Palpation of the extremity
- Temprature; colder limb in ischemia
- Tenderness
- Capillary refilling - normal 2-4 seconds; if cold no need for that examination as refilling will be abnormal
- Pulses
- carotid & abdominal aorta ( part of general examination)
- upper; arteries:ex.
- lower limb; arteries:ex. Pulse grading rated 0-4 - absent, weak, diminished, strong, full & bounding
Palpation: Upper limb pulses
- Axillary: in the axilla and medial upper arm.
- Brachial: antecubital fossa immediately medial to the biceps tendon.
- Radial: at wrist anterior to the radius.
- Ulnar: on medial side of the wrist.
Palpation: Lower limb pulses
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Femoral: At midinguinal point (midway between the anterior superior iliac spine and the pubic symphysis)
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Popliteal:
- Bimanual technique.
- Knee flexed to 45 degrees.
- Foot flat on the examination table.
- Both thumbs are placed on the tibial tuberosity anteriorly and the fingers are placed into the popliteal fossa between the two heads of the gastrocnemius muscle and compressing it against the posterior aspect of the tibia just below the knee
-
Posterior tibial: 2 cm posterior to the medial malleolus.
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Dorsalis pedis:1 cm lateral to the extensor hallucis longus tendon
Palpitation Grading
Pulse grading:
- o=absent
- +1= weak
- +2=diminished
- +3=strong
- +4= full and bounding
Palpation also consists of
- press on bony prominent to exclude edema; ex. pitting edema
- Muscle wasting and power
- Nervous system; motor, sensory, reflexes