Volumetric evaluation of upper extremities in 250 healthy persons N. Gebruers 1,2 , S. Truijen 1 , S. Engelborghs 1,2,3 and P. P. De Deyn 1,2,3 1 Department of Health Care Sciences, University College of Antwerp, Merksem, Belgium 2 Department of Neurology and Memory Clinic, Middelheim General Hospital (ZNA), Antwerp, Belgium, and 3 Laboratory of Neurochemistry and behaviour, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium Correspondence Dr P. P. De Deyn, Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium E-mail: peter.dedeyn@ua.ac.be. Accepted for publication Received 9 June 2006; accepted 11 September 2006 Key words handedness; limb volume; lymphoedema; oedema; stroke; volume assessment; water displacement Summary Background and purpose Upper extremity oedema frequently occurs as a complication of several diseases. The aim of this study was to establish normative data for upper extremity volumes with a modified water displacement method. These data were used to develop predictive formulas helpful in detecting abnormal swelling. Subjects and methods Upper extremities of 250 healthy subjects (138 men and 112 women) were measured by water displacement. Results A mean difference of 3Æ0% (3Æ2%) between right and left arm (forearm) was found. Intra-class correlation coefficients were 0Æ99 for intra-rater and inter-rater reliabilities. Coefficient of variation was 0Æ23%. To predict the premorbid volume of an oedematous arm, prediction formulas were constructed. Discussion and conclusion Water displacement as used in this study is a highly reliable technique for volume measurement of upper extremities. This technique was applied to gather normative data for upper extremity volumes. We suggest that this technique can be used in daily clinical practice for the evaluation of upper extremity oedema or atrophy caused by various diseases as well as for volume monitoring. Prediction formulas can be used to define abnormal swelling. Introduction Oedema or swelling is fluid accumulation in the interstitial space due to an imbalance between the pressures of the capillaries. This can occur when filtration is augmented or when the lymphatic system is damaged or obstructed (Rockson, 2001; Cho, 2002; Post et al., 2003). Oedema is often a complication after stroke or breast cancer surgery (Roper et al., 1999; Geurts et al., 2000; Petrek et al., 2000). Oedema after stroke can be an isolated complication or can occur in combination with chronic regional pain syndrome type I (Faghri, 1997; Geurts et al., 2000). The volume of the extremities is an easy measurable parameter to evaluate the severity and evolution of oedema. Therefore, the volume of the affected arm is a sensitive index to determine oedema (van Velze et al., 1991). Many techniques have been stated to measure volume, for example circumference measure- ment (Pani et al., 1995), water displacement, perometry (Tierney et al., 1996), ultrasound (Doldi et al., 1992; van der Veen et al., 2001), MRI and CT (Gerber, 1998). Some of these methods are expensive and not regularly accessible for physical therapists while limb circumference and water displacement measurements are common in physical therapy practice (Casley-Smith, 1994; Stizia, 1995; Boland & Adams, 1996; Perrin & Guex, 2000). Limb volume measurements by girth measurements or water displacement are both reliable and highly correlated but not interchangeable (Sander et al., 2002; Karges et al., 2003). When a volumeter is used, some guidelines can best be followed for securing reproducible measurements. Boland and King stressed that the water temperature influences the volume (King, 1993; Boland & Adams, 1996). When the difference in temperature is small (20–32°C) the differences in volume are not significant (King, 1993; Boland & Adams, 1996). When the temperatures differ about 40°C, the difference in volume becomes significant (King, 1993). A constant temperature is necessary when the weight of the water is used to determine the volume since the density of the water changes when tempera- ture is different. A study done by Stern concludes that repeated measurements should best be done in the same position. For measurement of the arm a seated position is recommended (Stern, 1991). The main aim of this study was to gather normative data about the normal variation between left and right upper limb volumes. In addition, these measurements will be used to determine prediction formulas. These formulas can be applied to predict the premorbid volume of a contralateral oedematous arm if the homolateral arm is not affected. Before gathering normative data, we had to test our modified water displacement method for reliability and reproducibility. Clin Physiol Funct Imaging (2007) 27, pp17–22 doi: 10.1111/j.1475-097X.2007.00708.x Ó 2007 The Authors Journal compilation Ó 2007 Blackwell Publishing Ltd • Clinical Physiology and Functional Imaging 27, 1, 17–22 17