Normative Volume Difference Between the Dominant and Nondominant Upper Limbs in Healthy Older Women

Abstract

Upper limb lymphedema is a possible consequence of the treatment for breast cancer. Accurate detection of swelling is important in implementing appropriate treatment. Currently used diagnostic cut-offs for excess volume have been chosen for ease of use and are not based on normative differences. The aim of this study, therefore, was to determine the normal inter-limb variance for healthy older women and identify statistically-based diagnostic cut-offs for both circumference and volume. Two hundred and four healthy women, over the age of 40 years, with no history of treatment for breast cancer or lymphedema, underwent measurement of their upper limbs with a perometer. Using the associated software, the circumference of the limb was determined at a number of set points along the limb and the volume of the intervening segments recorded. Segment volumes were also calculated from the circumferential measurements using the formulae for a truncated cone and cylinder. The mean inter-limb difference found was small but a large range was seen for all of the circumference and volume measurements. Dominance was found to have a significant effect on the limb size. Regression analysis showed that an individual's age was negatively related to their inter-limb difference. Diagnostic cut-offs, set at three standard deviations above the mean, were determined. New circumference and volume criteria based on normative data, taking arm dominance into consideration, will allow for more accurate diagnosis of changes in limb volume, allowing treatment to be started and monitored appropriately.