sub- and supraclavicular areas will help to distinguish lymphedema from the progression of the disease. With the progression of an oncological disease, such edema of the limb will go away only if the correct treatment is carried out under the supervision of your chemotherapist; measures to treat lymphedema without treatment in this case will be ineffective.

How often does lymphedema occur after surgery for breast cancer?

Most women do not develop lymphedema.

Most often it appears during the first 4 years after the operation. In most cases, once it occurs, it is permanent, and only in a small number of women does it go away.

◦ After axillary dissection (removal of axillary lymph nodes), the risk of lymphedema has been reported to be between 0% – 25%.
◦ The average is 3% (if no axillary radiation was performed).
◦ Adding radiation may increase the risk of edema by 5 to 10%.
◦ With bilateral axillary lymph node dissection and axillary radiotherapy, the risk of lymphedema ranges from 10% to 54%, with an average of 12%.

According to a German lymphostasis clinic, when they underwent surgery for breast cancer with the removal of all lymph nodes, edema to one degree or another was in 30% of patients. When surgeries with sentinel node biopsy were introduced, the frequency dropped to 6%.

How to find out if lymphedema has appeared?

◦ You may suspect its development if you notice that your arm has become swollen or seems unnaturally heavy.
◦ Your sleeve, wristwatch, or rings may start to dent your skin. You may experience pain in your hand, as lymph builds up in the remaining lymph vessels and can put pressure on the tissues and nerves in your hand. You may also experience pain in your upper back and shoulder due to the extra weight of your arm. Report these symptoms to your doctor immediately.
◦ Your doctor will be able to detect swelling of the arm by measuring its circumference with a tape measure. Measurements are taken at the joints, wrist, 10 cm below the elbow and 15 cm above the elbow. If the difference is 2 cm or more (comparing the similar circumferences of the two hands), we can talk about the presence of lymphostasis.

How can I reduce the risk of upper limb swelling after breast surgery?

There are currently no proven methods to prevent lymphedema.

Is it possible to completely cure lymphedema (swelling of the hand)?

In 7% of women after surgery for breast cancer (whose lymph nodes were removed), there is a so-called mild edema, which, as a rule, disappears with time. Such an incoming or temporary edema may appear for several years after the operation and, as a rule, is associated with excessive (for each case – individual) physical activity. In such cases, it is recommended to avoid such a load in the future, and if edema occurs, give the hand peace, an elevated position; you can apply lymphatic drainage massage, pneumomassage, compression sleeve.

It is much more dangerous if the edema is caused by other causes, such as infection. Once having arisen, such edema can become permanent.

Who should (should) treat lymphedema (swelling of the arm due to cancer)?

Our public health system does not provide specialists for the treatment of this disease. In other countries, an integrated approach is used with the participation of physiotherapists, massage therapists, nurses, psychologists and social workers.

There is a private medical company in St. Petersburg, , whose specialists were trained in Germany on this problem.

Specialist – Rovnaya Alexandra Vadimovna, her email is [email protected].

Rehabilitation specialist in St. Petersburg: Idiatulina Albina Vladimirovna – 8(911)010-98-29.

How to treat lymphedema?

You have already seen some recommendations on the page above.

If the swelling is mild (accidental or temporary), a compression sleeve may be sufficient. Physiotherapists or trained staff from a specialized medical store will help you find the right sleeve size for you. For example, http://lite-step.spb.ru/.

It is recommended that you consult your doctor or physiotherapist to make sure that the resulting swelling is not permanent, as permanent swelling requires constant assistance: compression of the entire arm or part of it (sleeve or sleeve + glove).

In addition to compression underwear, a set of measures is used, which includes physiotherapy, manual lymphatic drainage massage, anti-edema therapy, pneumocompression.

In developed countries, patients are provided with 2 sleeves and 2 gloves per year under special programs. Treatment in the clinic – 350 € per day (3-4 weeks) 1 time per year.

For the prevention and treatment of persistent edema, the following are of no small importance: hand skin care, exercises for flexibility and mobility of the hand joints (provide natural lymphatic drainage). Similar exercises are present in our daily activities: swimming, cycling, walking.

Resistance-based vigorous repetitive exercise such as boating, cross-country skiing, tennis, weight lifting is not recommended by some lymphedema specialists. However, the effects of such exercise are poorly understood: 100 women competed in sprint boat races after breast cancer surgery; none of them deteriorated, including those who already had edema at the time of the competition.

