How is lymphedema diagnosed?

If you notice signs of lymphedema, see a health professional as soon as you can. They will review your medical history, examine any visible swelling or other symptoms, and check for lymphedema with Stemmer’s and pitting tests. They will also do tests to rule out other causes of swelling (e.g. varicose veins, thyroid issues, lipedema or other causes). Sometimes an imaging test is also done to show where lymph flow is blocked.

A proper diagnosis and assessment of lymphedema is the first step toward effective treatment.

Stemmer’s Test

The fold of skin at the base of the second toe or middle finger is pinched. If you can easily pinch and lift a fold of skin less than 2-3 mm thick, this is not a sign of lymphedema. If the skin fold is thicker than 3mm or you are unable to raise a skin fold, this may be a sign of lymphedema.

Pitting Test

A thumb or finger is gently pressed into the swelling and held for 30 seconds. If it leaves an indent for some time, this is a sign of lymphedema.

If the assessment suggests lymphedema, you must be referred to a certified lymphedema therapist for further assessment. Lymphedema cannot be cured, but it can be managed with the help of a therapist. Early diagnosis and treatment can help reduce swelling and other symptoms, prevent your condition from getting worse, and lower your risk for complications.

Certified lymphedema therapists are the experts in lymphedema assessment, staging and treatment.

What is Lipedema?

Lipedema is a condition that affects some women. It is caused when higher than normal fat deposits build up on the buttocks, legs, ankles and feet. This is not obesity and weight control makes no difference. Like lymphedema, lipedema is a lifelong condition. But, they are different conditions and lipedema is often misdiagnosed as lymphedema.

What are the stages of lymphedema?

Lymphedema is a lifelong condition that will get worse over time if it is left untreated or not managed well.

There are four stages of lymphedema that describe its progress from early to advanced. The signs of lymphedema and treatment needed are different at each stage. When you are diagnosed with lymphedema, a certified lymphedema therapist will assess your stage. Knowing the stage helps the therapist develop the best treatment plan for you.

Stage 0: Latent/Early

There are subtle changes in the tissue, skin and how an affected limb feels, but no visible sign of swelling. This stage may continue for months or years before visible swelling occurs.

Stage 1: Mild (swelling can be reversed)

The first visible signs of swelling show at this stage. The swelling is soft and may indent with thumb pressure (called pitting’). When the affected arm or leg is raised, the swelling tends to reduce.

The swelling often comes on by the evening but has gone by morning.

Stage 2: Moderate (swelling cannot be reversed)

Raising the affected limb no longer reduces tissue swelling at this stage. Pitting may still occur, but more pressure may be required to show an indent. In later stage 2, pitting may not be possible due to a buildup of fatty tissue or hardening of the tissue (fibrosis).

Stage 3: Advanced

The swelling is extreme, the skin has hardened (fibrotic) and pitting is no longer possible. The skin may also be dry and thicker with warty growths and leakage of lymph fluid (called lymphorrhea).

To assess the stage of lymphedema, a certified therapist will consider: the degree of swelling, the health of underlying tissue, and whether you have had infections such as cellulitis, inflammation or other complications.