This may indicate a chronic state of venous insufficiency, located in either the saphenous veins or the deep venous system. As the hands are placed on the medial and lateral legs, feel for warmth, dilated veins, focal fascial defects, areas of tenderness, or a cyst in the popliteal area. At the knee level, one of the earliest signs of greater saphenous insufficiency is the retrocondylar bulge that is felt before it is seen as the greater saphenous vein passes behind the femoral condyles. While palpating the skin, be sure to pay particular attention to induration and the presence of edema, as this may indicate the presence of more severe disease. In the setting of greater saphenous vein insufficiency, a thrill may be palpated at the site of the saphenofemoral junction when the patient performs a Valsalva maneuver.
Percussion Examine the patient's right leg to locate the greater saphenous vein.
The optimum position of the patient is facing the examiner with the leg externally rotated. The right index and third fingers are used to percuss the vein as it is felt behind the femoral condyle. The left index and third fingers are placed at the inferior aspect of Scarpa's triangle, attempting to reach the apex of the triangle eight to ten centimeters below the inguinal ligament. This is the junction of the medial border of the sartorius muscle with the lateral border of the abductor longus muscle. In examining the short saphenous vein, it is best to have the patient slightly flex the knee while keeping the heel on the ground.