◦ Strive to maintain your ideal body weight. Obesity is a risk factor for the development of lymphedema and makes it difficult to treat.
◦ Avoid hand injuries. Due to poor lymph flow, you are at greater risk of infection.

◾ Muscle strain, bruises, and fractures can cause swelling, which can further block the flow of lymphatic fluid from the arm.
◾ Avoid cuts, scrapes, burns (including sunburn), and insect bites on your hand.
◾ Wear gloves when working in the garden, when in contact with hot (stove, oven).
◾ For blood tests, intravenous injections, or infusions, if possible, use your good hand. For adjuvant chemotherapy, it is recommended to use a port system.
◾ It is not yet known whether weightlifting, snow shoveling, or resistance work causes the development or worsening of lymphedema. However, giving excessive heavy load or doing resistance exercises in the early postoperative period is probably not a good idea. It is wise to gradually increase activity.

◦ Be alert for infection on the arm from the side of the operation. Infection (erysipelas) can appear suddenly and be very severe, even after such trivial injuries as a burr or cut on a finger by the edge of a sheet of paper. Within just a few hours, your hand may become bright red, sore, hot to the touch, and swollen; well-being can get very bad. In other cases, the infection may be less severe and you may notice some redness and pain in the area.

Erysipelas

Redness of the skin – solid or red spots, pain, fever (locally in the spot area or the whole body up to 38-39 degrees) – signs of erysipelas that can occur on swollen skin.

Photo of a patient with erysipelas after a radical mastectomy and subsequent breast reconstruction with an implant.

◾ Always seek medical attention in case of infection.
◾ If the infection occurs suddenly and spreads rapidly, you need to go to the hospital urgently for intravenous antibiotics (penicillin group or clindamycin).
◾ If erysipelas proceeds without intoxication, tablet preparations are sufficient (amoxicillin 500 mg 3 times a day for 7-10 days; cephalexin 500 mg, cloxacillin or erythromycin 4 times a day for 7-10 days are also suitable).
◾ If infectious complications recur, they are prevented: monthly injections of 1.2 million Bicillin or oral penicillin 250 mg 4 times a day for 1 week a month or Amoxicillin 250 mg 3 times a day for 1 week.
◾ At the first signs of infection, a single dose of amoxicillin 500 mg or cephalexin 500 mg (prescribed by a doctor) is sometimes sufficient.
◾ Remember to take a week’s supply of amoxicillin or cephalexin if you are traveling to remote areas.

◦ Don’t hesitate to seek help if you have lymphedema: the sooner you seek help, the more successful the treatment will be.

◦ Elective treatment of lymphedema (massage and pneumocompression) is contraindicated in cases of infection or a thrombosed arm vein.

◦ What is the cost of lymphedema treatment? Treatment for lymphedema can be expensive and time consuming (prices and options are for the US, most are covered by health insurance).

◾ Compression sleeves and gloves should be replaced with new ones approximately every 6 months.
◾ Special compression stockings cost about $100 and up.
◾ Custom-made clothes cost more.
◾ Compression equipment can cost upwards of $4,000.
◾ MLD (manual lymphatic drainage massage) costs $75 per session but many sessions are required.
◾ CDP (complex decongestant therapy) costs about $7,000.00 for a 4-week program.

What other ways to treat lymphedema exist?

Laser (PSA – more efficient but expensive – up to 800 €/course)
Sound therapy (playing plucked stringed musical instruments). The effect is achieved through resonance. The operation of a special Italian device is based on this – for 30 minutes / day with a change of sensors every 10 minutes.
Electrical muscle stimulation and electrostatic field, magnets
Cryotherapy, transcutaneous electrical nerve stimulation (TENS), microwave and heat therapy – these have not been proven and require further study.

    What does not work in the treatment of edema, lymphostasis?

    Should not be used: diuretics, surgery and therapeutic ultrasound. Diuretics are not effective, the benefits of Detralex have not been proven. Therapeutic ultrasound can cause the growth of a cancerous tumor (proven in an experiment in mice). Do not confuse therapeutic ultrasound with absolutely safe ultrasound.

    The effectiveness of Wobenzym has not been proven, but in some clinics it is traditionally actively prescribed.

    For the treatment of primary and secondary lymphedema (as an adjunct to bandaging, massage, and other therapies), one of the following translational lymphatic drainage systems may be recommended.