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Outdated (don’t mention if not asked)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Outdated, Avoided in most circumstances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Outdated, Avoided in most circumstances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