CLT Contraindications & Precautions for Lymphatic Therapy 2 — Questions and Answers
Question 1: Controlled hypertension in a lymphedema patient is best described as:
- An absolute contraindication requiring treatment cancellation
- A relative contraindication/precaution requiring monitoring during treatment (Correct answer)
- Not clinically relevant to lymphatic therapy planning
- A contraindication only for compression therapy
Correct answer: A relative contraindication/precaution requiring monitoring during treatment
Controlled hypertension is a relative contraindication; lymphatic therapy can proceed with blood pressure monitoring and appropriate precautions.
Question 2: Before applying compression therapy to a diabetic patient's lower extremity, the most important assessment is:
- Current blood glucose level
- Ankle-brachial index (ABI) to assess arterial circulation (Correct answer)
- Lymphoscintigraphy results
- Number of years since diabetes diagnosis
Correct answer: Ankle-brachial index (ABI) to assess arterial circulation
ABI assessment is critical in diabetic patients to rule out peripheral arterial disease before compression, which could worsen arterial insufficiency.
Question 3: MLD over the thyroid gland area should be specifically avoided in patients with:
- Hypothyroidism managed with medication
- Hashimoto's thyroiditis in remission
- Hyperthyroidism (Correct answer)
- History of thyroidectomy
Correct answer: Hyperthyroidism
MLD over the thyroid in hyperthyroidism may further stimulate the gland, potentially worsening thyrotoxicosis.
Question 4: A pregnant patient in her second trimester seeks MLD for lower extremity edema. The appropriate clinical response is:
- Decline all treatment during pregnancy
- Treat normally following standard protocols without modification
- Proceed cautiously, avoiding the abdomen and lower back, after physician clearance (Correct answer)
- Use compression garments only and avoid all MLD
Correct answer: Proceed cautiously, avoiding the abdomen and lower back, after physician clearance
MLD during pregnancy can be performed with caution while avoiding the abdomen and lower back, following physician consultation and clearance.
Question 5: For a patient with peripheral arterial disease (PAD) and lower limb lymphedema, the key precaution before compression therapy is:
- Ensuring adequate skin hydration before bandaging
- Confirming ABI is above 0.8 before applying standard compression (Correct answer)
- Reducing MLD session duration by half
- Using only short-stretch bandages regardless of ABI findings
Correct answer: Confirming ABI is above 0.8 before applying standard compression
ABI must be above 0.8 before applying standard compression, as lower values indicate significant arterial compromise that compression could worsen.
Question 6: A patient completed radiation therapy to the axilla 6 months ago and now presents with early lymphedema. The therapist should:
- Refuse treatment as radiation history is an absolute contraindication
- Perform CDT with caution, monitoring skin tolerance in the irradiated field (Correct answer)
- Apply standard full-intensity CDT without modifications
- Treat only with compression and avoid MLD entirely
Correct answer: Perform CDT with caution, monitoring skin tolerance in the irradiated field
Post-radiation (completed, not acute) is a relative precaution; CDT can proceed with careful skin assessment due to potential fibrosis and skin fragility in the irradiated field.
Question 7: Sunburn on a patient's affected arm is best classified as:
- A systemic absolute contraindication
- A local relative contraindication (Correct answer)
- An absolute contraindication to all CDT components
- Not relevant to lymphatic therapy planning
Correct answer: A local relative contraindication
Sunburn is a local relative contraindication; MLD should avoid the burned area but can be performed safely in unaffected regions.
CLT Contraindications & Precautions for Lymphatic Therapy 2
Controlled hypertension in a lymphedema patient is best described as: