Lymphedema diagnosis, treatment, and follow-up from the view point of physical medicine and rehabilitation specialists

Lymphedema is an incurable, debilitating and progressive condition, characterized by persisted swelling of one or more parts of the body, due to impaired lymph transport.It is a major healthcare problem in both developed and non-developed countries.Lymphedema may be present in the extremities (Figures 1a, b), trunk, abdomen, head and neck, external genitalia, and internal organs.It is a serious concern due to its long-term physical and psychosocial consequences for the patient, if left untreated.The lack of awareness and medical expertise in the diagnosis and treatment of this condition and the tendency of clinicians to overlook lymphedema in patients who previously underwent cancer surgery, making this condition more problematic.[1,2] Within this context, PMR specialists play a critical role in clinical care that their global approach of this problem, by integrating the physical disorders, psychological dimensions and quality of life (QoL) issues, provide the extensive management and rehabilitation of patients.[3] The PMR specialist is responsible for the differential diagnosis and assessment of the patients to tailor management and rehabilitation strategies.Therefore, he/she should have a comprehensive knowledge about the pathophysiology, epidemiology, and diagnostic and preventive measures, as well as therapeutic approaches of lymphedema. EpidEmiologyThe incidence of lymphedema has not been precisely estimated in Turkey and the estimated rates according to different areas vary widely in the literature.About 200 million cases of lymphedema have been estimated worldwide with filariasis, a parasitic infestation, being the most common cause in the world.[1,4] Lymphedema may be primary due to the congenital dysfunction of the lymphatic system and can be diagnosed at different stages in life without an obvious cause.Secondary forms mostly develop after cancer surgery and/or radiation therapy for various ABSTRACT Lymphedema is an incurable, debilitating and progressive condition, leading to physical and psychosocial consequences for the patients, if left untreated.The Physical Medicine and Rehabilitation (PMR) specialist is responsible for the differential diagnosis and evaluation of the patient to tailor management and rehabilitation strategies.Therefore, the PMR specialist must have knowledge and education on the diagnosis of disease and possible complications as well as evaluation, treatment and follow-up of the patient.In this review, the pathophysiology, epidemiology, and diagnostic and therapeutic approaches of lymphedema as well as preventive strategies and follow-up strategies are discussed in the light of the current literature.