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Complete decongestive physical therapy in a patient with secondary lymphedema due to orthopedic trauma and surgery of the lower extremity.

Abstract

BACKGROUND AND PURPOSE

This case report describes a patient who developed lower-extremity lymphedema secondary to orthopedic trauma and surgery and reports the response to complete decongestive physical therapy (CDP), with 8 treatment sessions over 3 months.

CASE DESCRIPTION

The patient was a 56-year-old man who sustained a right ankle displaced fibular fracture, underwent open reduction internal fixation surgery 12 days later, and developed lymphedema 4 months postinjury. The patient's impairments of the right lower extremity included increased girth, decreased ankle range of motion, and increased pain. Due to these impairments and the inability to fit into normal footwear, the patient limited activities such as ambulating long distances and climbing stairs. This limited activity restricted him from participating in his normal lifestyle activities such as walking his dog in the community and performing all necessary work duties.

OUTCOMES

Using the truncated cone formula to measure limb volume, the limb volume of the right (involved) lower extremity decreased 368 mL as a result of CDP. The percentage of difference in limb volume between the right and left lower extremities at the initial examination was 9%, and it was reduced to less than 1% at discharge. He was independent with his home program in order to maintain the results of therapy.

DISCUSSION

Physical therapist management of secondary lymphedema due to orthopedic trauma and surgery of the lower extremity was effective in decreasing circumferential girth measurements and decreasing limb volume, thereby improving gait and allowing the patient to fit into his work and leisure shoes. The patient reported improvement in his ability to perform all work activities, and he returned to his prior level of participation in the community.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    mercohphysicaltherapy@gmail.com

    Source

    Physical therapy 91:11 2011 Nov pg 1618-26

    MeSH

    Activities of Daily Living
    Fibula
    Fracture Fixation, Internal
    Fractures, Bone
    Humans
    Lymphedema
    Male
    Middle Aged
    Physical Therapy Modalities
    Postoperative Complications

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    21868611

    Citation

    Cohen, Meryl D.. "Complete Decongestive Physical Therapy in a Patient With Secondary Lymphedema Due to Orthopedic Trauma and Surgery of the Lower Extremity." Physical Therapy, vol. 91, no. 11, 2011, pp. 1618-26.
    Cohen MD. Complete decongestive physical therapy in a patient with secondary lymphedema due to orthopedic trauma and surgery of the lower extremity. Phys Ther. 2011;91(11):1618-26.
    Cohen, M. D. (2011). Complete decongestive physical therapy in a patient with secondary lymphedema due to orthopedic trauma and surgery of the lower extremity. Physical Therapy, 91(11), pp. 1618-26. doi:10.2522/ptj.20100101.
    Cohen MD. Complete Decongestive Physical Therapy in a Patient With Secondary Lymphedema Due to Orthopedic Trauma and Surgery of the Lower Extremity. Phys Ther. 2011;91(11):1618-26. PubMed PMID: 21868611.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Complete decongestive physical therapy in a patient with secondary lymphedema due to orthopedic trauma and surgery of the lower extremity. A1 - Cohen,Meryl D, Y1 - 2011/08/25/ PY - 2011/8/27/entrez PY - 2011/8/27/pubmed PY - 2011/12/30/medline SP - 1618 EP - 26 JF - Physical therapy JO - Phys Ther VL - 91 IS - 11 N2 - BACKGROUND AND PURPOSE: This case report describes a patient who developed lower-extremity lymphedema secondary to orthopedic trauma and surgery and reports the response to complete decongestive physical therapy (CDP), with 8 treatment sessions over 3 months. CASE DESCRIPTION: The patient was a 56-year-old man who sustained a right ankle displaced fibular fracture, underwent open reduction internal fixation surgery 12 days later, and developed lymphedema 4 months postinjury. The patient's impairments of the right lower extremity included increased girth, decreased ankle range of motion, and increased pain. Due to these impairments and the inability to fit into normal footwear, the patient limited activities such as ambulating long distances and climbing stairs. This limited activity restricted him from participating in his normal lifestyle activities such as walking his dog in the community and performing all necessary work duties. OUTCOMES: Using the truncated cone formula to measure limb volume, the limb volume of the right (involved) lower extremity decreased 368 mL as a result of CDP. The percentage of difference in limb volume between the right and left lower extremities at the initial examination was 9%, and it was reduced to less than 1% at discharge. He was independent with his home program in order to maintain the results of therapy. DISCUSSION: Physical therapist management of secondary lymphedema due to orthopedic trauma and surgery of the lower extremity was effective in decreasing circumferential girth measurements and decreasing limb volume, thereby improving gait and allowing the patient to fit into his work and leisure shoes. The patient reported improvement in his ability to perform all work activities, and he returned to his prior level of participation in the community. SN - 1538-6724 UR - https://www.unboundmedicine.com/medline/citation/21868611/Complete_decongestive_physical_therapy_in_a_patient_with_secondary_lymphedema_due_to_orthopedic_trauma_and_surgery_of_the_lower_extremity_ L2 - https://academic.oup.com/ptj/article-lookup/doi/10.2522/ptj.20100101 DB - PRIME DP - Unbound Medicine ER -