Document Type : Research Article
Abstract
Background: Due to its diverse appearances and challenges in clinical evaluation, secondary lymphedema is frequently underreported and undertreated. Normative-determined criteria from western population have high sensitivity and specificity for detection of mild lymphedema in western women. It is uncertain if these requirements apply to Indian women, whose body types differ from those of Western women. The purpose of this study was to define the typical upper extremity inter-limb variation in a sample of healthy Indian women and to establish statistically based diagnostic cut-offs for both circumference and volume measures.
Methods:Descriptive research design was adopted. Six hundred and thirty one healthy Indian women, between the age the age of twenty to seventy years, participated in this study. At 5 cm intervals, the upper limb circumference was measured from wrist to above. Each segment of the limb depicted a frustum or truncated cone as a result of the measurement levels dividing the limb into parts. By combining the volumes of the segments individually, the ultimate volume was calculated. Diagnostics cut-offs for lymphoedema were derived by calculating three standard deviations plus the mean difference between the limbs.
Results: Significant differences were revealed by the paired t-tests between the dominant and non-dominant circumference and volumetric measurements. Regression analysis found a strong correlation between Age and BMI with the inter-limb circumference and volume difference. The diagnostic cut-offs ranged between 5% for the age 20-25yrs to ≤10% for the age upto 70yrs.
Conclusions: The threshold values provided by this study, taking arm dominance and population specificity into consideration, are likely to be appropriate for accurate diagnosis of changes in limb volume, helping in early detection of lymphoedema and increasing the probability of early intervention. This study delineates the percentage of ≤10% inter upper limb difference to be considered normal and acceptable as non-pathological.
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