Before any treatment, every patient with suspected varicose veins should undergo a structured clinical examination followed by a duplex Doppler ultrasound. The classical bedside clinical tests — Trendelenburg, Perthes, Schwartz — are still important to localise valve incompetence, especially in the absence of ultrasound. This page describes each test step-by-step, written for medical students, MBBS undergraduates, GPs and patients curious about the workup.
1. Trendelenburg Test (Two-Part)
Tests competence of saphenofemoral junction (SFJ) and perforator valves.
- Patient lies supine; leg elevated to drain veins.
- Tourniquet applied just below SFJ (groin).
- Patient stands.
- Part I: Veins fill rapidly from below before tourniquet release → perforator incompetence.
- Part II: Tourniquet released — rapid filling from above → SFJ incompetence.
2. Perthes Test
Assesses deep venous system patency — critical before treating superficial varicose veins.
- Tourniquet applied just below the knee with patient standing.
- Patient walks for 5 minutes.
- If varicose veins empty → deep system competent (safe to treat).
- If they become more prominent / painful → deep venous obstruction (cannot remove superficial system).
3. Other Useful Bedside Tests
- Cough impulse test — palpable thrill at SFJ on coughing → SFJ incompetence.
- Schwartz / Tap test — tap distally, feel impulse proximally → column of blood without intervening competent valve.
- Multiple tourniquet test — localises perforators between successive levels.
- Modified Perthes test — uses elastic bandage instead of tourniquet.
- Pratt's test — identifies perforators along the calf.
- Morrissey's cough impulse — positive in SFJ incompetence.
Why Duplex Doppler Has Replaced These Tests
Bedside tests are subjective, examiner-dependent and miss subclinical reflux. Duplex Doppler ultrasound is the current gold standard — it visualises flow direction in real time, measures reflux duration (> 0.5 sec is pathological), maps every incompetent perforator, and rules out deep vein thrombosis. At Dr. Raja's Vein Clinic in Bathinda, every patient gets a venous Doppler before treatment is planned.
Frequently Asked Questions
Are clinical tests still relevant for varicose veins?
Yes — they remain valuable in MBBS examinations and in resource-limited settings. However, all definitive treatment planning is now based on duplex Doppler ultrasound.
What is a positive Trendelenburg test?
Rapid retrograde filling of varicose veins from above after tourniquet release at the groin indicates saphenofemoral junction incompetence — the most common pattern in varicose veins.
Is the Perthes test painful?
Mildly uncomfortable. Patients with deep vein obstruction may experience increased leg pain when walking with the tourniquet on — this is itself diagnostic.
How long does a varicose-vein clinical examination take?
Bedside examination typically takes 10–15 minutes. A duplex Doppler scan adds another 20–30 minutes for both legs.
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