Which clinical sign, when positive, reliably differentiates lower limb lymphoedema from lipidaemia and systemic causes of oedema?
- A Pitting on sustained thumb pressure over the shin
- B Inability to pinch a fold of skin at the base of the second toe ✓
- C Loss of the ankle reflex
- D Positive Perthes test
Correct answer: B. Inability to pinch a fold of skin at the base of the second toe
Explanation
The Stemmer sign is the hallmark of established lymphoedema: protein-rich lymph and subsequent fibrosis thicken the dorsal toe skin so it cannot be pinched into a fold at the base of the second toe. Early lymphoedema may still pit, so pitting does not discriminate. Perthes tests deep vein competence in varicose veins and is irrelevant here, and ankle reflex loss points to peripheral neuropathy or hypothyroidism.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.