Osler Sign/Maneuver

Osler sign/maneuver

Thickened vessel wall causing Osler's sign and pseudo hypertension
Thickened vessel wall causing Osler’s sign and pseudo hypertension

Radial artery palpable even after occluding the brachial artery by local pressure, often noted in elderly with thickened vessel wall is taken as a positive Osler sign. Alternatively three fingers can used over the radial artery. Proximal and distal fingers are used to occlude the flow from radial artery and the retrograde flow from the ulnar artery through the palmar arch. Middle finger is used to assess the thickening of the radial artery vessel wall. This method is also known a trisection.

Thickened vessel wall indicates a chance for pseudohypertension due to difficulty in compressing the vessel with an externally applied blood pressure cuff. Intra arterial pressure recording will be normal in pseudohypertension, which is more common in elderly. Pseudohypertension should be suspected if patient develops giddiness after starting antihypertensive medication or following dose escalation [1]. Though intra arterial recording is the ideal way to confirm it, presence of Osler’s sign will give a hint. Moreover there will no evidence of target organ damage like changes in the optic fundi, left ventricular hypertrophy – both clinically and electrocardiographically.

Reference

  1. Milind M Patil, Sadishkumar Kamalanathan, Jaya Prakash Sahoo, Muthupillai Vivekanandan. Pseudo Hypertension: Clue From Osler Sign. J Family Med Prim Care
    . Jul-Sep 2016;5(3):743.