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Carpal Tunnel Syndrome - Part I (08/02/17)

Everyone has heard of carpal tunnel syndrome but what is it?

Did you know that the muscles that move your fingers are actually located in your forearms? Or that there are actually a surprisingly small number of muscles comparatively in your hand compared to, say, your shoulder? This is surprisingly because of the dexterity you can achieve with your hands compared to the larger movements achieved elsewhere in your body.

So, what happens when it goes wrong and your hands are not as able to move due to the discomfort or pain of carpal tunnel syndrome?

As we said before, your fingers are controlled by the muscles in your forearms and these muscles pull on tendons that act like ropes that are going through a series of pulleys, to clench or straighten your fingers.

To keep the 9 tendons from fraying and becoming painful, they pass through a protective tunnel that runs over the surface of all the little carpal bones in your hands. This is your carpal tunnel.

(Part II to follow)

Upper Limb Lymphoedema - Part VI (30/11/16)


Compression improves the drainage of lymph fluid. Wearing compression supports and protects your arm. Compression enhances the muscle pump action thus helping to pump lymph fluid out of the arm and reduce your swelling. Compression must be prescribed therefore your lymphoedema specialist will be able to advise on the suitability, style and type of compression you may benefit from.

This summary will hopefully give you some ideas to help manage your upper limb lymphoedema - remember if you have any underlying medical conditions seek medical advice before starting anything new or increasing your activity and if you experience any increased or new symptoms ensure you stop the activity / exercise and seek medical advice.

Upper Limb Lymphoedema - Part V (15/11/16)

The importance of exercise:

Moving your arms so the muscles contract and relax will help to pump the lymph fluid and help reduce swelling. As with all activity and movement try and do the activities little and often. So if for example you are sitting for long periods working at the computer, on a bus or watching television, try and break this time up by trying a few movements below to help keep the lymph fluid moving and to help reduce your swelling. A few specific exercises though that you could consider incorporating into your daily routine are as follows:

  1. Bend and straighten your elbow - repeat 10 times
  2. Bend, straighten and circle your wrist - repeat 10 times
  3. Make a fist and then stretch open your fingers - repeat 10 times
  4. Shrugging shoulders - shrug your shoulders towards your ears then rotate backwards before relaxing x 5-10 times

Upper Limb Lymphoedema - Part IV (18/10/16)

Cellulitis Management:

Cellulitis is an infection and inflammation of the skin. The symptoms of cellulitis can include the following:

  • Redness (erythema) to the region
  • Increased temperature - both systemically (fever) and to the localised infected area
  • Pain
  • Rash
  • Feeling unwell - like you have the flu.

Cellulitis is very treatable. if you think you may have cellulitis, the following advice should be followed:

  • Remove any compression from the affected area
  • Rest
  • Contact your GP for an urgent appointment (antibiotics are required as soon as possible to treat cellulitis. If symptoms occur over a weekend or evening, contact out-of-hours GP, do not wait until the next day or Monday morning)
  • If your symptoms increase whilst on antibiotics, inform your GP or contact your local hospital for advice.

Upper Limb Lymphoedema - Part III (01/10/16)

Skin care - Daily cleaning and cleansing of the skin, followed by moisturising, is essential to prevent skin infections such as cellulitis. If your skin is very dry, a soap-substitute can be used when washing followed by a non-perfumed ointment. If your skin is not dry but you wish to prevent dryness occurring, then a non-perfumed emollient is recommended.

If there is significant build-up of dry skin (hyperkeratosis) or a wound present, then debridement could be considered and implemented under clinical guidance from the clinician caring for you. Debridement helps to lift the dry skin and remove any damaged or infected skin, thus promoting the growth of healthy skin.

Top tips to maintain healthy skin:

  • Treat any cuts, scratches, burns with antiseptic spray to ensure they don't become infected
  • Keep nails in good condition
  • Treat any fungal infections or skin conditions, such as eczema
  • Use mosquito repellent if at risk of being bitten
  • Do not get sun burnt - wear high factor sun lotion
  • Be careful when removing hair - consider using electric razor or hair removal cream to minimise the risk of cutting yourself
  • Keep your swelling under control as best you can through techniques including exercise, compression and lymphatic drainage
  • If you have had recurrent cellulitis, you are going to be more prone to having cellulitis again in the future and therefore may benefit from a course of propholatic antibiotics to prevent cellulitis reoccuring - your lymphoedema specialist or GP will be able to discuss this with you
  • If you have arm/hand swelling, wear long sleeves and gloves when gardening, in addition to your compression hosiery and wear washing up gloves when washing up.

