Manual Lymph Drainage (MLD) In The Orthopedic Shoulder Patient
O'Toole J

Background:  Manual lymph drainage is a commonly used intervention strategy for the lymphedema therapist.  Most of what has been published about MLD addresses its efficacy in patients with compromised lymphatic systems.

Purpose:  The purpose for presenting this case study is to demonstrate the usage of manual lymph drainage in an orthopedic shoulder patient who has sustained trauma, resulting in effusion and edema.

Case Description:  The patient is a 78-year-old woman who sustained a proximal humerus fracture in her dominant arm in May of 2005.  She was immobilized in a sling for six weeks and referred to physical therapy at that point.  She initially presented with an extremely edematous right upper extremity pain and severely comprised shoulder, elbow, and hand function.  Her initial examination findings, the evaluation of the examination, the physical therapy intervention, and her outcome will be presented.

Outcome:  Manual lymph drainage was incorporated as part of her management, and clinically seemed to make a significant difference in her ability to progress with range of motion.  Her pain decreased more rapidly than one might have expected in someone with such a sympathetic response to trauma.

Discussion:  Manual lymph drainage seems to be a clinically useful tool to augment the plan of care for patients who have sustained trauma or orthopedic surgery.  This patient population usually has intact lymphatics, and MLD seems to result in a fairly rapid decrease in swelling.  Discussion will explore the principles of manual l ymph draininage, and when and how they might be considered as part of a treatment regimen for the orthopedic shoulder patient.