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
Well's Score
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
Other OSCE modules
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