WHAT IS LYMPHEDEMA?

Lymphedema is a recognized disease in the ICD-10 (International Code of Disease, 10th Revision) and is defined as high-protein fluid retention in an affected area of the body. It is characterized by a common characteristic of pitting in the affected region.

WHAT IS LYMPH?

Lymph is a naturally occurring fluid in the body made from the process of activity by the cardiovascular structures, which includes changing and difference of pressure between layers of soft tissue. As the heart pumps and blood passes into the arteries the walls of the arteries seep fluid out into the extracellular space. It’s important to note that the walls of the arteries are not fully enclosed but have perforations to allow for this seeping of fluid out of the artery and into the extracellular space. This seeping from the perforations is not the formation of lymph in the body itself, until it is processed by a lymph structure. Lymph itself contains protein content, external debris, internal metabolic debris, bacterial and viral loads, and bodily fluids. A lymph vessel will siphon the interstitial fluid from the extracellular space and eventually lead to a lymph node, which will act as a filter for this unprocessed fluid. Eventually this fluid leads back to your subclavian vein, which leads back to your heart and thereby completing the continuous cycle of lymph formation.

WHAT IS PITTING? PERFORMING THE PITTING TEST

Pitting occurs in the affected region presenting with lymphedema due to a certain material content found within the swelling. Regular swelling is mostly water content and other body fluids, however, lymphedema swelling also includes protein content. This protein content is what separates edema from lymphedema. This protein found in the fluid is also responsible for the impression left as “pitting” in the affected areas while testing for pitting.

To perform pitting testing simply apply pressure to a suspected region of lymphedema