A physical therapist is preparing to initiate manual lymphatic drainage on a patient with left upper extremity lymphedema secondary to breast cancer. Which finding from the chart review is a contraindication to this treatment?

Option 1- The patient has hypertension with a resting blood pressure of 158/96 mm Hg
Option 2- The patient has an active cellulitis infection with visible erythema
Option 3- The patient had a deep vein thrombosis in the right leg six months ago
Option 4- The patient has peripheral arterial disease affecting the left upper extremity

Transcript

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Before initiating manual lymphatic drainage, therapists must screen for conditions that could make treatment unsafe. Some findings are absolute contraindications requiring immediate deferral and physician consultation, while others are manageable comorbidities (or precautions) that do not prevent M.L.D. from proceeding. A precaution means the therapist should be aware of the finding, exercise clinical judgment, potentially modify the approach, and monitor closely - but treatment can still proceed

It is worth noting the structure of this question - three of the four options describe findings that might raise concern but do not require deferring treatment. Only one is a true contraindication. This question is asking you to identify which of the four findings crosses the line from precaution into absolute contraindication. Keep that distinction in mind as we evaluate each option.

Let's explore each of the options:

Option 1 - The patient has hypertension with a resting blood pressure of 158 over 96 millimeters of mercury

Elevated blood pressure is a relative precaution, not an absolute contraindication to M.L.D. While the therapist should note this and potentially consult with the physician, a blood pressure in this range does not require deferring treatment on its own. M.L.D. is a gentle, low-intensity technique that doesn't significantly stress the cardiovascular system.

It is one of the gentlest manual techniques in physical therapy, involving light, slow, rhythmic strokes that place minimal cardiovascular demand on the patient. The therapist should document the finding, monitor blood pressure throughout the session, and consider physician communication.

Option 2 - The patient has an active cellulitis infection with visible erythema

Cellulitis is a bacterial skin infection, and the lymphatic system is one of the primary pathways through which bacteria spread throughout the body. M.L.D. works by stimulating lymphatic flow and moving fluid through the lymphatic channels. If active infection is present, performing MLD does not just move fluid - it mobilizes bacteria along those same channels.

Active cellulitis is an absolute contraindication to M.L.D. Performing lymphatic drainage over infected tissue can mobilize bacteria, spreading the infection systemically and potentially causing sepsis. Treatment must be deferred until the infection is fully resolved.

Option 3 - The patient had a deep vein thrombosis in the right leg six months ago

An acute deep vein thrombosis is an absolute contraindication for MLD. However, this D.V.T. occurred six months ago in a different extremity - the right leg - and the treatment is targeting the left upper extremity. A resolved D.V.T. in a remote, unaffected limb is not a reason to defer treatment.

This option is carefully constructed to test your precision. DVT is indeed an absolute contraindication to M.L.D. only when it is acute and in the treatment area. A resolved DVT in the right leg has no bearing on the safety of performing M.L.D. on the left upper extremity.

Option 4 - The patient has peripheral arterial disease affecting the left upper extremity

Peripheral arterial disease in the affected extremity is a precaution, not an absolute contraindication. The therapist should be aware that tissue perfusion may be compromised and proceed with caution and appropriate monitoring, but it does not require deferring M.L.D. entirely.

Peripheral arterial disease in the treatment extremity is a legitimate clinical concern - reduced arterial perfusion means the tissue is already under stress, and the therapist should monitor carefully for any signs of vascular compromise during treatment. However, it does not create the same immediate, systemic risk that active infection does. The therapist can proceed while exercising appropriate caution, monitoring skin color, temperature, and patient symptoms throughout the session.

When we apply the absolute contraindication versus precaution framework across all four options, three of them describe findings that require clinical awareness and monitoring but do not prevent MLD from proceeding. Only Option 2 - active cellulitis - represents a true absolute contraindication that requires immediate deferral of treatment.

The correct answer is Option 2.

Let's explore the all student data:

76% of students selected Option 2 - The patient has an active cellulitis infection with visible erythema - the correct response
17% of students selected Option 4 - The patient has peripheral arterial disease affecting the left upper extremity
4% of students selected Option 1 - The patient has hypertension with a resting blood pressure of 158/96 mm Hg
3% of students selected Option 3 - The patient had a deep vein thrombosis in the right leg six months ago

System Classification
This question is an Other Systems question which represents approximately 18% of all exam items.

Content Outline Classification
This question is an Interventions question which represents approximately 26% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.

Academic Focus Area 
Looking to review related academic content? Check out page 567 in PTEXAM: The Complete Study Guide.