1. General considerations
2. History
3. Inspection
4. Palpation
5. Cough impulse test
6. Trendelenberg test
7. Perthes' test

General considerations

• 2 sets of veinsdeep and superficial. "Deep veins" means deepto the fascia.
• Flow is superficial veins to deep veins.
• Arise by: calf pumps uppushing blood out into superficial veins.Superficial veins then dilatespreading their own valves apartso thesuperficial veins become torturous.
• Walking with a pressure tourniquet on leg
  • If competent valvesgets better as walk.
  • If incompetent valves between deep and superficialno effect.
  • If DVTgets more painful as walk [since exit is blocked]. 
• Can optionally use a Doppler after physical examination.

History

Inspection

• Pt standsboth legs completely visible.
• Inspect from anterior of thighs to lateral of legs (long saphenous vein).
• Inspect back of calves (short saphenous vein).
• Venous ulcers. See Venous ulcer exam.
• DDx from femoral herniasince varicose veins:
  • Are blue.
  • Disappear when lie flat.
  • Show a positive cough impulse.

Palpation

• Tenderness (thrombophlebitis).
• Hard (thrombosis).

Cough impulse test

• Pt stands.
• Dr's fingers held over saphenofemoral opening [medial to femoral vein].
• Pt. coughs.
• If saphenofemoral incompetentcough makes a fluid thrill.

Trendelenberg test

• Pt lies flatleg is elevated.
• Tie tourniquet around thigh at saphenous opening.
• Pt stands.
• If normal valve at tourniquet sitewill see filling from belowtourniquet.
• Take off tourniquet: if incompetent valve therewill have a suddenfilling from above when remove tourniquet.
• Can repeat procedure down the leguntil find the incompetent valve.
• Note: there's a different Trendelenbergtest for proximal myopathy of hip.

Perthes' test

• Similar to Trendelenberg test.
• Release a bit of tourniquetbut pt raises up and down on toes afterreleasing.
• If perforating calf veins have competent valvescalf pump will functionmaking varicosities less tense.

Main Menu | Homepage