Diagnosing Lipedema Part 1 – Diagnosis Interview

Karen Herbst and Yvonne Russell interviewed Lori Doman, a potential lipedema patient. Lorie begins by explaining her questions about why her body isn’t responding to diet and exercise. Lori explains that when she was a child, she was exceptionally skinny; however, after puberty, her hips grew. Later, after the birth of her four children, her body became extremely swollen. Lori does yoga four to five times a week, spin twice a week, weight training and circuit training, but still struggles to lose any weight. Her mother also struggles with the same circumstances. If she does lose weight, Lori states that the first place is her waist. This however makes it hard to find pants that fit because of her small waist, but large hips and legs. Lori finds herself rapidly losing flexibility and becoming more stiff, despite her childhood full of cheerleading and hypermobility. Yvonne explains in the video that after knowing Lori for many years, she has witnessed the hard work and determination that Lorie has put fourth to lose weight and that Lori has suffered emotionally, which affects her confidence.

Diagnosing Lipedema Part 2 – Physical Exam

Herbst conducts a physical exam for lipedema. She begins by examining the head, neck, supraclavicular area, and chest feeling for bone and firm tissue, opposed to fat tissue. Since the fat is not depressed, Karen can assume there is some type of lymphatic dysfunction. Karen examines the weight of the patient’s breast tissue, suggesting that the patient may have some fluid in the breast tissue. Karen feels for nodules in the hands, as well as checks the joints in the patient’s hands. Karen finds nodules in the cubital region of the arm, nodular tissue along the brachioradialis, and acanthosis nigricans in the axillary area. Following, Karen examines the abdomen from behind by pressing along the ribs looking for nodular tissue and abnormalities. She palpates the tissue along the hips and notices disproportion throughout the patient’s body. Karen finds superficial varicosities on the thighs, suggesting that further investigation of the veins is necessary. Karen looks for nodules in the thighs, behind the knees, on the lower leg, and ankles. With the patient’s joint pain and stretch marks, she would qualify as having hypermobility, which could be contributing to the progression of her lipedema and her inability to lose weight. Looking at the hemoglobin a1c, lipid profile and blood pressure would allow the patient to be classified with metabolic syndrome. In a nutshell, Karen Herbst concludes that the patient has lipedema, hypermobility, and metabolic syndrome.

Assessing Lipedema Post Liposuction

The purpose of performing a physical exam on an individual post liposuction with lipedema is to look for excess tissue and not bone.
Begin at the top of the head moving to the back, you should feel bone. Continue to palpate as you move your hands from back to front on the neck using a rolling technique of the fingers. Now focus on the supraclavicular area by having the patient shrug, you want the extra fat to depress, indicating lymph is moving through the area. Next, have the patient make a fist with a hole through the center bringing it to the mouth and breathing in while you observe the supraclavicular area for excess fat. Continuing with the trunk palpate the chest, less fat here on women may be a sign of lipedema. Finish the trunk by checking the weight of the breasts by gently lifting. Move to the hands and begin by bending the fingers back looking for fat at the MCP joints and base of the thumb. Flex the wrist observing for formation of skin folds then continue with the rolling technique of the fingers up the arm paying close attention to the area over the bracioradialis and under the armpit. In stage I/II nodules are often present over the bracioradialis muscle. Next, move to the abdomen, stand behind the patient and palpate under the ribs rolling the fingers laterally over the abdomen and moving centrally. The superpubic area is a common area for nodules, be sure to palpate well. Take note that fibrotic tissue often presents in the groin and top of the hips. Continue with larger sweeping palpations over the buttock by running fingers sideways, up, and down. Finish by feeling the weight of the buttock by gently lifting at the base. Finally, begin at the top of the legs and roll the fingers over the thigh towards the knee, fibrotic tissue is often found medially. Both sides of the knees, just inferior, and the popliteal space are common areas for pockets of fat and nodules. Perform the stemmer sign by pinching the skin on the top of the feet; a positive stemmer occurs when the skin cannot be pinched. On the inside of the foot observe for piezogenic papules, fat herniating to the skin. In stage I, there is often an absence of fat around the achilles and malleoli, in higher stages fat will be present here. Common spots for lipedema in women include: posterior arm, hips, buttocks, thighs and into ankles.