patient education : 04023--Limb Edema After Stroke

LIMB EDEMA AFTER STROKE

What is edema?

Edema is another word for swelling caused by excess fluid trapped in the body’s tissues.  After a stroke, a patient may have edema in the weakened arm or leg.

What are some causes of edema?

• Loss of voluntary movement and inactivity
• Allowing the affected arm or leg to hang down for extended periods
• Changes in blood vessel function
• Decreased muscle function and tone leading to impaired drainage of fluids in the affected limb
• Leaking of IV fluids under the skin

What complications might result from edema IF UNTREATED?

• Limited movement/range of motion can lead to muscle contractures
• Increased risk of infection
• Pain
• Decreased blood flow leading to increased risk of skin breakdown

What precautions should BE FOLLOWED WITH EDEMA?

1.   Have blood drawn and blood pressures taken on the other arm.

2.   Avoid prolonged use of arm slings-consult with occupational or physical therapy.

3.   Regularly inspect the swollen area and take note of any changes (discoloration, increased pain).  If you have any concerns, contact your physician or therapist promptly.

What treatments are used to control edema?

The excess fluid needs to be moved back into the bloodstream so it can be removed from the body. Your therapist and doctor will customize an edema management program for you.  Keep in mind that not all treatment options are appropriate for everyone.  In particular, individuals with cardiac problems or blood clots require special consideration. 

• Elevation – Place the swollen arm or leg above heart level on pillows for a minimum of 45-60 minutes at a time to allow gravity to move fluids back into circulation.
• Positioning – Follow the recommendations given by your occupational or physical therapist.
• Medications – Diuretics (fluid pills), for example, reduce fluid retention and swelling.  Other medications focus on preventing blood clots.
• Regular stretching and exercises – Try to move the affected extremity as much as possible. If you can’t move it, it is still important to have someone help you move the arm or leg through a full range of motion.  Follow the programs your therapists have customized for you.
• Massage – Gentle massage can be helpful by starting with the hands or feet and working towards the trunk of your body.
• Compression garments – Examples include Isotoner gloves, elastic stockings, and ace wraps.  These should never restrict blood flow and should only be used after you are instructed by a health care professional.
• Ice or contrast baths – Soaking the swollen extremity in an ice bath or alternating submersion between ice water and warm water can reduce swelling to an area. Please consult your therapist before beginning this treatment.