Varicose Vein: Examination

                                                                Varicose Vein: Examination

[A] Inspection

·         Examined in standing position (supine for special tests)

·         Dilated veins: Location

·         Venous                system affected

§  Great saphenous system(in front of medial malleolusàruns medially in leg and thigh àsaphenous opening)

§  Short saphenous system(behind lateral malleolusàruns posteriorlyà terminates in popliteal fossa)

§  Perforators

§  Both great and short saphenous              

·         Extent of involvement

·         Skin of the leg

−        Pigmentation

−        Eczema

−        Ulcer (describe details of ulcer)

−        Texture

−        Colour

§  localized redness- superficial thrombophlebitis

§  White (generalized)- Phlegmasia alba dolens (due to edema/lymphatic obstruction)

§  Blue and congested- Phlegmasia cerulea dolens (due to DVT)

·         Morrisey's test – Cough                impulse                at saphenous opening (present in Saphena varix)

·         Any discrepancy in limb size (local gigantism)

[B] Palpation

1.       Tenderness or thickening of veins along                its course

2.       Cough impulse at sapheno-femoral junction (Morrisey's test)

3.       Brodie Trendelenburg’s                test: Two parts

(To evaluate perforaters and saphenofemoral valve respectively)

·         First Part (for perforator)

Empty veinsàblock SF Junction by tourniquet àmake him stand (keeping tourniquet tied)

Positive –superficial veins get distended (suggest perforator incompetence)

·         Second Part

Empty veinsàblock SF Junction by tourniquet àmake him standà Release tourniquet

Positive – superficial veins get filled quickly from above (suggest              incompetence   of SF junction)

4.       Tourniquet test

Multiple torniquet at the level of each known perforator ( 1above and 1 below)

5.       Schwartz test

·         Tap lower part of long saphenous system àImpulse at saphenous opening (positive test)

6.       Fegan’s                test

·         Crescentic gap felt in deep fascia (site of perforator)

7.       Modified Perthes’ test

·         Block SFJ à walk for about 3–5 minutesàEvaluate change in dilated superficial veins

§  Collapse- deep veins patent

§  More distended and bursting pain- deep veins occluded by thrombosis

8.       Pratt’s test (to look for position of perforaters)

·         Outdated (don’t mention if not asked)

·         Elastic bandage from toe to groin to empty varicose veinàblock SFJ by tourniquetàbandage taken off ànow bandage from groin to toesà blow outs seen at position of perforaters

9.       Palpation of the ulcer

10.   Palpation of arterial pulses

11.   Homan’s sign

·         Outdated, Avoided in most circumstances

·         Passive forceful dorsiflexion of foot with knees extendedàstretches calf muscle àpain

·         Positive in DVT

12.   Moses’ sign

·         Outdated, Avoided in most circumstances

·         Calf muscle squeezed side to sideà Pain

·         Positive in DVT

[C] Auscultation

·         „ Bruit in arterio-venous fistula