From the Research
Stemmer's sign is a diagnostic indicator used to differentiate between lymphedema and other causes of swelling in the extremities, and it is considered positive when the skin at the base of the second toe or second finger cannot be pinched and lifted due to fibrosis and thickening of the tissues. This sign is typically present in lymphedema but absent in other forms of edema such as venous insufficiency or cardiac edema. The inability to pinch the skin occurs because lymphedema leads to chronic inflammation, protein accumulation in the tissues, and eventual fibrosis, making the skin and subcutaneous tissues firm and non-pliable 1.
Key Points About Stemmer's Sign
- It is a useful tool in the early diagnosis of lymphedema when other clinical features may not be obvious.
- The sign is associated with a high sensitivity for predicting lymphedema, as shown in a study where a positive Stemmer sign was found in 92% of patients with abnormal lymphatic function by lymphoscintigraphy 1.
- However, the specificity of the sign is moderate, and lymphoscintigraphy should be considered for patients with a high suspicion of lymphedema who have a negative Stemmer sign 1.
- Other clinical signs, such as the dorsal hump of the foot, square toes, and nonpitting edema, may also be present in lymphedema but are less reliable than Stemmer's sign for diagnosis 2.
Clinical Application of Stemmer's Sign
When evaluating a patient with swelling, this simple bedside test can provide valuable diagnostic information to guide appropriate management strategies for lymphedema, which differ significantly from treatments for other types of edema. It is essential to consider Stemmer's sign in conjunction with other diagnostic tools, such as lymphoscintigraphy, to ensure an accurate diagnosis and effective treatment plan 1, 2.