Hand and Arm Guidelines After Your Axillary Lymph Node Dissection

This information describes how to prevent infection and reduce swelling in your hand and arm after your axillary lymph node dissection surgery. Following these guidelines may help prevent lymphedema.

About Your Lymphatic System

Your lymphatic system has 2 jobs:

• It helps fight infection.
• It helps drain fluid from areas of your body.

Your lymphatic system is made up of lymph nodes, lymphatic vessels, and lymphatic fluid (see Figure 1).

• Lymph nodes are small bean-shaped glands located along your lymphatic vessels. Your lymph nodes filter your lymphatic fluid, taking out bacteria, viruses, cancer cells, and other waste products.
• Lymphatic vessels are tiny tubes, like your blood vessels, that carry fluid to and from your lymph nodes.
• Lymphatic fluid is the clear fluid that travels through your lymphatic system. It carries cells that help fight infections and other diseases.

Axillary lymph nodes are a group of lymph nodes in your armpit (axilla) that drain the lymph fluid from your breast and arm. Everyone has a different number of axillary lymph nodes. An axillary lymph node dissection is a surgery to remove a group of axillary lymph nodes.

About Lymphedema

Sometimes, removing lymph nodes can make it hard for your lymphatic system to drain properly. If this happens, lymphatic fluid can build up in the area where the lymph nodes were removed. This extra fluid causes swelling called lymphedema.

Lymphedema can develop in the arm, hand, breast, or torso on your affected side (the side where your lymph nodes were removed).

Signs of lymphedema

Lymphedema can develop suddenly or gradually. It can happen months or years after your surgery.

Watch for these signs of lymphedema in your affected arm, hand, breast, and torso:

• A feeling of heaviness, aching, or pain
• A tight feeling in your skin
• Less flexibility
• Swelling
• Skin changes, such as tightness or pitting (skin that stays indented after pressing on it)

If you have swelling, you may notice that:

• The veins in your affected hand are less noticeable than on your other hand.
• The rings on your affected finger(s) are tighter or don’t fit.
• The shirt sleeve on your affected side feels tighter than usual.

If you have any signs of lymphedema or aren’t sure, contact your healthcare provider.

Lowering Your Risk of Developing Lymphedema

It’s important to prevent infection and swelling to lower your risk of developing lymphedema.

Preventing infection

You’re more likely to get lymphedema if you get an infection in your affected arm. This is because your body will make extra white blood cells and lymphatic fluid to fight the infection, and this extra fluid may not drain properly.

Follow these guidelines to lower your risk of getting an infection.

• Be careful not to get sunburned. Use a sunblock with an SPF of at least 30. Reapply it often.
• Use insect repellent to avoid stings and bug bites.
• Use a lotion or cream daily to help protect the skin on your affected arm and hand.
• Don’t cut your cuticles on your affected hand. Instead, push them back gently with a cuticle stick.
• Wear protective gloves when doing yard work or gardening, washing dishes, or cleaning with harsh detergent or steel wool.
• Wear a thimble when you’re sewing.
• Be careful if you shave under your affected arm. Think about using an electric razor. If you get a cut while shaving, take care of it following the instructions below.

If you notice any signs of infection (such as redness, swelling, skin that’s warmer than usual, or tenderness), call your healthcare provider.

Caring for cuts and scratches

Caring for burns

Preventing swelling

Right after your surgery

Some mild swelling after surgery is normal. This swelling may last for up to 6 weeks. It’s often temporary and will gradually go away. You may also feel pain or other sensations such as twinges and tingling after your surgery. Follow these guidelines to help relieve the swelling after your surgery.

• Do your exercises 5 times per day. If your healthcare provider told you to do them more or less often, follow their instructions.
• Keep doing your exercises until you get back your normal range of shoulder and arm movement. This can take 4 to 6 weeks after surgery.
  • If you feel a stretch in your chest or under your arm, it may be helpful to keep doing the stretching exercises for even longer.
  • If you don’t get your normal range of motion back after 4 to 6 weeks, call your healthcare provider.

Over the long term

Doing the following things may help lower your risk of developing lymphedema.

• Ask your healthcare providers to use your unaffected arm for blood draws, injections (shots), intravenous (IV) lines, and blood pressure measurements.
  • In some situations, if blood can’t be drawn from your unaffected arm, it’s OK to use your affected arm. Your healthcare provider can discuss this with you.
  • If an injection can’t be given in your unaffected arm, buttocks, thigh, or abdomen (belly), it’s OK to get it in your affected arm.
  • If your blood pressure can’t be measured using your unaffected arm, it’s OK to use your affected arm.
  • If lymph nodes were removed on both sides of your body, talk with your healthcare provider about which arm is be safest to use.
• Stay at or safely work towards a healthy body weight.
• Use your unaffected arm or both arms to carry heavy packages until you get your strength back on your affected side.
• Exercise and stretch your muscles regularly. Talk with your doctor or nurse about which exercises are right for you.
  • When you start doing exercise and activity again, build up slowly and gradually. If you feel discomfort, stop and take a break. Exercise shouldn’t cause pain.
  • Check with your healthcare provider before you start doing any strenuous exercise, such as lifting weights or playing tennis.
• Don’t wear tight or heavy jewelry or clothing that has tight elastic and leaves a mark. These things can lead to swelling.
• Don’t use heating pads or hot packs on your affected arm, shoulder, or torso.
• If you develop swelling in your arm or hand, make a note of when it started. If it doesn’t go away after 1 week, call your healthcare provider.

For more information about lymphedema, read the New York State Department of Health’s resource Understanding Lymphedema at www.health.ny.gov/publications/0399.

When to Call Your Healthcare Provider

Call your healthcare provider if:

• Any part of your arm, hand, breast, or torso on your affected side:
  • Feels hot
  • Is red
  • Is more painful
  • Is more swollen
• You have a fever of 101 °F (38.3 °C) or higher
• You’re doing your exercises as instructed by your healthcare provider but don’t get your normal range of motion back after 4 to 6 weeks.
• You have swelling that doesn’t go away after 1 week.