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ICD-9-CM CODES

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  • 457.0 Postmastectomy lymphedema syndrome

  • 457.1 Other lymphedema

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ICD-10-CM CODES

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  • I89.0 Lymphedema, not elsewhere classified

  • I97.2 Postmastectomy lymphedema syndrome

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PREFERRED PRACTICE PATTERNS

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation1

  • 6H: Impaired Circulation and Anthropometric Dimensions Associated with Lymphatic System Disorders2

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PATIENT PRESENTATION

Patient is a 52-year-old female diagnosed with right invasive breast cancer 2 years ago with a right modified radical mastectomy and axillary node dissection. Patient deferred reconstruction due to the need for chemotherapy and radiation to right axilla and chest wall. She reports healing well from surgery and completed radiation and chemotherapy with limited side effects and only mild radiation fibrosis.

Patient reports going on a canoe trip with her family and soon after, noticing her rings and bracelets becoming tight and some edema in her knuckles and hand that subsided with elevation. In the next week, the edema became worse, did not subside and she began to notice tingling and mild numbness in her fingertips that worsened in the evening and also when she first woke up in the morning. An ultrasound was negative for DVT in right upper extremity.

Patient now presents with limitations in available AROM in elbow flexion, wrist extension and flexion and finger flexion. Full AROM measured in shoulder flexion and abduction. Grip is 10 lb less than nondominant left hand and lateral pinch strength also is 5 lb below left. Patient has limited muscle endurance in right shoulder due to weight of her arm and has begun using left arm for many tasks. There is a shiny appearance to the skin over the hand and forearm and pitting is noted. Stemmer’s sign is positive as well as a 15% greater limb volume noted with arm-volume measurement than unaffected left arm.

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KEY FEATURES

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Description
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  • Occurs when lymph system is damaged or blocked and buildup of lymph fluid occurs in soft tissues, causing swelling

  • Obstruction of lymphatic vessels or lymph nodes

  • Increased water and protein in the interstitial space3

  • Lymphedema can occur as a result of surgery, chemotherapy, or radiation causing interruption of the lymphatic system

  • Postmastectomy, axillary, or sentinel lymph node dissection affects upper extremities

  • Considered secondary lymphedema

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Essentials of Diagnosis
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  • Detailed medical history (e.g., surgical procedures, chemotherapy, radiation)

  • Presence of nonpitting edema

  • MRI or CT

  • Circumferential upper-extremity measurement

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General Considerations
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  • Commonly occurs following breast cancer surgery

  • Axillary or sentinel node dissections and radiation therapy increase risk of occurrence

  • Classification for lymphedema3

  • Mild: Less than 3 cm difference between the affected and unaffected limb3

  • Moderate: Between 3 and 5 cm difference between the unaffected and affected limb3

  • Severe: 5+ cm difference between the unaffected and affected limb

  • Graded ...

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