Trendelenburg Test
Encyclopedia
The Trendelenburg Test or Brodie-Trendelenburg test (not to be confused with Trendelenburg's sign
) determines the competency of the valves in the superficial
and deep vein
s of the leg. With the patient in the supine position the leg is flexed at the hip and raised above heart level until the veins become empty. A tourniquet is then applied around the upper thigh to compress the superficial veins but not too tight as to occlude the deeper veins. The leg is then lowered by asking the patient to stand. Normally the superficial saphenous vein will fill from below within 35 seconds as blood from the capillary beds reaches the veins; if the superficial veins fill more rapidly with the tourniquet in place there is valvular incompetence below the level of the tourniquet in the "deep" or "communicating" veins. After 20 seconds, if there has been no rapid filling, the tourniquet is released. If there is sudden filling at this point it indicates that the communicating veins are competent but the superficial veins are incompetent. The test is reported in two parts, the initial standing up of the patient (positive or negative based on rapid filling) and the second phase once the tourniquet is removed (positive or negative based upon rapid filling). For example, a possible outcome of the test would be negative-positive meaning that the initial phase of the test was negative indicating competence in the communicating veins and the second phase of the test was positive meaning that there is superficial vein incompetence.
The test can be repeated with the tourniquet at different levels to further pinpoint the level of valvular incompetence:
Superficial veins of the leg normally empty into deep veins, however retrograde filling occurs when valves are incompetent, leading to varicose veins
.
This is not to be confused with Trendelenburg's sign which refers to a weakness or paralysis of the hip as opposed to a venular problem as mentioned here.
Trendelenburg's sign
Trendelenburg's sign is found in people with weak or paralyzed abductor muscles of the hip, namely gluteus medius and minimus. It is named after the German surgeon Friedrich Trendelenburg....
) determines the competency of the valves in the superficial
Superficial vein
Superficial vein is a term used to describe a vein that is close to the surface of the body. It is used to differentiate veins that are close to the surface from veins that are far from the surface, known as deep veins....
and deep vein
Deep vein
Deep vein is a term used to describe a vein that is deep in the body. It is used to differentiate deep veins from veins which are close to the surface, also known as superficial veins....
s of the leg. With the patient in the supine position the leg is flexed at the hip and raised above heart level until the veins become empty. A tourniquet is then applied around the upper thigh to compress the superficial veins but not too tight as to occlude the deeper veins. The leg is then lowered by asking the patient to stand. Normally the superficial saphenous vein will fill from below within 35 seconds as blood from the capillary beds reaches the veins; if the superficial veins fill more rapidly with the tourniquet in place there is valvular incompetence below the level of the tourniquet in the "deep" or "communicating" veins. After 20 seconds, if there has been no rapid filling, the tourniquet is released. If there is sudden filling at this point it indicates that the communicating veins are competent but the superficial veins are incompetent. The test is reported in two parts, the initial standing up of the patient (positive or negative based on rapid filling) and the second phase once the tourniquet is removed (positive or negative based upon rapid filling). For example, a possible outcome of the test would be negative-positive meaning that the initial phase of the test was negative indicating competence in the communicating veins and the second phase of the test was positive meaning that there is superficial vein incompetence.
The test can be repeated with the tourniquet at different levels to further pinpoint the level of valvular incompetence:
- above the knee - to assess the mid-thigh perforators
- below the knee - to assess incompetence between the short saphenous veinSmall saphenous veinThe small saphenous vein , is a relatively large vein of the superficial posterior leg.-Path:Its origin is where the dorsal vein from the fifth digit merges with the dorsal venous arch of the foot, which attaches to the great saphenous vein...
and the popliteal veinPopliteal veinThe popliteal vein course runs alongside the popliteal artery but carries the blood from the knee joint and muscles in the thigh and calf back to the heart.Its origin is defined by the junction of the posterior tibial vein and anterior tibial vein....
.
Superficial veins of the leg normally empty into deep veins, however retrograde filling occurs when valves are incompetent, leading to varicose veins
Varicose veins
Varicose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards . Leg muscles pump the veins to return blood to the heart, against the...
.
This is not to be confused with Trendelenburg's sign which refers to a weakness or paralysis of the hip as opposed to a venular problem as mentioned here.