Edema Exam

Aka: Edema Exam, Pitting Edema, Brawny Edema, Dependent Edema, Non-Pitting Edema

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II. Exam: Pitting Edema

  1. Technique
    1. Examiner impresses thumb into skin over bony surface
      1. Tibia
      2. Fibula
      3. Sacrum
    2. Withdraw thumb
    3. Measure depth of pit and record in millimeters (1-4 plus Pitting Edema)
  2. Interpretation
    1. Pitting Edema
      1. Deep Vein Thrombosis
      2. Congestive Heart Failure
      3. Liver Failure
      4. Renal Failure
      5. Venous Insufficiency
      6. Early Lymphedema
    2. Non-Pitting Edema (Brawny Edema)
      1. Chronic inflammation
      2. Pretibial Myxedema (Hypothyroidism)
      3. Chronic, longstanding Lymphedema
      4. Chronic, longstanding Venous Stasis (Venous Insufficiency)

III. Exam: Edema Distribution and Characteristics

  1. Dependent Edema (fluid shift in response to gravity)
    1. Standing patient accumulates fluid in feet and ankles
    2. Bed-bound patient collects fluid posteriorly (Sacrum)
  2. Chronic Leg Edema (Brawny Edema)
    1. Tissue becomes fibrotic and fails to pit
  3. Stemmer's Sign
    1. Attempt to pinch and lift skinfold at the base of the second toe (or middle finger)
    2. 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
    3. Positive (unable to pinch skin)
      1. Pathognomonic for Lymphedema

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