Strokes that cause one-sided weakness often have another frustrating consequence: swelling in the affected arm and hand. In a normally-functioning arm, muscle and joint movement pump lymph (tissue fluid) throughout the body. Weakened arm muscles from a stroke are less able to pump, causing fluid to accumulate towards the bottom of the limb. This fluid buildup results in arm swelling, which is also known as edema. Early recognition and treatment of edema is vital to prevent pain and improve arm function. (1, 2)

Strategies for managing post-stroke arm swelling:

1. Elevation
2. Compression
3. Massage
4. Exercise
5. Electrical stimulation

Elevation

“Dependent” or downward arm positioning can contribute to edema, as gravity will pull tissue fluid to the lowest point of a weakened limb. Elevating the limb throughout the day can help reduce fluid pooling and associated swelling. When in bed at night, prop up your arm with pillows, ideally above the level of your heart. During the day, you can try to keep your arm higher than your lap by supporting it with pillows, a padded chair armrest, or with an arm trough or lap tray if you are a wheelchair user.

Compression

Compression garments for the hand and arm may help push tissue fluid from the bottom of the limb back into bodily circulation. There are various types of compression gloves and sleeves that can be considered for edema. It is best to seek advice from a healthcare professional before purchasing a compression garment, as they often need to be sized for your body to work correctly.

Massage

Edema massage can assist with fluid circulation throughout the affected arm. It is best to consult with a therapist or nurse who is also a certified lymphedema specialist to teach you to perform this technique, as it involves specific pressure, speed, and direction of massage strokes on the swollen limb. Massage is contraindicated with some health conditions, and should not be performed if you have blood clots, heart or kidney failure, or certain cancers.

Exercise

Exercise is an excellent way to manage edema. Whether you can move the affected arm by itself, or you have to move it with the help of your strong arm, getting your muscles to shorten and lengthen can help reduce swelling. Depending on how strong your affected arm and hand are, you may chose to complete active movement exercises with or without additional weights or passive stretches. Both techniques can pump pooled tissue fluid back towards the heart. Exercise also helps maintain joint flexibility and can improve overall strength and arm function. (1 - 3)

Electrical Stimulation

Your occupational or physical therapist may perform electrical stimulation (e-stim) to reduce hand swelling following a stroke. This treatment modality involves application of electrode pads over the skin for the targeted transmission of an electrical current. There are many types and purposes of e-stim; however, studies show that certain stimulation parameters can enhance vascular circulation or aid in muscle pumping to move excess tissue fluid throughout the body. (4)

Watch for out for dangerous swelling

If you have arm swelling that also associated with redness, pain, and skin that is warm to the touch, seek medical advice immediately as this might indicate a blood clot. It is always a good idea to discuss edema management strategies with your medical team to find out which techniques might work best for your particular case before beginning a routine.

The Neofect line of Smart Rehabilitation Solutions can serve as a part of an active movement exercise program to help manage edema and improve upper extremity function following stroke. Our neurorehabilitation products include support from occupational therapists to maximize functional gains. Please call (888) 623-8984 or email info@neofect.com for further inquiry.

• References

1. Boomkamp-Koppen, H. G., Visser-Meily, J. M., Post, M. W., & Prevo, A. J. (2005). Poststroke hand swelling and oedema: prevalence and relationship with impairment and disability. Clinical Rehabilitation, 19(5), 552–559. doi: 10.1191/0269215505cr846oa

2. Leibovitz, A., Baumoehl, Y., Roginsky, Y., Glick, Z., Habot, B., & Segal, R. (2007). Edema of the paretic hand in elderly post-stroke nursing patients. Archives of Gerontology and Geriatrics, 44(1), 37–42. doi: 10.1016/j.archger.2006.02.005

3. Miller, L. K., Jerosch-Herold, C., & Shepstone, L. (2017). Effectiveness of edema management techniques for subacute hand edema: A systematic review. Journal of Hand Therapy, 30(4), 432–446. doi: 10.1016/j.jht.2017.05.011

4. Faghri PD. The effects of neuromuscular stimulation-induced muscle contraction versus elevation on hand edema in CVA patients. J Hand Ther. 1997;10(1):29‐34. doi:10.1016/s0894-1130(97)80008-7

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