Lymphatic system dysfunction can result in significant physical impairments and subsequent loss of function of either the upper or lower extremities. Disturbances in structure or function can lead to accumulation of lymphatic fluids in body tissues that affect their physiological health, impair joint mobility, and affect daily functioning. Lymphatic dysfunction can be a result of a congenital or hereditary abnormality or can be caused by trauma, infection, or treatment for a cancer.
For effective management of patients with lymphatic disorders, a therapist must understand the underlying pathologies and clinical manifestations of many types of lymphatic disorders, as well as the interplay between the lymphatic and venous systems. A therapist must also be aware of the use, effectiveness, and limitations of therapeutic exercise in the comprehensive management and rehabilitation of patients with lymphatic insufficiencies.
Disorders of the Lymphatic System
Structure and Function of the Lymphatic System
The lymphatic system’s primary function is to collect and transport fluid from the interstitial spaces back to the venous circulation (Fig. 26.1) using a series of lymph vessels and lymph nodes.49,74,85,104,167,168 The lymphatic system also has a role in the body’s immune function.49,85,104,167,168 When the lymphatic system is compromised by impairment of lymphatic structures or by an overload of lymphatic fluid, the result is swelling in the tissue spaces. Edema is a natural consequence of tissue trauma and the subsequent healing process. If the lymphatic system is compromised and does not function efficiently, lymphedema develops and impedes wound healing.
Major vessels of the lymphatic system.
Lymphedema is an excessive and persistent accumulation of extravascular and extracellular fluid and proteins in tissue spaces.25,37,85,91,168 It occurs when lymph volume exceeds the capacity of the lymph transport system, and is associated with a water and protein imbalance across the capillary membrane. An increased protein concentration draws larger amounts of water into interstitial spaces, leading to lymphedema.37,66,85,168 This accumulation of extracellular fluid and protein causes an inflammatory response that results in a proliferation of adipose tissue in the affected area.17,18,92,104 Many cardiovascular system disorders can also cause the load on lymphatic vessels to exceed their transport capacity and subsequently cause lymphedema.66,91,132
Anatomy of the Lymphatic System
The lymphatic system is an open system.49,85,86,168 The lymphatic capillaries are situated close to the blood capillaries and are responsible for pulling the fluid into the lymphatic circulation system of vessels and nodes (Fig. ...