Sharanjit Kaur

Examination in Musculoskeletal System

Examination for Venous Thrombosis
 Lowenberg Test
Early sign of venous thrombosis.
Procedure: The examiner applies blood pressure cuffs to each lower leg and pumps them up.
Assessment: Normally, discomfort will occur only beyond 180 mm Hg (24 kPa). Where
thrombosis is present, the normal leg will be observed to tolerate compression of the calf
musculature with far higher pressure than the affected leg.

 Trendelenburg Test
Assesses varicose veins in the thigh.
Procedure: With the patient supine and the leg raised, the examiner smoothes the distended
veins. The examiner then compresses the greater saphenous vein with a tourniquet distal to
its junction with the femoral vein at the inguinal ligament and asks the patient to stand up.
Assessment: If the varices only fill up slowly or not at all within 30 seconds of the patient
standing up but then fill rapidly from proximal once the tourniquet is loosened, this indicates
valvular insuficiency of the saphenous vein with normal function of perforating veins.
Relatively rapid filling from distal can occur as a result of insufficient perforating veins or
anastomoses with an insufficient lesser saphenous vein. Rapid filling of the varices from both
distal and proximal once the tourniquet is released indicates insufficiency of both the greater
saphenous vein and the communication with the deeper venous system.
 Sharanjit Kaur

 Perthes Test
Assesses the function of deep veins and perforating veins.
Procedure: With the patient standing, the examiner applies a tourniquet to the thigh or lower
legproximalto the lled varices.The patient is then asked to walk around with the tourniquet in
place.
Assessment: Complete emptying of the varices as a result of muscular activity indicates
proper function of the perforating veins and intact deep venous drainage. The congestion is
attributable to valvular insuficiency in the saphenous vein. Incomplete emptying is observed
where there is moderate valvular insuficiency of the communicating veins. Unchanged filling
in the varices occurs with signi cant insuficiency of the perforating veins and impaired blood
ow in the deep veins. An increase in filling suggests a severe post thrombotic syndrome with
reversed blood flow in the perforating veins.

 Homans Test
Assesses deep venous thrombosis.
Procedure: The patient is supine. The examiner lifts the affected
leg and rapidly dorsi flexes the patient’s foot with the knee
extended. This maneuver is repeated with the patient’s knee
exed while the examiner simultaneously palpates the calf.
Assessment: Pain occurring upon dorsiflexion of the foot with
the knee extended and flexed indicates thrombosis or
thrombophlebitis. Calf pain with the knee extended can also be caused by intervertebral disk
disease (radicular symptoms) or muscle contractures.