The effectiveness of MLD in reducing oedema of the hand after a traumatic injury was evaluated. Patients with oedema of the hand, which is defined as having a volume greater than 40ml compared to the uninjured hand, were chosen when the fixation period was completed after a fracture of the distal radius. Fractures were treated either with plaster or with an external fixator. A total of 51 patients were included in the study over a period of three years and were randomized into an experimental or control group. Therapy started on average three and a half days after mobilization. All patients received the same conventional treatment, including exercises, activities, oedema control and education. In addition, the experimental group received six treatments of MLD. Oedema of the injured hand was measured with a volumeter at 14 days and 60 days after commencement of treatment, and this was compared to the pre-treatment volume. There was a significantly greater reduction in oedema in the experimental group (median difference 30ml) compared to the control group (median difference 20ml) at the first measurement (p=0.005) taken at 14 days. These results indicate that MLD is a useful method for reducing post-traumatic oedema of the hand in the early phase.
Get full access to this article
View all access options for this article.
References
1.
BoardmanKC (2003). ‘Interstitial flow as a guide for lymphangiogenesis’Circulation Research7: 801–808.
2.
Boiselle HowardS (2001). ‘The use of manual edema mobilization for the reduction of persistent edema in the upper limb’Journal of Hand Therapy14: 291–301.
3.
BolandRA, and AdamsRD (1999). ‘Sphygmomanometer-induced increases in forearm and hand volume’Journal of Hand Therapy12: 275–283.
4.
BorisM, WeindorfS, LasinskiB, and BorisG (1994). ‘Lymphedema reduction by noninvasive complex lymphedema therapy’Oncology (Huntington)8: 95–106; discussion 109-110.
5.
BurkhardtA (1992). ‘Occupational therapy techniques used in treatment of edemas’Occupational Therapy Practice4:1:8–21.
6.
CampisiC, BoccardoF, ZilliA, MaccioA, and NapoliF (2001). ‘Long-term results after lymphatic-venous anastomoses for the treatment of obstructive lymphedema’Microsurgery21: 135–139.
7.
CarterPR (1996). ‘Management of distal radius fractures’Journal of Hand Therapy: 9:2:114–128
8.
Casley-SmithJR, RyanTJ, WitteMH, WitteCL, CluzanR, PartschH, JamalS, and O'BrienB (1985). Lymphedema summary of the 10th international congress of lymphology working group discussions and recommendations, Adelaide, Australia. Lymphology10:175–180.
9.
Casley-SmithJR (1981). ‘Excess plasma proteins as a cause of chronic inflammation and lymphedema: Quantitative electron microscopy’Journal of Pathology133: 243–272.
10.
Casley-SmithJR (1988). ‘The pathophysiology of lymphedema and the action of benzopyrones in reducing it’Lymphology21: 190–194.
11.
CollinsDC (1993). ‘Management and rehabilitation of distal radius fractures’Orthopaedic Clinics of North America24: 365–378.
12.
CurryC, JohnsonA, DuncanH, and OffenbackerT (2003). ‘The intertester and intratester reliability of hand volumetrics’Journal of Hand Therapy16: 292–299.
13.
DrakeRE, TeagueRA, and GabelJC (1998). ‘Lymphatic drainage reduces intestinal edema and fluid loss’Lymphology31: 68–73.
14.
FlinkkilaT, RaatikainenT, and HamalainenM (1998) AO and Frykman's classifications of colle's fracture. No prognostic value in 652 patients evaluated after five years. Acta Orthopaedic Scandinavia69:77–81.
15.
FöldiE, and ClodiusL (1989). ‘The lympedema chaos: a lancet’Annals of Plastic Surgery22: 505–515.
16.
HärénK, BackmanC, and WibergM (2000). ‘Effect of manual lymph drainage as described by Vodder on oedema of the hand after fracture of the distal radius: a prospective clinical study’Scandinavian Journal of Plastic Reconstructive Surgery and Hand Surgery34: 367–372.
17.
IkomiF, HuntJ, HannaG, and Schmid-SchonbeinGW (1996). ‘Interstitial fluid, plasma protein, colloid, and leukocyte uptake into initial lymphatics’Journal of Applied Physiology81: 2060–2067.
18.
International Society of Lymphology, (2003). ‘The diagnosis and treatment of peripheral lymphedema’Lymphology36: 84–91.
