TL;DR: The diagnosis of lymphedema requires careful attention to patient risk factors and specific findings on physical examination, and noninvasive diagnostic tools and lymphatic imaging can be helpful to confirm the diagnosis and to address a challenging clinical presentation.
Abstract: Background: Lymphedema is a chronic, debilitating condition that has traditionally been seen as refractory or incurable. Recent years have brought new advances in the study of lymphedema pathophysiology. as well as diagnostic and therapeutic tools that are changing this perspective. Objective: To provide a systematic approach to evaluating and managing patients with lymphedema. Methods: We performed MEDLINE searches of the English-language literature (1966 to March 2006) using the terms lymphedema, breast cancer-associated lymphedema, lymphatic complications, lymphatic imaging, decongestive therapy, and surgical treatment of lymphedema. Relevant bibliographies and International Society of Lymphology guidelines were also reviewed. Results: In the United States, the populations primarily affected by lymphedema are patients undergoing treatment of malignancy, particularly women treated for breast cancer. A thorough evaluation of patients presenting with extremity swelling should include identification of prior surgical or radiation therapy for malignancy, as well as documentation of other risk factors for lymphedema, such as prior trauma to or infection of the affected limb. Physical examination should focus on differentiating signs of lymphedema from other causes of systemic or localized swelling. Lymphatic dysfunction can be visualized through lymphoscintigraphy; the diagnosis of lymphedema can also be confirmed through other imaging modalities, including CT or MRI. The mainstay of therapy in diagnosed cases of lymphedema involves compression garment use, as well as intensive bandaging and lymphatic massage. For patients who are unresponsive to conservative therapy; several surgical options with varied proven efficacies have been used in appropriate candidates, including excisional approaches, microsurgical lymphatic anastomoses, and circumferential suction-assisted lipectomy, an approach that has shown promise for long-term relief of symptoms. Conclusions: The diagnosis of lymphedema requires careful attention to patient risk factors and specific findings on physical examination. Noninvasive diagnostic tools and lymphatic imaging can be helpful to confirm the diagnosis of lymphedema or to address a challenging clinical presentation. Initial treatment with decongestive lymphatic therapy can provide significant improvement in patient symptoms and volume reduction of edematous extremities. Selected patients who are unresponsive to conservative therapy can achieve similar outcomes with surgical intervention, most promisingly suction-assisted lipectomy. (Less)
TL;DR: The authors demonstrated the effectiveness of a surveillance program that included preoperative limb volume measurement and interval postoperative follow-up to detect and treat subclinical LE.
Abstract: BACKGROUND. The incidence of breast cancer (BC)-related lymphedema (LE) ranges from 7% to 47%. Successful management of LE relies on early diagnosis using sensitive measurement techniques. In the current study, the authors demonstrated the effectiveness of a surveillance program that included preoperative limb volume measurement and interval postoperative follow-up to detect and treat subclinical LE. METHODS. LE was identified in 43 of 196 women who participated in a prospective BC morbidity trial. Limb volume was measured preoperatively and at 3month intervals after surgery. If an increase >3% in upper limb (UL) volume developed compared with the preoperative volume, then a diagnosis of LE was made, and a compression garment intervention was prescribed for 4 weeks. Upon reduction of LE, garment wear was continued only during strenuous activity, with symptoms of heaviness, or with visible swelling. Women returned to the 3-month interval surveillance pathway. Statistical analysis was a repeated-measures analysis of variance by time and limb (P � .001) comparing the LE cohort with an age-matched control group. RESULTS. The time to onset of LE averaged 6.9 months postoperatively. The mean (� standard deviation) affected limb volume increase was 83 mL (� 119 mL;
TL;DR: The elasticity of the compressive garment provides increased flexion and extension torque at the end range of extension and flexion, respectively, and may assist the hamstrings in controlling the leg at theend of the swing phase in sprinting.
Abstract: The aims of this study were to determine how custom-fit compression shorts affect athletic performance and to examine the mechanical properties of the shorts. Ten male and 10 female track athletes on a university's nationally competitive track team, specializing in sprint or jump events, participated in the study. Testing utilized the compression shorts with loose-fitting gym shorts as the control garment. Several significant effects were revealed for the custom-fit compressive garment. Although 60 m sprint time was not affected, hip flexion angle was reduced. Skin temperature increased more and at a faster rate during a warm-up protocol. Muscle oscillation was decreased during vertical jump landing. Countermovement vertical jump height increased when the participants were wearing the custom-fit compression garment. In materials testing, the elasticity of the compressive garment provides increased flexion and extension torque at the end range of extension and flexion, respectively, and may assist the hamstrings in controlling the leg at the end of the swing phase in sprinting. The compressive garment significantly reduced impact force by 27% compared with American football pants alone. Through various mechanisms, these findings may translate into an effect on athletic performance and a reduction in injuries.
TL;DR: It was found that the more intensive and health professional based therapies generally yielded the greater volume reductions, whilst self instigated therapies such as compression garment wear, exercises and limb elevation yielded smaller reductions.
TL;DR: A meta-analysis evaluating the impact of recovery techniques on delayed onset muscle soreness, perceived fatigue, muscle damage, and inflammatory markers after physical exercise found massage was found to be the most powerful technique for recovering from DOMS and fatigue.
Abstract: Introduction: The aim of the present work was to perform a meta-analysis evaluating the impact of recovery techniques on delayed onset muscle soreness (DOMS), perceived fatigue, muscle damage and inflammatory markers after physical exercise. Method: Three databases including PubMed, Embase, and Web-of-Science were searched using the following terms: (“recovery” or “active recovery” or “cooling” or “massage” or “compression garment” or “electrostimulation” or “stretching” or “immersion” or “cryotherapy”) and (“DOMS” or “perceived fatigue” or “CK” or “CRP” or “IL-6”) and (“after exercise” or “postexercise”) for randomized controlled trials, crossover trials, and repeated-measure studies. Overall, 107 studies were included. Results: Active recovery, massage, compression garments, immersion, contrast water therapy and cryotherapy induced a small to large decrease (-2.26 < g < -0.40) in the magnitude of DOMS, while there was no change for the other methods. Massage was found to be the most powerful technique for recovering from DOMS and fatigue. In terms of muscle damage and inflammatory markers, we observed an overall moderate decrease in creatine kinase [SMD (95% CI) = -0.37 (-0.58 to -0.16), I2 = 40.15%] and overall small decreases in interleukin-6 [SMD (95% CI) = -0.36 (-0.60 to -0.12), I2 = 0%] and C-reactive protein [SMD (95% CI) = -0.38 (-0.59 to -0.14), I2 = 39%]. The most powerful techniques for reducing inflammation were massage and cold exposure. Conclusion: Massage seems to be the most effective method for reducing DOMS and perceived fatigue. Perceived fatigue can be effectively managed using compression techniques, such as compression garments, massage or water immersion.