Patient & Exam Details

Last name

First name

DOB

Age

Date of exam

Handedness

Examining provider

2

General Exam Overview

General Body habitus — adiposity distribution

Extremity Findings

Adipose deposition character

Soft Nodular

Areas of deposition Feet and hands Musculoskeletal

Gait assessment Joint tenderness Range of motion

3

Head, Neck & Supraclavicular

Head

Scalp / top of head

None Lipedema tissue over scalp Firm nodular, top of head

Posterior head / occipital nodes

None Enlarged occipital nodes Excess fat posterior head

Neck

Anterior neck nodules

None Small 2–3mm nodules Larger lumps

Posterior neck masses

None Larger masses Diffuse firm tissue

Supraclavicular

Fat pad with shoulder shrug

None — depresses normally Elevated with shrug Elevated with Valsalva Elevated with both

Significant supraclavicular fat — possible lymphatic dysfunction

Yes No

4

Chest, Shoulders & Breasts

Chest

Subcutaneous nodules, chest wall

PresentNone

Tissue thickness

Petechiae

PresentNone

Cherry angiomas (possible capillary fragility)

PresentNone

Shoulders

Nodules at shoulder tips

PresentNone

Breasts

Breast tissue weight

HeavyNormal

5

Hands, Arms & Axillae

Hands

Fat between MCP joints

None — spared Minimal, isolated MCP Increased between MCPs

Base of thumb

None Soft non-nodular fat Nodular tissue

Wrist cuff sign (rounded cuff of tissue)

PresentNone

Wrist nodules

None Minimal nodularity Nodular tissue

Forearms / Arms

Cubital (antecubital) nodes

PresentNone

Lymphatic chain to 5th digit

PresentNone

Brachioradialis nodularity

None Small amount Moderate

Medial upper arm fibrosis (may be normal)

PresentNone

Overall upper arm fat character

Axillae

Acanthosis nigricans

PresentNone

Nodular tissue / lymph nodes

PresentNone

6

Abdomen, Hips & Buttocks

Abdomen

Subcostal / lateral nodules

None Rare/flat nodules Scattered laterally

Medial / central nodularity

PresentNone

Abdominal girth

EnlargedNormal

Hips

Nodular tissue (likely lipedema)

PresentNone

Proportion vs. upper body

DisproportionateProportionate

Tissue weight

HeavyNormal

Buttocks

Tissue character

Normal Thick/fibrotic Nodular Mixed

Tissue weight

HeavyNormal

Proportion vs. upper body

DisproportionateProportionate

7

Thighs, Knees & Ankles

Thighs

Superficial varicosities

PresentNone

Skin elasticity (upper thigh)

Tissue thickness

ThickenedNormal

Nodular tissue

None Nodules present Possibly masked by fluid

Knees / Popliteal

Popliteal nodules

AbnormalExpected only

Tenderness

PresentNone

Lateral lower-leg nodules

PresentNone

Ankles / Feet

Achilles fill / pre-malleolar

FilledNone

Malleolar cuff

PresentNone

8

Edema, Stemmer Sign & Skin

Pitting assessment Stemmer sign Skin

Intact Hyperpigmentation Stasis changes No ulcerations

9

Hypermobility (Beighton)

Thumb-to-forearm 5th finger >90° Elbow hyperextension Knee hyperextension Trunk flexion (palms to floor)

Chronic joint pain (minor criterion)

PresentNone

Stretch marks (minor criterion)

PresentNone

0

/ 9

Enter findings to score

Cutoff applied: ≥5/9 (age not entered).

What the score means (2017 International EDS Consortium thresholds):

Age ≤18	Generalized joint hypermobility (GJH) if score ≥6/9.
Age 19–50	GJH if score ≥5/9.
Age >50	GJH if score ≥4/9.
Score 0	No hypermobility in the joints tested.
Below cutoff	May reflect localized rather than generalized hypermobility.

A positive screen is not a diagnosis on its own — interpret alongside symptoms, history, and clinical judgment. Maneuvers should not be forced into pain.

10

Lipedema Staging & Typing

Clinical stage

Type classification

11

Circumference Measurements

Optional. Recorded in cm. Leave blank to omit from the note.

Waist

Hips

Waist-to-Hip Ratio

Site	Right	Left
Thigh (mid)
Knee
Calf (mid)
Ankle

Additional exam notes

My Wellness Physicians

Lipedema Physical Examination

Patient & Exam Details

General Exam Overview

Head, Neck & Supraclavicular

Chest, Shoulders & Breasts

Hands, Arms & Axillae

Abdomen, Hips & Buttocks

Thighs, Knees & Ankles

Edema, Stemmer Sign & Skin

Hypermobility (Beighton)

Lipedema Staging & Typing

Circumference Measurements

📋 OBJECTIVE Note (auto-generated)