Deep vein thrombosis physical examination

Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]

Deep Vein Thrombosis Microchapters
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Overview
Classification
Pathophysiology
Causes
Differentiating Deep vein thrombosis from other Diseases
Epidemiology and Demographics
Risk Factors
Triggers
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Natural History, Complications and Prognosis
Diagnosis
Diagnostic Approach
Assessment of Clinical Probability and Risk Scores
Assessment of Probability of Subsequent VTE and Risk Scores
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Physical Examination
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Overview

The actual physical signs of venous thrombosis can be quite unreliable. There may be pain and tenderness in the thigh along the course of the major veins

Appearance of the Patient

Obesity may be present.

The patient may complain of lower limb pain.

Vitals

Temperature, Blood Pressure, Pulse and Respiratory rate may all be within normal range.

Physical examination

Physical examination may 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.

Test

• Homan's test: is said to be present when passive dorsiflexion of the ankle by the examiner elicits sharp pain in the calf.. A positive Homans sign does not positively diagnose DVT (poor positive predictive value), and a negative Homans sign does not rule out the DVT diagnosis (poor negative predictive value).
• Pratt's sign: Squeezing of posterior calf elicits pain

However, these medical signs do not perform well and are not included in clinical prediction rules that combine best findings in order to diagnose DVT.

Screening for malignancy

Venous thromboembolism may be the first manifestation of an underlying malignancy. However, a detailed and routine search for an occult malignancy is neither mandatory nor cost effective.

The following test should be considered:

In Males

• Rectal Examination
• Fecal occult blood testing (FOBT) must be performed.

In Females

• Pelvic examinations to rule out any mass/malignancy.