Swelling is an abnormal enlargement of an area of the body. The possible cause of swelling is collection of body fluid in the tissues. It is actually body’s reaction to an injury. A swelling may contains blood, pus and acute inflammatory cells. While examining a swelling, one should look for the following signs.
- Look for site, size, shape, and surface of the swelling.
- Examine the state of artery, bone, joint and nerve near the swelling. Means the keen examination that whether the related artery is passing behind, beneath or besides the swelling. Whether the swelling is on the bone, joint, or nerve.
- Examine the color. It may be reddish, bluish, pale etc depending on the fluid (blood, pus) in the swelling.
- Check the consistency of the swelling. It means that check the softness, firmness, and hardness of the swelling.
- Swelling with inflammatory process is usually hot. While non inflammatory swellings are cold, so check the temperature of the swelling.
- Check whether the swelling is tender or non tender.
- Transillumination test to check the color of the swelling. Also to check the nature of the fluid in the swelling, whether it is viscous, pus containing or thin fluid.
- Examine the edge of the swelling. Swelling with well-demarcated edges are usually benign, while those with ill-demarcated edges may be malignant.
- Fluctuate the swelling from the edges in order to move the fluid into center and then press the mid of the swelling.
- Examine the swelling whether it reduce with different actions or not, so that the swelling will not misdiagnose with other structures i.e hernia.
- Check the lymph nodes in the surrounding of the swelling to see whether they are inflamed or not. For example, if swelling is on the chest then look for the axillary and cervical lymph nodes inflammation.
- Check the pulsibility of the swelling. Means examination of nervo-vascular status. If pulse is palpable beyond the swelling, it means that the vessels are intact yet.
- If the swelling itself is pulsatile, then probably there is a vascular problem. i.e aneurysm, vascular tumors etc.
- Examine the plane of the swelling that whether it is in skin, sub-cutaneous tissue, muscle, above or below the deep fascia etc.
- check whether the swelling is mobile or immobile.
MNEMONIC for examination of swelling:
S5 T3 C2 R2
Site, size, shape, surface, state of artery bone joint and nerve.
Temperature, tenderness, transillumination.
Reducibility, relative lymph nodes.