Upper Limb

Findings on Upper Limb Examination
Component Inspection Palpation Percussion Auscultation
General
  • Trackmarks
  • Long-term lines
    • PICC
    • Midline
Respiratory
Cardiovascular
  • Radial and brachial access sites
    • Evidence of vascular sheath
  • Previous radial graft harvesting
  • Peripheral venous filling
  • Pulse character
    • Radial
    • Brachial
Neurological
Endocrine and Metabolic
Renal
  • AV Fistula
  • Fistula thrill
  • Fistula hum
Gastrointestinal
Haematological
Integumentary
  • Tense compartments
Trauma
Infective
Malignant
Toxic
Immune
  • Lymphadenopathy
Congenital
Obstetric

Features

Cardiovascular

  • Venous filling
    Presence of visible peripheral veins significantly ↓ likelihood of hypovolaemia. The absence of venous filling is not specific.

  • Pulse character
    • Bounding, strong pulses
      Suggests:
      • Peripheral vasodilation
        • Distributive shock
        • Hypercapnoea
        • Stress
      • Anaemia
      • ↓ HR
    • Pulsating “string”
      Suggests stiffened and calcified radial artery, known as “pulsus durus”.

References

  1. Foot C, Steel L, Vidhani K, Lister B, MacPartlin M, Blackwell N. Examination Intensive Care Medicine. Elsevier Australia; 2011. (Examination series).
  2. Dünser MW, Dankl D, Petros S, Mer M. Clinical Examination Skills in the Adult Critically Ill Patient. Springer International Publishing; 2018.