All WALES LYMPHOEDEMA
GUIDANCE:
Measuring Limb Volumes to Determine
Lymphoedema Outcome
April 2013
Created by the All Wales Lymphoedema Service Leads
Aim
To standardise the procedure for taking limb circumferential measurements to
determine limb volumes as well as excess volumes.
Background
As of 2011 Wales has dedicated services within all Health Boards to assess and
manage people who have lymphoedema / chronic oedema. All clinics utilise
circumferential measurements and input these into a Lymcalc programme to
determine limb and excess volumes. It has been recognised that standardisation of
how measurements are taken is needed so that all therapists and assistant staff will
follow the same procedure for consistency, reproducibility and comparability. This
standard will also give service users uniformity should they transfer to a
neighbouring Health Board, and it will enable research to take place across Wales.
This guidance follows on from the work done by the Australian Lymphoedema
Association’s (ALA) Measuring Standards Protocol March 20041 and is supported by
recent research executed by Brorson and Höijer2 (2012).
Tools Required:
The following tools are recommended for the taking and recording of circumferential
measurements:
 Tape measure
 Ruler
 Marking pen or pencil
 Measuring chart for recording measurements
 Skin wipes
Type of tape measure: the tape must be of plastic/nylon material with an accuracy of
1 millimetre. The choice of hand held or spring-tensioned is dependent on staff
training and personal choice.
Cleaning equipment: Ensure the tape and ruler are cleaned and dried between
patient use in accordance with manufacturer’s guidance and local Health Board
Health & Safety and Infection Control policies.
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Measuring:
Positioning:


hand held tape measure: lay the tape measure to overlap with the mark* in the
‘middle’
spring-tensioned tape: lay the tape above the mark*
* the mark is the point on the limb that has been drawn (see in photos below)
Tension:

hand held tape measure: place the tape measure snugly around the limb without
tightening the tape (secure tape to prevent it slipping/falling down)
Correct ‘laying’ of tape

Too much tension
spring-tensioned tape: position the tape at the required mark, hook the plastic
end in the hole of the unit, and push the button so as to take up the slack of the
tape
Inter-reliability: where possible, the same therapist should do measurements during
a course of intensive treatment.
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Measuring the Upper Limb:
Position of the patient:

The plinth should be raised to obtain
90 shoulder elevation (or as near as)

Sitting with arms extended to the front
and hands resting on the plinth or
back of a chair. Ensure elbows are
as straight as possible and palms
down

Avoid forearm resting on the plinth
Marking:

Use ruler to mark the arm

First mark: from the nail bed of the little
finger to above (proximal) the ulnar
process; alternatively measure 2cm from
the wrist crease

The mark is made on the lateral border of the arm (outer aspect of the arm)

Use the ruler to mark every 4cm along the
lateral edge of the arm up to the axilla; if a ruler
unavailable, use the tape measure tensioned
straight (i.e. not following curvature of arm)

End point is 2cm below the axilla

For Lymcalc documentation:
o Distal = from wrist to elbow crease
o Proximal = from elbow crease to axilla
o If unsure about elbow crease, flex elbow to determine if mark is above or
below the elbow
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Measuring the Lower Limb:
Position of the patient:

Sitting on plinth with legs in an elevated position; knees as straight as possible

If the patient is unable to get on plinth or straighten their legs; sit with feet flat on
floor or on the foot plate if in wheel chair; document patient position in notes
Marking:

Use ruler to mark the leg

First mark: from the base of the heel to above the lateral
malleolus (lateral border of leg)

The mark is made on the lateral border of the leg (outer
aspect of the leg)

Use the ruler to mark every 4cm along the lateral
border of the leg up to 2cm below the groin; if a
ruler unavailable, use the tape measure tensioned
straight (i.e. not following curvature of leg)

End point is 2cm below the groin

If measuring in the chair: measure lower leg to the knee;
then straighten the leg to obtain some knee/thigh
measurements

For Lymcalc documentation:
o Distal = from ankle to crease of knee
o Proximal = from crease of knee to groin
o If unsure about crease of knee, flex knee to determine
if mark is above or below the knee
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The Palliative Patient
For the patient who is in the terminal phase of their illness the therapist can choose
to do measurements as for made-to-measure ‘garments’ or ready-to-wear garments.
Document in the patient notes the method of measurement used for repeatability.
References:
1. Setting a National Standard for Measurement of Lymphoedematous Limbs;
Prepared for ALA Conference, Brisbane 2004 by ALA Standards Committee:
Louise Koelmeyer, Kerryn Shanley, Hildegard Reul-Hirche, Neil B Piller
2. Brorson H, Hoijer P (2012) Standardised measurements used to order
compression garments can be used to calculate arm volumes to evaluate
lymphoedema treatment; J Plast Surg Hand Surg (2012) 46: 410-415
Review Date: April 2015
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