Upper Limb Lymphoedema - Part II (14/09/16)

Management of upper limb lymphoedema:

Scar Management - Scar tightness can cause swelling to increase but tightness can be prevented and managed. Scars can feel hypersensitive or numb initially but through touching and moving the scar, it can help to normalise those sensations. Following surgery, touching a new scar can be daunting, so here are a few tips to help you manage your scars.

  • Initially get used to looking at the scar. Depending on the type of surgery, this can be challenging as a significant alteration to your body image may have taken place.

Once the scar has fully healed, all stitches and drains have been removed, there is no sign of infection and no further treatment of the area is required, the following can be commenced:

  • Use a non-perfumed moisturiser (with vitamin E) to apply to the scar.
  • Move and glide the skin surrounding the scar to move and stretch the connective tissue. Stretch the skin away from the scar.
  • Move the scar - use movements that go across the scar, moving along the whole length of the scar to ensure all aspects of the scar move freely (as shown on image).

If you have had breast surgery - for people that have had a lumpectomy, moving the breast in a figure of 8 motion can help to loosen scar tissue. If you have had a mastectomy and are unable to touch or move the scar initially, moving the contra-lateral breast can help to achieve some movement and help loosen the connective tissue.

Part III to follow

Upper Limb Lymphoedema - Part I (26/08/16)

Lymphoedema is not just isolated to the legs. Lymphoedema can occur in both the arms and trunk too. Lymphoedema in these areas are often associated with treatment for cancer, usually through the removal of lymph nodes in the axilla (armpit) or radiotherapy to the chest wall, breast and axilla, although occasionally non-cancer related causes can occur.

The most common cancer associated with upper limb lymphoedema is breast cancer, but malignant melanoma, if diagnosed in the upper limb, can also cause symptoms of lymphoedema. Physical symptoms can include swelling of the hand, arm, breast and chest wall, ache and heaviness within the limb, firmness of the tissues and increased susceptibility to skin infections such as cellulitis. Lymphoedema can also have an impact on psycho-social well-being and cause anxiety, altered body image and social isolation. It is important to recognise the impact upper lymphoedema can have on an individual both physically and psycho-socially so effective personal management and support can be offered to each person.

There are many ways in which upper limb lymphoedema can be managed including scar management, skin care, exercise, compression, lymphatic drainage, kinesio tape, maintenance of healthy body weight and surgery. Some top tips for managing upper limb swelling are summarised in Part II.

Management of Venous Disease - Part II (17/06/16)

Compression can come in various forms:

  • Adjustable Velcro Compression Device (AVCD)
  • Stockings and Hosiery (for both males and females)
  • Bandaging

There are various prescription strengths of compression so expert medical advice should always be sought.

Medication can be used to reduce the symptoms of venous disease. These include:

  • diuretics: medications that draw extra fluid from your body through your kidneys
  • anticoagulants: medications that thin the blood
  • medication that helps improve blood flow

Alongside all these medical interventions, there are very simple ways that everyone can use to improve blood flow and decrease lower limb swelling:

  • keep your legs elevated whenever possible
  • keep your legs uncrossed when seated
  • exercise regularly

Management of Venous Disease - Part I (10/06/16)

Management of venous disease depends on many factors, including the reason for the condition and your health status and history. A full medical assessment by a health care professional should always be carried out prior to starting any management regime.

The most common management for venous disease is prescribed compression. These are special elastic and inelastic compression garments that apply pressure at the ankle to just below the knee and can go as high as your upper thigh.

These garments help improve blood flow by providing graduated compression and can reduce leg and foot swelling by aiding venous return.

Why Compress Venous Disease - Part II (18/04/16)

Why use compression?

Once the valves in the veins have been damaged, there is nothing that can be done to repair them. The best management is to try and prevent any further damage to the veins and treat the symptoms you are experiencing. The current management for venous disease is through compression and can be administered in a variety of forms, depending on the severity of your condition. There is compression hosiery, wrap-around devices and compression bandages.

Compression will gently squeeze your leg, forcing the excess fluid in and around your veins to move back up the vein towards the heart. This will help reduce the symptoms you may be experiencing and help the veins to work more efficiently.

