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ULY CLINIC

ULY CLINIC

9 Septemba 2025, 04:57:50

Edema of the Arm

Edema of the Arm
Edema of the Arm
Edema of the Arm

Arm edema is the localized swelling of the upper limb due to fluid imbalance between the vascular and interstitial spaces. It may develop gradually or abruptly and can be unilateral or bilateral. Immobility may worsen the condition, while arm elevation and exercise can alleviate it.


Pathophysiology

Fluid accumulates in the arm when the balance of capillary hydrostatic and osmotic pressures, as well as lymphatic drainage, is disrupted. Causes include trauma, burns, envenomation, venous obstruction, surgical or radiation therapy, and systemic vascular syndromes.


Signs and Symptoms

  • Visible swelling of one or both arms

  • Pitting or nonpitting edema

  • Pain, numbness, tingling, or heaviness

  • Skin changes: erythema, ecchymoses, warmth, or tautness

  • Reduced range of motion if edema is severe

  • Possible signs of systemic involvement in envenomation or vascular syndromes


Clinical Assessment


History

  • Onset, duration, and progression of swelling

  • Pain, numbness, tingling, or functional limitations

  • Relation to exercise or arm elevation

  • Recent trauma, burns, insect or animal bites, IV therapy, surgery, or radiation therapy


Physical Examination

  • Compare size, symmetry, and girth of both arms (mark reference points for serial measurements)

  • Assess for pitting, erythema, ecchymoses, and wounds

  • Palpate radial and brachial pulses, test capillary refill

  • Evaluate temperature and tenderness

  • Assess for neurovascular compromise and elevate arm if present


Medical Causes

Cause

Onset/Pattern

Distinguishing Features

Angioneurotic edema

Acute, recurrent

Sudden, painless, nonpruritic swelling of hands, feet, eyelids, lips, face, neck, genitalia, or viscera; may cause stridor or dyspnea if laryngeal involvement occurs

Arm trauma

Acute

Severe swelling following crush injuries, fractures, or contusions; may include pain, numbness, paralysis, or ecchymoses

Burns

Acute

Localized or generalized edema; severity correlates with burn depth; pain and tissue damage present

Envenomation

Acute

Rapidly spreading edema around bite or sting; erythema, pruritus, paresthesia; systemic symptoms may include nausea, vomiting, hypotension, dyspnea, or seizures

Superior vena cava syndrome

Gradual

Bilateral arm swelling with facial and neck edema; dilated veins, headache, vertigo, visual disturbances

Thrombophlebitis

Acute/subacute

Arm swelling with pain, warmth, redness along vein; deep vein thrombosis may cause cyanosis, fever, malaise

Other causes

Cause

Onset/Pattern

Distinguishing Features

Surgical treatments

Postoperative

Radical or modified mastectomy, axillary lymph node dissection; disrupts lymphatic drainage causing localized or whole-arm edema

Radiation therapy

Immediate or delayed

Edema may occur immediately after treatment or months later; commonly follows breast cancer therapy

IV therapy complications

Acute

Localized infiltration of fluids into interstitial tissue, leading to swelling at the infusion site; may cause tenderness or erythema


Special Considerations

  • Elevate the affected arm above heart level to promote fluid drainage

  • Reposition frequently to prevent pressure ulcers

  • Apply bandages or dressings as appropriate to encourage circulation

  • Administer analgesics and anticoagulants as indicated

  • Monitor for neurovascular compromise and systemic complications


Patient Counseling

  • Instruct patients on proper postoperative arm care

  • Teach arm exercises to prevent lymphedema

  • Advise on early signs of complications, including pain, numbness, or rapidly increasing swelling


Pediatric Pointers

  • Rare except as part of generalized edema

  • May occur after trauma, burns, or crush injuries

  • Monitor fluid balance and neurovascular status closely


Geriatric Pointers

  • Older adults may be at increased risk due to frailty, reduced mobility, or comorbidities

  • Exercise caution with interventions that may exacerbate edema


References

  1. Ballots JC, Tamaoki MJ, Atallah AN, Albertoni WM, dos Santos JB, Faloppa F. Treatment of reducible unstable fractures of the distal radius in adults: A randomized controlled trial of De Palma percutaneous pinning versus bridging external fixation. BMC Musculoskelet Disord. 2010;11:137.

  2. Schneppendahl J, Windolf J, Kaufmann RA. Distal radius fractures: Current concepts. J Hand Surg Am. 2012;37:1718–1725.

  3. Rockson SG. Lymphedema. Am J Med. 2001;110:288–295.

  4. Nguyen DH, Suh JD, Wang MB. Upper extremity edema: Evaluation and management. Otolaryngol Clin North Am. 2015;48(6):975–989.

  5. Olszewski WL. Lymphatic drainage disorders: pathophysiology, diagnosis, and therapy. Adv Clin Exp Med. 2014;23(6):911–918.

  6. Cox JL, Tarwater PM. Arm edema: Clinical evaluation and treatment. Am J Med Sci. 2015;350(5):393–401.

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