Lymphodema

Hi Samantha,

We are sorry to hear about your dad's stroke and the ongoing oedema he is experiencing as a result. It isn't uncommon for stroke survivors to experience swelling of the affected limbs after stroke, particularly in the upper limb. How long has this been an issue? He may have already ruled out other causes but for any others reading this post it is important to do some investigation before you start addressing the problem.

Firstly, find out if something unrelated to the stroke is causing the problem. Has the arm/hand been injured? Sensation can be affected as a result of stroke, so the limb may have been knocked or in some cases fallen on at the time of the stroke injuring the arm.

Once this has been ruled out, the medical team will usually rule out deep vein thrombosis (DVT). A DVT is a blood clot that forms in a vein in the body. Ruling this out is important because many of the treatments to help reduce swelling could send the clot to the lungs.

If the cause isn't injury or a blood clot, the swelling is brought about by weakness in the arm. The hand's normal muscle pumping action is disrupted by disuse (in this case, because of the stroke) and fluid can begin to pool in the tissues along the back of the hand and in the forearm. The fluid needs to be pushed back into the bloodstream. Getting clearance prior to starting oedema management techniques is important, particularly if there are cardiac issues. 

You might like to read our fact sheet on upper limb management for more information. The draft Clinical Guidelines for Stroke Management 2017 have also been released recently. While there isn't any robust evidence for the treatment and prevention of swelling of the upper extremities after stroke, the consensus-based practice recommendations for managing swelling of the upper limb are:

For stroke survivors who have swelling of the hands or feet management may include the following:
• dynamic pressure garments
• electrical stimulation
• continuous passive motion with elevation
• elevation of the limb when resting.

I would also add in active movement if this is possible for your father, even if he is only able to move his fingers slightly. Using the limb as much as possible helps to pump the fluid away from the limb and back towards the heart. He might find the limb swells up more over the day, particularly if the arm is hanging while walking or if he has slept on it without realising. Elevation where possible in a supported position on pillows etc at rest can help to alleviate swelling that has built up over the day. Care with positioning when sleeping is also important.

I hope this is helpful. If he is seeing a physio or an occupational therapist, have a chat with them further as well. I am sure other stroke survivors in our community will share their lived experiences with you and your dad as well once they've seen your post.

If you would like to discuss further please contact StrokeLine on 1800 787 653.

Best wishes,

Simone (Occupational Therapist for StrokeLine)

Hi, thanks for the reply - it was very useful.  My dad's oedema has been maintained by rehab and some exercises.  

However, over the past month or so, he has started developing a sore that keeps returning and is being maintained by an antibiotic cream that the GP prescribes.

I'm just wondering if this is usual?  Before his stroke he's never had sores like this on his right hand.