Proper compression constitutes 90% of lymphedema treatment. In the case of lymphedema after breast cancer surgery, compression is delivered with elastic sleeves and gloves. There are three “classes” of compression, that refer to the degree of elasticity. Class 1 is the most stretchy, class 3 the least stretchy and most uncomfortable, relatively. These can be custom-made or off-the-shelf. In either case, modifications can be made to better adapt them to your exact arm and hand characteristics. This is what I have been doing for the last 10 years. Here are some ideas:
Arm compression is relatively easy to achieve. It has to be greatest at the wrist and progressively less higher up towards the armpit. However, arm compression has to be balanced with compression of the hand because if the sleeve is too tight then the hand will swell.
Depending on the sensitivity of the skin, the inside of the elbow may get irritated, as the arm and sleeve bend. To avoid that you may use foam, but I prefer to wrap the “artiflex” or “Cellona” bandage around my elbow. Then, with a good slider I put the compression sleeve on. (For sleeve-slider construction look under the making a slider heading). At the beginning after diagnosis I was using some foam chips to break up fibrotic tissue and I placed them in between the folds of the artiflex, or I taped them together with cloth tape. Then I put the compression sleeve on using the slider. Without a slider it is impossible to put anything under the sleeve!
I am using “Juzo” sleeves and gloves since a few years now. With use they stretch lengthwise, ie they become longer. After a couple of weeks, the sleeve material may bunch up at the inside of the elbow and become uncomfortable. To avoid that, I ask the fitter to make the sleeve shorter when she takes the measurements, because it will stretch lengthwise with use.
I have also tried “Mediven” sleeves at first for ~2 years. In my experience this brand of sleeves does not stretch lengthwise, it becomes shorter and wider with time. To correct that, I was making a pleat along the length of the sleeve to fit better. The pleat is very useful because it gives a good handle, you can grab it to turn the sleeve too as you put it on.
Hand compression vs dexterity
There are several companies making compression gloves and sleeves, using different materials and designs. Juzo, Jobst, Mediven and others.
However, hand compression is easier said than done. The glove has to be fitting perfectly, especially if it is of higher compression class, ie stiffness, and the thumb has to be able to move, if you are to have any dexterity.
I have tried gloves from Mediven, Jobst and Juzo, all German companies. Most are manufactured the easiest way: Two pieces in the shape of a hand for the back of the hand and the palm, and a long “ribbon” that joins them along the contour (Figure 1). This is the simplest way to make a glove, and it makes it easy to follow the precise measurements for each customer, but it does not fit most hands. This may matter to different degrees. If you try to hold something, a bar, a broomstick, or a computer mouse, the thumb has to be at a vertical angle to the rest of the palm, if you are to have any strength. We are animals with opposable thumbs after all…
For me, flat gloves do not work. I’ve been using a computer mouse for many hours a day and the base of my thumb was getting very sore and blue with the pressure. I was afraid it would bleed, get infected and give me cellulitis. What was even scarier was that my thumb was getting numb and felt paralyzed because of pressure on nerves and then I had to take the glove off right away.
To correct this problem, I made a “pleat” at the base of the thumb, to bring the thumb in its natural position, opposite the other fingers (Figure 2).
How to make the pleat: Fold the thumb inside the glove as shown. With some practice you can figure out the exact curve. Place pins at the edge to hold in place, then sew with the sewing machine (Figure 3). You can sew it by hand too but it takes longer.
A company in Toronto (Yes, Canada! Recovery Garment Center) is making gloves for burn patients and will be making them for lymphedema too. They have a perfect shape of the thumb (Figure 4). Dressy leather gloves, eg “Isotoner” gloves have the same fitted shape for the thumb.
Open or closed fingers?
A glove with open fingers is much more comfortable and allows you to have much better touch. However, after wearing a class 2 glove with open fingers for 5 years, my fingertips became red, swollen and inflamed. I started having infections, and Dr Towers said that I should wear gloves with the fingertips covered. But, allas, you cannot even use a cellphone with a glove like this, if you are righthanded (like me). So, I undid the seam of my Juzo glove to be able to use the phone at least. Once finished, I close the flap (Figure 5).
Need for padding?
Hands are never the same between people. I have a bone that sticks out at the first metacarpal and it used to rub against the glove and get red and raw, risking an infection. I made a small pad out of foam with a 1cm-hole in the middle to fit the bone. Then I covered it with nylon material (what they use for petticoats) and sewed it on the inside of the glove as you see in Figure 6. The redness on my knuckle faded away slowly and now it looks fine.