Diagnostic Criteria for hand LE

KS1

Hi all,

I just got a call saying that a LANA certified LE Tx had a cancellation this afternoon and can see me for a consultation. This is a minor miracle because she is < 45 minutes away and within network for insurance and has a long waiting list. I would like to make the strongest case for insurance coverage. Here's the thing - my hand is swollen, but  my arm is pretty good, soI don't meet the > 2 cm difference in arm circumference.

Kira, you mentioned that the > 2 cm difference is just a convenient measure and that it isn't good at picking up hand LE. Are there any objective measurements that are generally accepted for diagnosing LE of the hand.

I was diagnosed and referred LE Tx 1.5 years ago by an MD who specializes in LE  based on my clinical signs. measurements, and a bioimpedance of 16. I've been pretty compliant with LE maintenance and, to my eyes, my arm which looks better than it did a year and a half ago.  My referral this time is just from my internist.

Sorry to start a new thread, but I see the Tx in 2 hours. -KS1

kira66715

KS1--there is no diagnostic criteria for LE--but people/insurance companies use the 2 cm arm measurement discrepancy.

For hand swelling, they should examine between the MCP joints, observe the fingers. do the "stemmer sign"--pick up a fold of skin at the base of the finger and feel if it's thicker, observe the palm.

There is an article by AW Stanton on subtle findings in LE:

Http://britishjournaloflymphoedema.com/journal/0101_arm.pdf 

http://britishjournaloflymphoedema.com/journal/0101_arm.pdf 

Conclusions: Measurement of arm volume may not detect mild lymphoedema and close inspection of the arm is necessary. Early
diagnosis and treatment are essential, as are detection and reporting for healthcare prioritisation. Conflict of interest: None.
 

The International Best Practices Guidelines, on the front page of the stepupspeakout site have some diagnostic information

Good luck.

History is just as important as physical--stress the sudden onset of severe ulnar swelling.

Kira