Swollen leg exam

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Examination of the unilaterally swollen leg

Differential Diagnosis[edit]

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


ABC's and initial assessment[edit]

  • extreme pain → compartment syndrome

Vitals[edit]

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

Well's Score[edit]

History[edit]

  • 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[edit]

  • swelling of entire leg (+ 1)
  • collateral superficial veins (+ 1)
  • erythema, sharp demarcated border → cellulitis

Palpation[edit]

  • 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[edit]

  • likelihood of alternative diagnosis (- 2)

Well’s score[edit]

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

Other OSCE modules[edit]