A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Skin
- Extremities (including measurement of lower leg circumference on both sides).
- In arterial thrombosis: [partial/complete ischemia (reduced blood flow), localized peripheral cyanosis (blue discoloration of the skin)[
- In venous thrombosis: [fever, inflammation, hyperthermia, edematous swelling (e.g., tightness, calf swelling), cyanosis (blue discoloration of the skin)/livid discoloration of an extremity, localized pain/pain in the area of the affected veins].
- Pain provocation in suspected deep vein thrombosis (DVT):
- Calf compression pain (Meyer’s sign); positive: tenderness on the medial side of the lower leg along the so-called Meyer’s pressure points (inner side of the upper lower leg).
- Calf pain on dorsiflexion of the foot (Homans sign); positive: calf pain on dorsiflexion of the foot (flexion toward the dorsum of the foot) with the leg extended.
- Foot sole pressure pain (Payr’s sign); positive: pressure painfulness, especially the medial sole of the foot, when pressure is applied to the sole of the foot with the fingers
- Auscultation (listening) of the heart.
- Inspection (viewing).
Square brackets [ ] indicate possible pathological (pathological) physical findings.
Wells score for determining the clinical probability of deep vein thrombosis (DVT)
| Symptoms | Points |
| Active or treated cancer in the last six months | 1 |
| Paralysis or recent immobilization of legs (e.g., cast immobilization) | 1 |
| Bed rest (> 3 days); major surgery (< 12 weeks). | 1 |
| Pain /hardening along the deep venous system | 1 |
| Swelling whole leg | 1 |
| Swelling of lower leg >3 cm compared to opposite side | 1 |
| Impressible edema on symptomatic leg | 1 |
| Dilated superficial (non-varicose) collateral veins. | 1 |
| Previous documented DVT | 1 |
| Alternative diagnosis at least as likely as DVT | -2 |
| Clinical probability of DVT | |
| Low-risk group (cut-off of the sum value). | ≤ 1 |
| High-risk group (cut-off of the sum value). | > 1 |
Clinical procedure:
- Low-risk group → D-dimer test required; if negative, further diagnosis and anticoagulation may be omitted Cave! This procedure is not safe in the presence of active or treated cancer in the last six months.
- High-risk group → compression sonography required.
