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