Lymphedema is classified as either primary or secondary, with secondary being the most common type of lymphedema. Lymphedema is caused by an abnormal accumulation of protein-rich fluid in the affected area, and can cause swelling from head to toe, but is most likely found in the extremities.
Secondary lymphedema is typically caused by cancer radiation therapy, surgery, endocrine disease, venous disease, injury, scarring, inflammation, immobility, or an infection in the lymphatic system.
Diagnosing lymphedema involves a combination of many things but usually includes a patient’s history along with non-invasive tests. It is always important to have a thorough physical examination because not all swelling is the result of lymphedema.
One of the most common non-invasive tests for determining if lymphedema is present is the “Stemmer’s Sign” test.
The test results will show either a positive or negative sign for lymphedema. To perform, try to pinch and lift a skinfold at the base of the second toe or middle finger. If you are able to pinch and lift the skin, then the Stemmer’s sign is negative. If you are unable to do so, then the sign is positive.
The interesting point to note is that false positives never occur, but a negative Stemmer’s test doesn’t inherently rule out lymphedema. If the result is positive, the patient must seek further evaluation and treatment by a lymphedema specialist.
And while a 10-second test might seem too good to be true, it is accurate. The primary function of the lymphatic system is to recycle blood proteins. Half of the plasma proteins leak and are recovered by the lymphatic system each day. But when the lymphatic system is blocked or damaged, proteins accumulate in the tissue. This is what causes a positive Stemmer’s Sign.
It is typical that chronic lymphedema will progress from the toes or fingers proximally. The skin located at these areas is usually fairly thin, which makes it easier to show signs of thickening.
Stemmer’s Sign is a useful tool for screening patients and once a lymphedema diagnosis is rendered, it is important to understand the proper management needed. See here for more information.
Lymphedema Skin Care Mnemonic1
Lifestyle changes lessen the risk of starting or worsening lymphedema.
Yield extreme temperatures of cold or heat.
Moisturize skin with only low-pH lotions.
Protect skin. Cleanse frequently with soap and water.
Heavy lifting and joint over-rotation are to be avoided.
Exercise as tolerated.
Do not travel by air without seeking advice of a lymphedema specialist.
Eat a healthy diet.
Monitor skin regularly for dryness, cracking, and signs or symptoms of infection.
Avoid exposure to animal scratches, bites, and stings.