Radial Pulse Examination

The radial Pulse is palpated just proximal to the thumb on the palmar side of the radial aspect of the wrist, it is used to determine the frequency, quality, and rhythm of the pulse.

How to find Radial Pulse Location?

Radial pulse location is found as following:

• With the patient in seated position. Turn the hand over so that the palm-side up.
• Put your index and middle finger tip on the palmer side of lateral part of the distal forearm, just proximal to the thumb and above the styloid process of the radius.
• When you locate the radial pulse, count the number of pulses in a 15-second interval and multiply that number by 4 to determine the number of beats per minute.
• Also attempts to determine the quality of the pulse: strong (bounding) or weak.

See Also: Capillary Refill Test

Heart rate outside of expected values or values that deviate from any baseline values Bounding or irregular pulse.

Normal radial pulse rate is between 60-90 per minute, which reflects the normal heart rate.

The quality and quantity of the heart rate established:

1. Normal (general population): 60–100 bpm,
2. Well-trained athletes: 40–60 bpm,
3. Tachycardia: Greater than 100 bpm,
4. Bradycardia: Less than 60 bpm.

The baseline heart rate should be recorded and rechecked at regular intervals. Note the rhythm of the beats for symmetry and strength.

Radial Artery Anatomy

The course of the radial artery in the forearm is represented by a line joining the midpoint of the cubital fossa to a point just medial to the radial styloid process. The radial artery leaves the forearm by winding around the lateral aspect of the wrist and crosses the floor of the anatomical snuff box.

See Also: Allen Test

Notes

The heart rate is determined by palpating the carotid, radial, femoral, or brachial pulse. An athlete’s resting heart rate typically ranges from 60 to 100 beats per minute (bpm). Highly conditioned athletes have lower heart rates. Older or recreational athletes have heart rates at the higher end of the scale.

When assessing the heart rate of an athlete who has just stopped exercising, an increased heart rate caused by the demands of exercise should be considered.

Palpable pulses should have:

1. a consistent rhythm with a smooth,
2. quick upstroke,
3. consistent summit,
4. a gradual downstroke.

An abnormal rate or irregular rhythm could be indicative of an arrhythmia, stimulant use, or anxiety. A rapidly rising, large-amplitude pulse (water-hammer pulse) suggests hypertrophic cardiomyopathy, or aortic or mitral valve regurgitation; a slowly rising, small-amplitude pulse suggests aortic stenosis or heart failure.

Simultaneous palpation of the radial pulse and femoral pulse can identify narrowing (coarctation) of the aorta. A delay of the femoral pulse relative to the radial pulse warrants further cardiovascular examination.

References

1. Giese EA, O’Connor FG, Brennan FH, Depenbrock PJ, Oriscello RG. The athletic preparticipation evaluation: cardiovascular assessment. Am Fam Physician. 2007 Apr 1;75(7):1008-14. PMID: 17427614.
2. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.