Varicose Vein Examination

Rash Description:

• Primary Morphology:

  • Describe the site of the rash on the leg.
  • Note the size of the rash (e.g., dimensions in centimeters).
  • Determine if the rash appears as discrete lesions or if it is confluent.
  • Assess the borders of the rash, including whether they are well-defined or ill-defined.
  • Examine the margins of the rash for any specific features.

• Secondary Morphology:

  • Mention any secondary characteristics of the rash, such as texture, elevation, or presence of scales.
  • Observe for any signs of inflammation or infection, such as erythema or pustules.

• Distribution:

  • Describe how the rash is distributed on the leg.
  • Note if the rash is localized to a specific area or if it is more widespread.

• Keypoints:

  • Explain the anatomy of the venous system in the lower limb.
  • Mention the presence or absence of varicose veins.
  • If varicose veins are present, describe their location and extension.

Physical Examination Steps:

1. Exposure: Instruct the patient to take off their pants while keeping their underwear on for privacy.

2. General Appearance:

   • Assess the patient’s overall condition, including any signs of pain or distress.
   • Record vital signs, including blood pressure, temperature, respiratory rate, heart rate, and oxygen saturation.
   • Note the patient’s level of consciousness.

3. Inspection of the Rash:

   • Use the primary morphology description to assess the rash.
   • Look for any ulcers or erosions in the affected area.
   • Examine for signs of venous insufficiency:
     • Hemosiderin staining or hyperpigmentation.
     • Presence and extent of varicose veins.
     • Lipodermatosclerosis.
     • Nail changes.
     • Presence of edema (check for pitting or non-pitting edema).
     • Note the presence of Saphenovarix in the upper part of the limb.
   • Check for any signs or features suggestive of arterial disease:
     • Shiny skin.
     • Hair loss.
     • Deformities, such as Charcot deformity.
     • Muscle wasting.

4. Palpation:

   • Assess the temperature of different levels of the leg using the dorsal aspect of your fingers. Compare both sides for temperature differences.
   • Perform a capillary refill time (CRT) test by gently squeezing a nail and recording the time it takes for color to return to normal (normal CRT should be less than 2 seconds).
   • Palpate the area around the ulcer for tenderness.
   • Check for palpable varicose veins or a firm cord-like vein suggestive of thrombophlebitis.
   • Assess for pitting and non-pitting edema.

5. Movement:

   • Instruct the patient to perform movements of the toes, ankle, and knee to assess joint mobility.

6. Special Tests:

   • Explain and perform the following special tests as needed:
     • Cough test to evaluate the SaphenoVarix.
     • Tap test to check for valve incompetence.
     • Trendelenburg test to assess the superficial and deep venous systems.
     • Perthe’s Test to evaluate deep venous system function.
     • Auscultate the varicosities for bruit.
     • Auscultate the femoral artery for bruit (important for guiding management).
     • Conduct the Burgers test to observe for hyperemia or flushing.
     • Perform a sensory neurological examination.
     • Consider a Doppler ultrasound of the venous system for further assessment.