As mentioned previously, venous disease is a life-long condition, the damage to the veins cannot be reversed. We can successfully manage and maintain your legs with compression but you will always need to wear compression to prevent any further damage to your veins.

Why Compress Venous Disease - Part I (12/04/16)

How do healthy veins work?

The main function of veins is to return blood back to the heart. When we are standing or sitting, the blood in our legs is working against gravity to make its way back to the heart. In our legs there are two mechanisms which help the blood to move up through the veins and back to the heart. Firstly, when we exercise such as when we walk, the calf muscle will pump the blood in the veins back up the leg towards the heart. Secondly, the veins have a one-way system made up of valves running along the vein which stop the blood from flowing back down towards the foot.

What is venous disease?

Problems with the veins can occur when the valves in the veins no longer work. When this happens some blood will flow up the veins towards the heart but some will flow back down into the leg through the damaged valves. Over time, valves in the veins can be damaged though many causes, such as

  • broken bones
  • surgery to the lower leg
  • spending long periods of time standing on your feet
  • obesity
  • genetics

Skin changes and compression

Over time, you may start to see skin changes in your legs. Here are a list of some skin changes which are often seen in Venous Disease but which compression garments can help and improve deterioration of

  • Swelling of the ankle and lower leg
  • Changes to the colour of your skin - sometimes purple or brown in colour
  • Varicose veins
  • Hardening and thickening of skin
  • Thickening of toe nails
  • Small spider veins, especially around the ankle and foot

Stages of Lymphoedema (04/04/16)

Whether you have been diagnosed with primary or secondary lymphoedema, the condition progresses through a series of significant changes. It is important to seek help just after your diagnosis, even if your symptoms seem mild and insignificant.

Every person diagnosed with lymphoedema is unique and no two cases are the same, but you should aim to reduce the risk of your symptoms getting worse by seeking prompt care.

There are several stages of lymphoedema which have been classified according to the British Lymphology Society (The BLS):

Stage 0: this is also called the sub-clinical or latent stage and occurs after lymph nodes have been disturbed, for example after lymph node biopsy or surgery. You may not experience any symptoms at all, but you need to be mindful that damage to the lymphatic system has occurred and be aware to seek assistance if any changes to your skin or tissues occur.

Stage 1: this stage is mild, when your affected area may feel slightly swollen. If you press your skin, a temporary dent may appear. You may experience a tightness in your clothes or a feeling of heaviness in your arm or leg. Symptoms often resolve over time. This stage is often referred to as 'pitting oedema' and may be temporary so the swelling resolves over time, or over night when the affected area is elevated. This stage is often considered reversible.

Stage 2: this stage is moderate and the affected area is more swollen. Elevation fails to reduce the swelling and pressing the area fails to create a pitting effect. Your skin may start to feel thickened and hard. Treatment still has good outcomes but tissue damage sustained cannot be reversed easily.

Stage 3: this stage is classified as severe and advanced. Swelling increases and the affected area is often distorted. Your skin may feel thickened and tough, and you may see changes to your skin texture. Pressing the area fails to leave a pitting element. Sometimes an infection can occur if swelling is not treated and sometimes the skin can break down. Swelling can, however, still be reduced, though treatment may need to be repeated several times.

Whatever stage your lymphoedema is at, it is vitally important that you seek help as soon as possible. Apart from specialist intervention there are self-help groups widely available via social media or the internet.

Prevention of venous disease and reducing the risks (30/03/16)

Prevention of venous disease is particularly important if there is a family history of venous disease. A doctor can help determine which strategies are appropriate for each individual. There are several steps that can be taken to minimise the risks and symptoms of venous disease:

  • Having a healthy lifestyle and maintaining a healthy body weight
  • Exercise regularly
  • Don't smoke, smoking is harmful to the circulation
  • Don't sit or stand in the same position for long periods. If your job requires this, speak to a doctor about appropriate compression hosiery, these will keep your circulation moving
  • Look after your legs, keep the skin moisturised and in good condition, protect them from injury Venous leg ulcers can heal quickly when treated by a healthcare professional who is trained in compression therapy, however some ulcers take longer.

Venous ulcers have a high recurrence rate, so it is highly likely that an ulcer will come back unless the underlying cause in treated and maintained.

Further information

  • 438 KB

    Lympho-Opt Klinik, Germany - Elephantiasis

  • 282 KB

    Relay for Life, Aylesbury

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