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Thrill

Exams and Signs

Historical Overview

  • Patients experience thrills, or palpable vibratory sensations, over a vessel in which a bruit is heard. The word bruit derives from the French braire, to bray or roar; it refers to sounds heard from blood vessels.1

Description

  • It is vital to check for a thrill if a bruit is characterized by longer duration or changed pitch; this may indicate a progression of stenosis.

Pathophysiology

  • Thrills are often caused by vaso-occlusive disease or upper extremity arterial aneurysm.
  • Underlying conditions such as diabetes mellitus, lupus, peripheral vascular disease (PVD), sickle cell anemia and cardiac arrhythmias can have a significant influence on upper extremity hemodynamics.2
  • Thrills can also be associated with atherosclerosis, which may result in the progression of osteoarthritis (OA).3

Instructions

  1. Record the patient’s history, including the presence of comorbid diabetes, lupus, PVD, sickle cell anemia, cardiac arrhythmias and/or OA.
  2. In a quiet room, listen for a bruit in the affected hand.
  3. Palpate at the origin of the bruit to check for a thrill.1
  4. Observe for swelling, discoloration and/or pain in the fingers.4
  5. Examine the contralateral hand for comparison.

Variations

  • Use laboratory studies, including a complete blood count (CBC), erythrocyte sedimentation rate (ESR) and C-reactive protein, to check for an underlying autoimmune disease.2

Related Signs and Tests

  • Doppler exam
  • Radiographs

Diagnostic Performance Characteristics

  • To verify the diagnosis, a Doppler exam may be helpful. However, Doppler studies are susceptible to error, especially in atherosclerotic vessels.4

Additional Information

Presentation Photos and Related Diagrams
Palpation for Thrill
  • Examiner palpating the thrill of a ulnar artery aneurysm (arrow).
    Examiner palpating the thrill of a ulnar artery aneurysm (arrow).
Definition of Positive Result
  • A positive result occurs when there is a palpable thrill over the vessel in which a bruit is heard.
Definition of Negative Result
  • A negative result occurs when there is no palpable thrill over the vessel in which a bruit is heard.
Comments and Pearls
  • Cessation of smoking, if applicable, would be the first step towards treatment of vaso-occlusive disease or Raynaud’s disease.2
  • Operative treatment, such as sympathectomy, may be needed for severe Raynaud’s disease.2
  • Patients with hand OA should be checked for atherosclerosis, to help avert coronary artery disease.3
Diagnoses Associated with Exams and Signs
References
  1. Loscalzo J, Creager MA, Dzau VJ eds. Vascular Medicine. Boston: Little, Brown and Company, 1996.
  2. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  3. Cemeroglu O, Aydin HI, Yasar ZS, et al. Hand and heart, hand in hand: is radiological hand osteoarthritis associated with atherosclerosis? Int J Rheum Dis 2014;17(3):299-303. PMID: 24330251
  4. Rayan G, Akelman E. The Hand: Anatomy, Examination, and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012.
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