Category Archives: Challenge Tests

Pneumatic cuff

The apparatus consist of Velcro cuffs with inbuilt air bags attached to a pneumatic pump by a long tube. The cuffs can be placed around the calf or foot depending on the venous segment under investigation. The inflation pressure is selected manually (usually 120 mmHg) and can be maintained until the deflation switch is activated… Read More »


This was named after Antonio Maria Valsalva from the 17th Century. This is a manoeuvre which increases the intra-abdominal pressure by straining against a closed glottis. It is a powerful stimulus of retrograde flow within the intra-abdominal and pelvic veins. This is in direct contrast to the other challenge tests which augment antegrade flow and… Read More »

Trendelenburg tests

This is the oldest of the challenge tests. It describes an elevation-dependency manoeuvre with the application of a tourniquet around the leg. Venous refilling (reflux) can be assessed visually by assessing the time taken for the varicosities to distend. In the classic test the leg is first elevated. An upper-thigh tourniquet is applied to occlude… Read More »

Wunstorf manoeuvre

This manoeuvre is performed standing with most of the subjects weight on the contralateral leg. The subject is requested to curl their toes and then relax on the command. This has the effect of raising the metatarsal heads and foot arch. This test causes activation of the foot muscle pump as well as the calf… Read More »