A stethoscope is placed over the brachial artery, below the cuff. When the cuff is inflated above the systolic pressure, the artery is completely occluded and there is no blood flow through the artery. The cuff is slowly released at 2-3 mm Hg/s and the observer listens for the sounds.

When the cuff pressure within the bladder of the cuff reaches systolic pressure, there is partial opening of the artery and blood flow with each pulse. This event is accompanied by the appearance of a characteristic sound. As the deflation of the cuff continues, there is greater opening of the artery until the artery remains open throughout the cardiac cycle. This results in a change in the quality of the sounds.

These sounds were first described by Nicolai Korotkoff in 1905. Depending on the intensity and quality of the sounds, five phases have been described.