Physical Exam: Palpation – Basic Diagnostic Techniques

by Joseph Alpert, MD

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    00:00 to listen over the femoral artery in the groin.

    00:01 Another thing you want to do then is you want to palpate various places. There are many clues to vascular disease from palpation.

    00:11 The first thing you want to do is feel the temperature in the legs and particularly the feet. If the feet are cool and higher up the leg is warm, that suggests that we’re not getting enough blood flow down to the feet. Or if there’s a difference – one leg is cooler than the other – that suggests that there’s narrowing of the blood vessel in the cooler leg. Is there edema – that is swelling? And you can figure that out by pressing slightly on the area and see if you make, for example on the leg, do you make an indentation? That suggest that there’s oedema there or swelling. If the patient’s been in bed for a long time, then the lower back is a very good place to test for swelling. And then there’s a test for capillary refill. That is you put the leg up in the air or the arm up in the air and then you bring it down. Does the pink colour come back into the leg or the arm within 3 seconds? If it doesn’t, it suggests that there’s slow blood flow into that area of skin.

    01:19 Another thing on palpation is you want to feel the pulses. Are the pulses nice and strong? Do you feel the artery bouncing under your fingers? Or is it very weak and hard to feel or, in fact, is it missing? Another thing that suggests a disease called coarctation of the aorta, where there’s a constriction in the aorta as you can see from the diagram, there is a delay between the radial and the femoral pulse. Why? Because the blood coming out of the left ventricle through the aortic valve is being delivered at a normal rate to the upper-extremity arteries but at a much slower rate to the lower-extremity arteries because of the constriction in the aorta. So you’ll feel the radial pulse well before you feel the femoral pulse. And really they should be just about simultaneously. This delay signifies the presence of coarctation of the aorta.

    02:22 So, again, you want to palpate the carotid arteries. You want to palpate the radial arteries.

    02:31 You want to palpate the femoral artery. Sometimes even feeling behind the knee, you can feel the popliteal artery. And then you want to try and feel the two foot arteries: the dorsalis pedis artery and the posterior tibial. The posterior tibial is lateral. The dorsalis pedis is medial – that is inner aspect is dorsalis pedis, outer aspect is the posterior tibial.

    About the Lecture

    The lecture Physical Exam: Palpation – Basic Diagnostic Techniques by Joseph Alpert, MD is from the course Introduction to the Vascular System.

    Included Quiz Questions

    1. The left leg has features of peripheral vascular disease.
    2. Vessel abnormalities are most likely found only in the left leg.
    3. Both legs show features of peripheral vascular disease.
    4. The right leg has features of varicose veins.
    5. The left leg has features of varicose veins.
    1. Coarctation of aorta
    2. Aortic aneurysm
    3. Aortic regurgitation
    4. Syphilitic aortitis
    5. Aortic root dilatation
    1. Abdominal aorta
    2. Carotid arteries
    3. Femoral arteries
    4. Dorsalis pedis arteries
    5. Posterior tibial arteries

    Author of lecture Physical Exam: Palpation – Basic Diagnostic Techniques

     Joseph Alpert, MD

    Joseph Alpert, MD

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