Early Diagnosis
Lipedema requires a clinical diagnosis, meaning there is not yet a standardized test such as bloodwork or imaging that can confirm the presence of Lipedema. Diagnosis should be reached in the context of a thorough patient history and physical exam.
Patients rely on providers to be diligent in their examinations and diagnosis to identify lipedema early in order to prevent unnessesary pain and progression.
Patient History
Clinicians should complete a detailed history with the patient, taking note if the following symptoms are reported:
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Family history of similar body type
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Difficulty losing fat in affected areas
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Onset/worsening at time of hormonal change
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Pain, tenderness, heaviness in affected areas
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Fatigue
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Brain fog
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Easy tendency to bruise
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Decreased functional ability (including mobility)
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Decreased quality of life
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History of joint issues
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The following treatments have limited to no effect:
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Elevation
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Nutritional Interventions
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Exercise
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Diuretics
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Bariatric Surgery
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Physical Examination
The physical examination for a Lipedema diagnosis includes visual inspection and physical palpation. Clinicians may also complete the Stemmer sign test to assess for co-morbid Lymphedema.
VISUAL INSPECTION
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Bilateral, symmetrical fat accumulation that can appear in a combination of the legs, buttocks, hips, arms and/or lower trunk
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Disproportion between upper and lower body
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Lobules of fat may present at hips, medial knees, lateral malleoli, or above elbows
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Presence of raised ridge/fold of fat, possibly a “cuff” at wrists and ankles
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Presence of spider veins/varicosities
PALPATION
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Presence of nodular and/or fibrotic texture in affected areas
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Lipedema tissue texture can vary widely and be quite diverse. It may feel like fluffy fat with nodules embedded in it, have a dense, cement-like texture, feel granular or grainy, or even have a spongy texture
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Nodules may feel like rice, peas, or walnuts
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Fibrosis may feel dense, firm, woody, putty-like, cement-like, stringy, or spider-web like
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Pain/tenderness in affected areas
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Cutaneous hypothermia may be present
The Stemmer Sign Test
Lipedema typically spares the hands/feet and presents with a negative Stemmer sign. However, a positive sign does not rule out Lipedema, and likely indicates the presence of concomitant Lymphedema. If both conditions are present, this is termed “Lipo-Lymphedema”.
Performing the test: Examiner pinches the dorsal skin proximal to the MTP joint of the second toe (or MCP joint of the second finger). If the examiner cannot create a fold of pinched skin, this results in a positive sign.
If you can pinch, the Stemmer sign is negative, and Lymphedema is likely not present.
If you cannot pinch, the Stemmer sign is positive, and Lymphedema is likely present.
Common Signs & Patterns
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Fat that feels tender, painful, or sensitive to even light pressure or touch.
Easy bruising in affected areas, often without a clear memory of an injury.
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Symmetrical swelling in the legs or arms that doesn't go away with weight loss or leg elevation.
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A visible 'cuff' or ring of fat at the ankles or wrists, while hands and feet remain unaffected.
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The affected skin may feel cooler than other parts of the body and have a pebbled or 'bean-like' texture under the surface.
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Fat accumulation that began or worsened during periods of hormonal shift, like puberty or pregnancy.