Measurement of limb volume in Arm Lymphedema

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Measurement of limb volume in Arm Lymphedema

Postby patoco » Sun Dec 03, 2006 9:57 am

Measurement of limb volume in Arm Lymphedema

A Review of the Literature

Lymphedema People


A simple and innovative device to measure arm volume at home for patients with lymphedema after breast cancer.

December 2006

Lette J.

Department of Nuclear Medicine, Maisonneuve Hospital, 5415 Assomption Blvd, Montreal, QC, Canada H1T 2M4; e-mail:


We designed an arm volumeter specifically for home use based on the water displacement method. The objective of this study was to determine its accuracy and precision, and compare it with a standard volumeter used in lymphedema clinics worldwide.


Using a standard model hospital volumeter and our own device, we took three consecutive measurements of 11 specially cast cylinders, which had known volumes ranging from 10mL to 4 L, and measurements of both arms of 15 volunteers. Results Measurements with both volumeters were highly accurate (R(2) = 0.9999) when compared with the known volumes of the cast cylinders, and were strongly correlated (R(2) = 0.9974) when each arm volume was compared between volumeters. Measurements with our volumeter were more precise both with the cylinders (average standard deviation [SD], 3.2 v 8 mL; P = .0553) and with the arms (average SD, 11.1 v 19 mL; P = .0034). Whereas the standard volumeter is expensive, fragile (acrylic), and prone to leaks, our volumeter is inexpensive, virtually indestructible, leak proof, and suitable for home use.


Arm volumes can be measured quickly and accurately at home using a simple, inexpensive, and robust device based on water displacement. Readily accessible arm volumetry at home may have widespread influence on the management of lymphedema after breast cancer.


Validation of the inverse water volumetry method: a new gold standard for arm volume measurements.

October 2006

Damstra RJ, Glazenburg EJ, Hop WC.
Department of Dermatology, Phlebology and Lymphology, Hospital Nij Smellinghe, Compagnonsplein 1, 9202, NN Drachten, The Netherlands,


No consensus exists with respect to a commonly accepted and standardized method for measuring arm volumes in patients with lymphedema. Knowing the exact volume in (potential) lymphedemic arms and comparing this volume with healthy arms is important to detect the first signs of lymphedema and to study the effects of treatment.


A new apparatus, based upon the principle of measuring shortness of water, was developed to measure arm volumes. This measuring-method, inverse water volumetry, was prospectively validated in patients, suffering from lymphedema after complete or partial mastectomy for primary breast cancer. Healthy and lymphedemic arm were measured 3 times: twice by nurse A (A1 and A2) and once by nurse B (B). Subsequently, these differences in volumes were compared with differences in volumes obtained by the Herpertz method, which is based upon circumferential measurement.


In every patient at every occasion volume of the lymphedemic arm was bigger than the corresponding volume of the control arm. Mean volumes of healthy arms were 3958(A1), 3966(A2) and 3961(B) ml respectively. Mean volumes of lymphedemic arms were 4721(A1), 4752(A2) and 4773(B) ml respectively, volume B being significantly different from volume A1. Volume difference of edemic arms minus control arms was not significant between measurements (A1 vs. A2 and A1 vs. B, respectively), while this difference was significant (A1 vs. B) using the Herpertz method.


Inverse water volumetry is an easy measuring device with a high inter- and intra-observer agreement. The small but significant volume increase of lymphedemic arms in time compared to the constant volumes of control arms is as well indicative for the accuracy of the method as for the volume of lymphedemic arms to increase when no therapeutic garment is carried.


Reliability and validity of arm volume measurements for assessment of lymphedema.

February 2006

Taylor R, Jayasinghe UW, Koelmeyer L, Ung O, Boyages J.
School of Population Health, Faculty of Health Sciences, University of Queensland, Herston, Queensland, Australia.


Arm lymphedema following breast cancer surgery is a continuing problem. In this study, we assessed the reliability and validity of circumferential measurements and water displacement for measuring upper-limb volume.


Participants included subjects who had had breast cancer surgery, including axillary dissection--19 with and 22 without a diagnosis of arm lymphedema--and 25 control subjects.


Two raters measured each subject by using circumferential tape measurements at specified distances from the fingertips and in relation to anatomic landmarks and by using water displacement. Interrater reliability was calculated by analysis of variance and multilevel modeling. Volumes from circumferential measurements were compared with those from water displacement by use of means and correlation coefficients, respectively. The standard error of measurement, minimum detectable change (MDC), and limits of agreement (LOA) for volumes also were calculated.


Arm volumes obtained with these methods had high reliability. Compared with volumes from water displacement, volumes from circumferential measurements had high validity, although these volumes were slightly larger. Expected differences between subjects with and without clinical lymphedema following breast cancer were found. The MDC of volumes or the error associated with a single measure for data based on anatomic landmarks was lower than that based on distance from fingertips. The mean LOA with water displacement were lower for data based on anatomic landmarks than for data based on distance from fingertips.


Volumes calculated from anatomic landmarks are reliable, valid, and more accurate than those obtained from circumferential measurements based on distance from fingertips.


Validity and intra- and interobserver reliability of an indirect volume measurements in patients with upper extremity lymphedema.

Sept 2004

Meijer RS, Rietman JS, Geertzen JH, Bosmans JC, Dijkstra PU.
Department of Rehabilitation, University Hospital Groningen, The Netherlands.

We investigated a method of indirect volume measurement that utilized surface measurements and a simplified formula derived from the formula for a frustum (Sitzia's method) to determine limb volumes in patients with breast cancer-related lymphedema of the upper extremity. Repeated measurements of upper-extremity limb volume were obtained by two observers on both upper extremities of 30 women with unilateral lymphedema. Volume was calculated using a simplified formula and compared with water displacement method as a gold standard. Indirect volume determination using Sitzia's method is comparable with the water displacement method, has comparable intra- and interobserver reliabilities, and can be used for diagnosis and follow up measurements of lymphedema. Indirect volume determination using surface measurements at 8 cm intervals is only suitable for follow up measurements. The methods should not be used interchangeably.

PMID: 15560108 [PubMed - indexed for MEDLINE] ... s=15560108


Concurrent validity of upper-extremity volume estimates: comparison of calculated volume derived from girth measurements and water displacement volume.

February 2003

Karges JR, Mark BE, Stikeleather SJ, Worrell TW.
Department of Physical Therapy, Division of Health Sciences, School of Medicine, University of South Dakota, 414 E Clark St, Vermillion 57069, USA.


The volume of all limbs can be determined by water displacement methods or calculations derived from girth measurements. The purpose of this study was to determine the concurrent validity of calculated volume and water displacement volume measurements.


Both upper extremities of 14 women with lymphedema were measured.


Volumetric measurements were taken with a volumeter, and circumferential measurements were taken with a tape measure. Calculated volume was determined by summing segment volumes derived from the truncated cone formula. Pearson product moment correlations, paired t tests, and linear regression tests were used to assess relative association and absolute differences between calculated and actual volumes.


The correlation coefficient for calculated volume versus upper extremity minus fingers (UE-F) water displacement volume was.99. Paired t tests showed differences between calculated volume and UE-F water displacement volume (t=-3.88, mean difference=-95.62 mL), and the linear regression slope was 0.83 with an intercept of 255.28 mL.


Calculated volume measurements were highly associated with measurements based on water displacement; therefore, clinicians should feel confident in using either calculated volume or water displacement volume. The differences, however, indicated that the measures were not interchangeable. Thus, clinicians should not mix or substitute measurement methods with a single patient or in a single study.
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