Examination and Evaluation of Arterial Sufficiency

By Carolyn Kisner PT, MS and Lynn Allen Colby PT, MS on February 9th 2009

A comprehensive examination of a patient with known or suspected peripheral arterial disease is necessary to determine or verify the etiology of a patient’s impairments and functional limitations. For example, the origin of a patient’s buttock and leg pain or lower extremity weakness could be caused by vascular or neuromuscular pathologies.The initial and subsequent examinations also provide a basis to determine a patient’s status before treatment and the effectiveness of the interventions at the conclusion of treatment.

Some procedures are used by therapists to indirectly assess arterial blood flow, whereas others, such as angiography or arteriography, are administered by practitioners with specialized training and are interpreted by a physician.

Palpation of Pulses

The basis of any evaluation of the integrity of the arterial system is the detection of pulses in the distal portion of the extremities. Pulses are described as normal, diminished, or absent. The strength of pulses also can be rated quantitatively from 0 to +3. Even if pulses appear normal, blood flow to the extremity may, in fact, be substantially restricted. Pulselessness is a sign of severe arterial insufficiency.

The femoral, popliteal, dorsalis pedis, and posterior tibial pulses should be palpated in the lower extremities. The radial, ulnar, and brachial pulses are palpated in the upper extremities.

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