To differentiate Stage 1 from Stage 2 lymphedema, which test would be MOST appropriate for the physical therapist to perform?

• A. Checking for decreased strength and sensation
• B. Checking if the skin indents or pits when pressed
• C. Checking if the skin is warm and discolored
• D. Checking for changes in extremity girth and circumference

Answer: (B)

The main idea is that early-stage lymphedema is soft and pits under pressure, while later-stage lymphedema becomes firmer and non-pitting due to tissue fibrosis. The most direct way to tell them apart is to press the skin and see if it indents. If it pits, that indicates Stage 1; if it does not pit, that indicates Stage 2. This pitting test aligns with how the tissue changes from fluid-dominant edema to fibrotic, non-pitting edema as the condition progresses. Other signs like strength or sensation changes, skin warmth or discoloration, or simply measuring girth can indicate edema presence or other issues, but they don’t differentiate the tissue’s pitting versus non-pitting quality as clearly or reliably as the skin-pitting test.