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Clinical Examination of Varicose Veins
Clinical Examination of Varicose Veins
TO EXAMINER:
THERE IS NO EVIDENCE OF ANY VARICOSE VEINS, SIGNS OF VENOUS INSUFFICIENCY
IN THE DISTRIBUTION OF SSV.
TO PATIENT:
I AM JUST GOING TO FEEL THE VEINS. PLEASE LET ME KNOW IF IT IS TENDER.
ACT:
FEEL TEMPERATURE OVER VARICOSITIES AND PALPATE ANY OBVIOUS VARICOSE
VEINS.
TO EXAMINER:
ON PALPATION, SKIN OVER VARICOSITIES IS NOT WARM. VARICOSITIES ARE
PALPABLE AND NON TENDER.
TO PATIENT:
I AM NOW GOING TO PRESS FOR A SECOND ON YOUR ANKLE.
ACT:
PRESS 5 CMS ABOVE MEDIAL MALLEOLUS FOR 3 SECONDS FOR PITTING EDEMA.
TO EXAMINER:
PITTING EDEMA IS PRESENT.
TO PATIENT:
COULD YOU PLEASE TURN BACK AROUND TO FACE ME?
ACT:
AGAIN CHECK TEMPERATURE, TENDERNESS OVER VEINS.
TO PATIENT:
I AM GOING TO FEEL ALONG THE LEG JUST BEHIND THE MEDIAL BORDER OF TIBIA
FOR TENDER DEFECTS IN THE DEEP FASCIA (THAT IS ABOUT 5, 10 AND 15 CMS ABOVE
THE MEDIAL MALLEOLUS)
TO PATIENT:
PLEASE LET ME KNOW IF IT IS TENDER ANYWHERE. I AM LOOKING FOR EVIDENCE
OF PERFORATOR INCOMPETENCE.
TO EXAMINER:
PALPATION ALONG THE COURSE OF THE VEIN JUST BEHIND/ ALONG THE MEDIAL
BORDER OF TIBIA DOES NOT REVEAL ANY TENDER DEFECTS IN THE DEEP FASCIA
(WHERE THE COMMUNICATING VEINS PASS FROM THE SUPERFICIAL TO THE DEEP
SYSTEM .PHALENS TEST)
TO PATIENT:
DO YOU MIND IF I FEEL IN THE GROINS.
ACT:
FEEL ANATOMICAL LANDMARKS:
REST A HAND ON THE MEDIAL CALF JUST BELOW THE KNEE ALONG THE COURSE OF
THE VARICOSE VEIN AND TAP THE SAPHENA VARIX/ SFJ/LSV FROM ABOVE
DOWNWARDS.
TO EXAMINER:
PERCUSSION AT SFJ DEMONSTRATES TRANSMISSION OF WAVES DOWN THE VEIN
(CRUVHEILLIERS SIGN) INDICATING A POSITIVE TAP TEST (INDICATES INCOMPETENT
VALVES BELOW SFJ).
I WOULD NOW LIKE TO PERFORM THE TOURNIQUET TEST.
TO PATIENT:
COULD YOU LIE DOWN PLEASE? I AM GOING TO LIFT YOUR ANKLE GENTLY AND
REST IT ON MY SHOULDER. KEEP YOR LEG STRAIGHT IF YOU CAN PLEASE.
ACT:
LIFT THE LEG, PUT THE ANLE ON ONE SHOULDER AND STROKE THE LEG FIRMLY
(WITH PALMAR SURFACE OF FINGERS).
TO PATIENT:
I AM JUST EMPTYING THE VEINS.
ACT:
PUT THE RUBBER TOURNIQUET TIGHTLY AROUND THE UPPER THIGH BELOW SFJ.
TO PATIENT:
STAND UP PLEASE.
ACT:
WATCH BELOW THE TOURNIQUET. DO THE VEINS FILL IMMEDIATELY?
1. IF YESTHE VARICOSITIES ARE NOT CONTROLLED AT THE LEVEL OF THE SFJ
SUGGESTING INCOMPETENT PERFORATORS LOWER DOWN.
2. IF NOT.THE VARICOSITIES ARE CONTROLLED AT THE LEVEL OF
SFJ.
NOTE:
IF ASKED THEN ONLY MENTION.
KEEP REPEATING THE PROCEDURE, MOVING THE TOURNIQUET PROGRESSIVELY
DOWN THE LEG (JUST ABOVE KNEE, JUST BELOW KNEE) THAT IS BETWEEN THE
SITES OF THE PERFORATOR VEINS. REPEAT UNTIL THE VEINS BELOW THE
TOURNIQUET STAY COLLAPSED. IT DEFINES THE SEGMENT OF LEG CONTAINING
INCOMPETENT PERFORATORS.
TO EXAMINER:
THE TOURNIQUET TEST REVEALS THAT THE VEINS ARE CONTROLLED AT THE SFJ.
NOTE:
ONLY DO THIS IF ASKED BY EXAMINER SPECIFICALLY OTHERWISE OMIT
TRENDELENBURG TEST:
ASK PATIENT TO LIE FLAT. ELEVATE THE LEG UNTIL THE SUPERFICIAL VEINS ARE
EMPTIED. ONLY PERFORM THE TEST IF THE TOURNIQUET TEST IS POSITIVE AT THE
UPPER THIRD OF THIGH. PLACE TWO FINGERS AT THE SFJ. ASK PATIENT TO STAND UP,
KEEPING YOUR FINGERS FIRMLY IN PLAE. WATCH LEG. NO FILLING OF SUPERFICIAL
VEINS BELOW FINGERS, FILLING ON RELEASE OF FINGER PRESSURE INDICATES SFJ
INCOMPETENCE.
TO EXAMINER:
I WOULD LIKE TO PERFORM PERTHES TEST.
TO PATIENT:
LEAVING THE TOURNIQUET ON COULD YOU PLEASE WALK AROUND/ STAND UP AND
DOWN ON TIPTOES PLEASE.
ACT:
WATCH LEG.
IF VEIN GET BETTER.THE DEEP VENOUS SYSYTEM APPEARS TO BE FUNCTIONING.
IF VEINS GET WORSE AND PATIENT DEVELOPS SEVERE DISCOMFORT THERE MAY BE
PROBLEMS WITH THE DEEP VENOUS SYSTEM THAT IS THERE IS OCCLUSION OF THE
DEEP VEINS.
TO EXAMINER:
PERTHES TEST REVEALS TAT THE DEEP VENOUS SYSTEM IS FUNCTIONING.
TO PATIENT:
I AM JUST GOING TO FEEL IN YOUR GRONS SIR.
ACT:
PALPATE ALL PULSES INCLUDING FOOT PULSES.
TO EXAMINER:
ALL THE PULSES INCLUDING FOOT PULSES ARE PALPABLE AND PERFUSION IS GOOD.
TO PATIENT: