Deep vein thrombosis physical examination: Difference between revisions
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==Extremities== | ==Extremities== | ||
The most significant part of physical exam in a patient with suspected [[DVT]] is measurement of the size of both legs at same point (usually measured vertically from the knee joint), to assess for | The most significant part of the physical exam in a patient with a suspected [[DVT]] is the measurement of the size of both legs at the same point (usually measured vertically from the knee joint), to assess for differences. If a difference is detected, and there is suspicion of DVT, further tests should be conducted. It may also reveal: | ||
* Palpable cord (reflecting a thrombosed vein) | * Palpable cord (reflecting a thrombosed vein) | ||
* Calf or thigh pain | * Calf or thigh pain | ||
* Unilateral edema or swelling with a difference in calf diameters, warmth, tenderness and erythema. | * Unilateral [[edema]] or swelling with a difference in calf diameters, warmth, tenderness and [[erythema]]. | ||
* Superficial venous dilation. | * Superficial venous dilation. | ||
'''[[Homans test]]''' is mainly of historical perspective. It is said to be positive when passive dorsiflexion of the ankle (knee in flexed position) elicits sharp pain in the calf. However, the test has a very poor positive or negative predictive value. Previous studies have shown that Homans test was present only in 30% of the patients with positive [[DVT]]. | |||
''' | '''Pratt's sign''': When squeezing of posterior calf elicits pain. This is not recommended.<ref name="pmid16403932">{{cite journal| author=Wells PS, Owen C, Doucette S, Fergusson D, Tran H| title=Does this patient have deep vein thrombosis? |journal=JAMA | year= 2006 |volume= 295 | issue= 2 | pages= 199-207 | pmid=16403932 | doi=10.1001/jama.295.2.199 | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16403932 }}[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813372 Review in: ACP J Club. 2006 Jul-Aug;145(1):24] [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17213132 Review in: Evid Based Med. 2006 Aug;11(4):119] </ref> | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:56, 12 October 2012
Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] ; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
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Overview
The physical examination may be completely normal in patients with DVT. A high degree of suspicion is necessary for early identification of venous thrombosis, as sometimes these patients are admitted with a different complaint and a thorough physical exam gives a clue to the diagnosis.
Vitals
Temperature, blood pressure, heart rate and respiratory rate may all be within normal range.
Extremities
The most significant part of the physical exam in a patient with a suspected DVT is the measurement of the size of both legs at the same point (usually measured vertically from the knee joint), to assess for differences. If a difference is detected, and there is suspicion of DVT, further tests should be conducted. It may also reveal:
- Palpable cord (reflecting a thrombosed vein)
- Calf or thigh pain
- Unilateral edema or swelling with a difference in calf diameters, warmth, tenderness and erythema.
- Superficial venous dilation.
Homans test is mainly of historical perspective. It is said to be positive when passive dorsiflexion of the ankle (knee in flexed position) elicits sharp pain in the calf. However, the test has a very poor positive or negative predictive value. Previous studies have shown that Homans test was present only in 30% of the patients with positive DVT.
Pratt's sign: When squeezing of posterior calf elicits pain. This is not recommended.[1]
References
- ↑ Wells PS, Owen C, Doucette S, Fergusson D, Tran H (2006). "Does this patient have deep vein thrombosis?". JAMA. 295 (2): 199–207. doi:10.1001/jama.295.2.199. PMID 16403932.Review in: ACP J Club. 2006 Jul-Aug;145(1):24 Review in: Evid Based Med. 2006 Aug;11(4):119