19.
JaffeR, ChidgeyLK, and LaStayoPC (1996). ‘The distal radioulnar joint: Anatomy and management of disorders’Journal of Hand Therapy9:2:129–138.
20.
KasserollerRG (1998). ‘The Vodder school: the Vodder method’Cancer83: 2840–2842.
21.
KurzI (1994) Lehrbuch der Manuellen Lymphdrainage nach Dr Vodder, Therapie. Vol. 2. 6th ed.Heidelberg, KF Haug.
22.
KurzI, WittlingerG, LitmanovitchYI, RomanoffH, PfeiferY, and TalE (1978). ‘Effect of manual lymph drainage massage on urinary excretion of neurohormones and minerals in chronic lymphedema’Angiology29: 764–772.
23.
LaStayoPC, WintersKM, and HardyM (2003). ‘Fracture healing: bone healing, fracture management, and current concepts related to the hand’Journal of Hand Therapy16: 81–93.
24.
MackinEJ (1986). ‘Prevention of complications in hand therapy’Hand Clinics2: 429–447.
25.
MichlovitzSL, AlznerS, and WatsonE (2001). ‘Distal radius fractures: Therapy practice patterns’Journal of Hand Therapy14: 249–257.
26.
MoreyKR, and WatsonAH (1986). ‘Team approach to treatment of the post-traumatic stiff hand. A case report’Physical Therapy66: 225–228.
27.
RocksonSG (2001). ‘Lymphedema’American Journal of Medicine110: 288–295.
Schmid-SchonbeinGW (1990). ‘Microlymphatics and lymph flow’Physiology Reviews70: 987–1028.
30.
SchuindF, and BurnyF (1997). ‘Can algodystrophy be prevented after hand surgery?’Hand Clinics13: 455–476.
31.
SchurmannM, GradlG, AndressHJ, FurstH, and SchildbergFW (1999). ‘Assessment of peripheral sympathetic nervous function for diagnosing early post-traumatic complex regional pain syndrome type I’Pain80: 149–159.
32.
SchurmannM, ZaspelJ, GradlG, WipfelA, and ChristF (2001). ‘Assessment of the peripheral microcirculation using computer-assisted venous congestion plethysmography in post-traumatic complex regional pain syndrome type I’Journal of Vascular Research38: 453–461.
33.
SimonsP, Coleridge SmithP, LeesWR, and McGroutherDA (1996). ‘Venous pumps of the hand. Their clinical importance’Journal of Hand Surg [Br]21: 595–599.
34.
StockleU, HoffmannR, SchutzM, von FournierC, SudkampNP, and HaasN (1997). ‘Fastest reduction of post-traumatic edema: continuous cryotherapy or intermittent impulse compression?’Foot and Ankle International18: 432–438.
35.
SzczesnyG, and OlszewskiWL (2002). ‘The pathomechanism of post-traumatic edema of lower limbs: I. The effect of extravasated blood, bone marrow cells, and bacterial colonization on tissues, lymphatics, and lymph nodes’Journal of Trauma52: 315–322.
36.
SzczesnyG, and OlszewskiWL (2003). ‘The pathomechanism of posttraumatic edema of the lower limbs: II - Changes in the lymphatic system’Journal of Trauma55: 350–354.
37.
van VelzeCA, van der MerweCA, and MennenU (1991). ‘The difference in volume of dominant and nondominant hands’Journal of Hand Therapy4:1:6–9.
38.
VasiliauskasR, DijkersM, AbelaMB, and LundgrenL (1995). ‘Characteristics in addition to size of the contralateral hand predict hand volume but are not clinically useful’Journal of Hand Therapy8: 258–263.
39.
VasudevanSV, and MelvinJL (1979). ‘Upper extremity edema control: rationale of the techniques’American Journal of Occupational Therapy33:520–523.
40.
Waylett-RendallJ (1991). ‘A study of the accuracy of a commercially available volumeter’Journal of Hand Therapy4:1:10–13.
41.
WeinstockTB (1999). ‘Management of fractures of the distal radius: therapist's commentary’Journal of Hand Therapy12: 99–102.
42.
WittlingerG, and WittlingerH (1996). Lehrbuch der Manuelle Lymphdrainage nach Dr Vodder. Vol 1, 12th ed.Heidelberg: KF Haug.
