Deep vein thrombosis physical examination

Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

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

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
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.
 * 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

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.