Plastic Surgery Research Council

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Sensitivity and Specificity of the Stemmer Sign for Lymphedema: A Clinical-Lymphoscintigraphic Study
Jeremy A. Goss, Arin K. Greene, MD, MMSc.
Boston Children's Hospital, Boston, MA, USA.

PURPOSE: The Stemmer sign is a physical examination finding used to diagnose lymphedema. If the examiner cannot pinch the skin of the dorsum of the foot or hand then this positive finding is associated with lymphedema. The purpose of the study was to determine the accuracy of the Stemmer sign to predict lymphedema.
METHODS: All patients referred to our Lymphedema Program between 2016-2018 were tested for the Stemmer sign and underwent lymphoscintigraphy to define the patientís lymphatic function. Patient age, lymphedema type (primary, secondary), disease location (arm, leg), and body mass index (BMI) were recorded.
RESULTS: One-hundred ten patients were studied: patients with a positive Stemmer sign (n=87) exhibited abnormal (n=80) or normal (n=7) lymphatic function by lymphoscintigraphy (sensitivity=92%). False-positive Stemmer signs included individuals with obesity (n=6) or spinal muscle atrophy (n=1). Subjects with a negative Stemmer sign (n=23) had normal (n=13) or abnormal (n=10) lymphatic function by imaging (specificity=57%). Patients with a false-negative Stemmer sign were likely to have a normal BMI [mean 24 (range 16-34)].
CONCLUSION: A positive Stemmer sign is a sensitive predictor for primary and secondary lymphedema of the arms or legs and thus is a useful part of the physical examination. The test exhibits moderate specificity and consequently patients with a high suspicion of lymphedema with a negative Stemmer sign should undergo lymphoscintigraphy.


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