Deep vein thrombosis physical examination

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

Deep Vein Thrombosis Microchapters
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Patient Information
Overview
Classification
Pathophysiology
Causes
Differentiating Deep vein thrombosis from other Diseases
Epidemiology and Demographics
Risk Factors
Triggers
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Approach
Assessment of Clinical Probability and Risk Scores
Assessment of Probability of Subsequent VTE and Risk Scores
History and Symptoms
Physical Examination
Laboratory Findings
Ultrasound
Venography
CT
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Upper extremity DVT
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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 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 difference. 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 positive when passive dorsiflexion of the ankle (knee in flexed position) elicits sharp pain in the calf. However, the test has 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: Squeezing of posterior calf elicits pain, is also not recommended.