Patient assessment:
(1) The patient stands with her hands on her hips.
(2) Measurements in inches are taken at 3 points along the left and right arms:
(a) 6 inches above the elbow, measuring along the outer surface
(b) 2 inches above the elbow
(c) 4 inches below the elbow
difference between the 2 arms =
= (circumference in inches on side with lymph node dissection) – (circumference in inches on opposite side)
where:
• The arm opposite the arm involved by surgery serves as the control.
The maximal difference of the 3 sites is used for grading the lymphedema.
|
Maximal Difference in Inches
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Symptoms
|
Degree of Lymphedema
|
|
>= 2.0 inches
|
|
severe
|
|
> 0.5 inches and < 2.0 inches
|
|
moderate
|
|
> 0 inches and <= 0.5 inches
|
feeling of arm enlargement and/or heaviness
|
mild
|
|
> 0 inches and <= 0.5 inches
|
no symptoms
|
none
|
|
0
|
|
none
|
Problems:
(1) The sites have to be selected precisely.
(2) The tension on the tape has to be applied equally.
(3) If bilateral lymph node dissections were performed, then finding an adequate control site poses problems.
(a) The authors (page 1372) did the standard measurements in these patients even though the control might not be valid.
(b) Using arm circumference before surgery is possible, but changes in weight could affect the readings.
