From the Guidelines
Assessment for Lymphedema
For a patient with lymphedema, assessment typically involves a comprehensive evaluation of the affected limb, including measurement of circumference and volume, as well as evaluation of skin and soft tissue integrity 1. The patient's medical history, including any prior surgeries, radiation therapy, or infections, should also be thoroughly reviewed.
Key Assessment Components
- Tissue palpation to assess for fibrosis, pitting, and overall tissue quality 1
- Clinical examination using criteria such as the Modified Head and Neck External Lymphedema and Fibrosis assessment for diagnostic purposes 1
- Self-reported symptoms such as swelling, heaviness, and numbness to facilitate early diagnosis 1
- Bioimpedance analysis to detect lymphatic transport impairments and diagnose subclinical and early stage lymphedema 1
- Circumferential measurement to diagnose upper extremity lymphedema at Stage 1 or greater 1
- Water displacement to diagnose lymphedema with volumetry >200 mL when compared to the contralateral arm and with volumes >10% interlimb difference 1
- Imaging studies such as ultrasound, magnetic resonance imaging, and computed tomography to identify tissue changes and detect lymphatic system impairment 1
Additional Considerations
The assessment should also consider the patient's risk factors for lymphedema, such as obesity, and the potential impact of radiation therapy on lymphedema development and severity 1. A thorough assessment is essential to guide treatment and management of lymphedema, which may include compression therapy, complete decongestive therapy, and exercise 1.
From the Research
Assessment of Lymphedema
The assessment of lymphedema involves a comprehensive evaluation of the patient's condition, including:
- Patient-reported outcomes 2
- Palpation 2
- Visual assessment 2
- Assessment of limb size using circumference measurements 2, 3
- Assessment of extracellular fluid using bioimpedance spectroscopy 2
- Limb volume measurement, with a difference of >10% in the affected limb compared to the unaffected limb confirming a lymphedema diagnosis 4
Factors to Consider
When assessing a patient with lymphedema, the following factors should be considered:
- Prior surgical or radiation therapy for malignancy 5
- Other risk factors for lymphedema, such as prior trauma to or infection of the affected limb 5
- Duration of lymphedema, with longer durations potentially indicating more advanced stages of the condition 6
- Presence of peripheral arterial disease, which may impact treatment outcomes 6
Diagnostic Tools
The following diagnostic tools may be used to confirm a diagnosis of lymphedema:
Comprehensive Assessment
A comprehensive assessment of lymphedema should include a thorough medical, psychological, and physical examination, as recommended by guidelines 4. This assessment should inform the development of a personalized treatment plan, which may include Complex Decongestive Therapy (CDT), self-management strategies, and other interventions as needed.