Swollen leg exam

Examination of the unilaterally swollen leg

Differential Diagnosis

 * DVT
 * cellulitis, myositis, fascitis
 * venous obstruction due to a tumor
 * hematomas
 * muscle injury
 * compartment syndrome

ABC's and initial assessment

 * extreme pain → compartment syndrome

Vitals

 * Pulmonary embolism: SOB,↑ HR, ↑ RR, ↓ O2 sat → PE
 * cellulitis → fever

History

 * active cancer (+ 1)
 * paralysis, or recent cast (+ 1)
 * recent immobilization x > 3 days, major surgery (+ 1)
 * history of clots, DVT (+1)


 * pain - severity
 * recent trauma (sports, blunt) → hematoma, muscle injury

Inspection

 * swelling of entire leg (+ 1)
 * collateral superficial veins (+ 1)


 * erythema, sharp demarcated border → cellulitis

Palpation

 * tenderness along deep veins (+ 1)
 * ≥ 3 cm increase in calf circumference vs. other leg (+ 1)
 * pitting edema (+ 1)


 * compression of calve against the tibia → ↑↑ pain
 * warmth
 * distal pulses, capillary refill → ↓ in longstanding arterial disease
 * passive range of motion of the toes or ankle → ↑pain in compartment syndrome

Assessment

 * likelihood of alternative diagnosis (- 2)

Well’s score

 * > 3 = high probability of DVT
 * 1 - 2 = moderate
 * 0 = low