Edema of the arm

Edema of the arm: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)

The result of excess interstitial fluid in the arm, this type of edema may be unilateral or bilateral and may develop gradually or abruptly. It may be aggravated by immobility and alleviated by arm elevation and exercise.

Arm edema signals a localized fluid imbalance between the vascular and interstitial spaces. (See Understanding fluid balance, page 291.) It commonly results from trauma, venous disorders, toxins, or certain treatments.

Emergency interventions

History and physical examination

When taking the patient’s history, one of the first questions to ask is “How long has your arm been swollen?” Then find out if the patient also has arm pain, numbness, or tingling. Does exercise or arm elevation decrease the edema? Ask about recent arm injury, such as burns or insect stings. Also, note recent I.V. therapy, surgery, or radiation therapy for breast cancer.

Determine the edema’s severity by comparing the size and symmetry of both arms. Use a tape measure to determine the exact girth. Be sure to note whether the edema is unilateral or bilateral, and test for pitting. (See Edema: Pitting or nonpitting? page 292.) Next, examine and compare the color and temperature of both arms. Look for erythema and ecchymoses and for wounds that suggest injury. Palpate and compare the radial and brachial pulses. Finally, look for arm tenderness and decreased sensation or mobility. If you detect signs of neurovascular compromise, elevate the arm.

Medical causes

Angioneurotic edema

Angioneurotic edema is a common reaction that’s characterized by sudden onset of painless, nonpruritic edema in the hands, feet, eyelids, lips, face, neck, genitalia, or viscera. Although these swellings usually don’t itch, they may burn and tingle. If edema spreads to the larynx, signs of respiratory distress may occur.

Arm trauma

Shortly after a crush injury, severe edema may affect the entire arm. It may be accompanied by ecchymoses or superficial bleeding, pain or numbness, and paralysis.

Burns

Mild to severe edema, pain, and tissue damage may occur up to 2 days after an arm burn.

Superior vena cava syndrome

Bilateral arm edema usually progresses slowly in this disorder and is accompanied by facial and neck edema. Dilated veins mark these edematous areas. The patient also complains of headache, vertigo, and vision disturbances.

Thrombophlebitis

Thrombophlebitis, which can result from peripherally inserted central catheters or arm portacaths, may cause arm edema, pain, and warmth. Deep vein thrombophlebitis can also produce cyanosis, fever, chills, and malaise; superficial thrombophlebitis also causes redness, tenderness, and induration along the vein.

Other causes

Envenomation

Envenomation by snakes, aquatic animals, or insects initially may cause edema around the bite or sting that quickly spreads to the entire arm. Pain, erythema, and pruritus at the site are common; paresthesia occurs occasionally. Later, the patient may develop generalized signs and symptoms, such as nausea, vomiting, weakness, muscle cramps, fever, chills, hypotension, headache and, in severe cases, dyspnea, seizures, and paralysis.

Treatments

Localized arm edema may result from infiltration of I.V. fluid into the interstitial tissue. A radical or modified radical mastectomy that disrupts lymphatic drainage may cause edema of the entire arm, as can axillary lymph node dissection. Also, radiation therapy for breast cancer may produce arm edema immediately after treatment or months later.

Special considerations

Treatment of the patient with arm edema varies according to the underlying cause. General care measures include elevation of the arm, frequent repositioning, and appropriate use of bandages and dressings to promote drainage and circulation. Provide meticulous skin care to prevent breakdown and formation of pressure ulcers. Also, administer an analgesic and anticoagulant as needed.

Pediatric pointers

Arm edema rarely occurs in children, except as part of generalized edema, but it may result from arm trauma, such as burns and crush injuries.

Patient counseling

Warn the patient who has undergone a mastectomy or axillary lymph node dissection of the possibility of arm edema, and advise her not to have blood pressure measurements taken or phlebotomies performed on the affected arm. Teach the patient how to perform arm exercises after surgery to prevent lymphedema.

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

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