II. Indications

  1. Lower Extremity Edema

III. Mechanism

  1. Lymphedema results in thickened, fibrotic skin from protein and inflammatory cell deposition

IV. Exam: Technique

  1. Attempt to pinch and lift skinfold at the base of the second toe (or middle finger)

V. Interpretation

  1. Negative (able to pinch skin)
    1. Does not completely exclude Lymphedema (especially if recent onset), but is more suggestive of other edema cause
    2. No swelling at base of digit is more consistent with Chronic Venous Insufficiency
    3. Pitting swelling of the base of digit is more suggestive of CHF, Nephrotic Syndrome, Cirrhosis or other similar edema
  2. Positive (unable to pinch skin)
    1. Pathognomonic for Lymphedema

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