Palpation

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Palpation
Child examined by doctor.jpg
Palpation of a child's abdomen
MeSH D010173
MedlinePlus 002284

Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. [1] Usually performed by a health care practitioner, it is the process of feeling an object in or on the body to determine its size, shape, firmness, or location (for example, a veterinarian can feel the stomach of a pregnant animal to ensure good health and successful delivery).

Health care Prevention of disease and promotion of wellbeing

Health care or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals in allied health fields. Physicians and physician associates are a part of these health professionals. Dentistry, midwifery, nursing, medicine, optometry, audiology, pharmacy, psychology, occupational therapy, physical therapy and other health professions are all part of health care. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Contents

Palpation is an important part of the physical examination; the sense of touch is just as important in this examination as the sense of sight is. Physicians develop great skill in palpating problems below the surface of the body, becoming able to detect things that untrained persons would not. Mastery of anatomy and much practice are required to achieve a high level of skill. The concept of being able to detect or notice subtle tactile signs and to recognize their significance or implications is called appreciating them (just as in general vocabulary one can speak of appreciating the importance of something). Nonetheless, some things are not palpable, which is why additional medical tests, such as medical imaging and laboratory tests, are often needed to make a diagnosis. However, many other problems are palpable. Examples include pulses, abdominal distension, cardiac thrills, fremitus, and various hernias, joint dislocations, bone fractures, and tumors, among others.

Physical examination Process by which a medical professional investigates the body of a patient for signs of disease

A physical examination, medical examination, or clinical examination, is the process by which a medical practitioner examines the body of a patient for any possible signs or symptoms of a medical condition. It generally consists of a series of questions regarding patient medical history followed by an examination of the symptoms. Together, the medical history and the physical examination aids in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record.

Somatosensory system Widely distributed parts of the sensory nervous system

The somatosensory system is a part of the sensory nervous system. The somatosensory system is a complex system of sensory neurons and pathways that responds to changes at the surface or inside the body. The axons of sensory neurons connect with, or respond to, various receptor cells. These sensory receptor cells are activated by different stimuli such as heat and nociception, giving a functional name to the responding sensory neuron, such as a thermoreceptor which carries information about temperature changes. Other types include mechanoreceptors, chemoreceptors, and nociceptors which send signals along a sensory nerve to the spinal cord where they may be processed by other sensory neurons and then relayed to the brain for further processing. Sensory receptors are found all over the body including the skin, epithelial tissues, muscles, bones and joints, internal organs, and the cardiovascular system.

Visual perception is the ability to interpret the surrounding environment using light in the visible spectrum reflected by the objects in the environment. This is different from visual acuity, which refers to how clearly a person sees. A person can have problems with visual perceptual processing even if he/she has 20/20 vision.

Uses

Palpation is used by physicians, as well as chiropractors, massage therapists, physical therapists, osteopaths and occupational therapists, to assess the texture of a patient's tissue (such as swelling or muscle tone), to locate the spatial coordinates of particular anatomical landmarks (e.g., to assess range and quality of joint motion), and assess tenderness through tissue deformation (e.g. provoking pain with pressure or stretching). In summary, palpation might be used either to determine painful areas and to qualify pain felt by patients, or to locate three-dimensional coordinates of anatomical landmarks to quantify some aspects of the palpated subject.

Massage mechanical manipulation of skin, connective tissue and muscles through stretching, train and pressure stimulus

Massage is the manipulation of soft tissues in the body. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet, or a device. The purpose of massage is generally for the treatment of body stress or pain. A person who was professionally trained to give massages was traditionally known as a masseur (male) or a masseuse (female), but those titles are outmoded, and carry some negative connotations. In the United States, the title massage therapist has been recognized as a business norm for those who have been professionally trained to give massages.

An occupational therapist (OT) works with a client to help them achieve a fulfilled and satisfied state in life through the use of "purposeful activity or interventions designed to achieve occupational outcomes which promote health, prevent injury or disability to develop, improve, sustain or restore the highest possible level of independence."

Joint location at which two or more bones make contact

A joint or articulation is the connection made between bones in the body which link the skeletal system into a functional whole. They are constructed to allow for different degrees and types of movement. Some joints, such as the knee, elbow, and shoulder, are self-lubricating, almost frictionless, and are able to withstand compression and maintain heavy loads while still executing smooth and precise movements. Other joints such as sutures between the bones of the skull permit very little movement in order to protect the brain and the sense organs. The connection between a tooth and the jawbone is also called a joint, and is described as a fibrous joint known as a gomphosis. Joints are classified both structurally and functionally.

Palpation is typically used for thoracic and abdominal examinations, but can also be used to diagnose edema. Palpation is also a simple method of examining the pulse. It is used by veterinarians to check animals for pregnancy, and by midwives to determine the position of a fetus.

Edema abnormal accumulation of fluid in the interstitium

Edema, also spelled oedema or œdema, is an abnormal accumulation of fluid in the interstitium, located beneath the skin and in the cavities of the body, which can cause severe pain. Clinically, hyperaldosteronism, edema manifests as swelling. The amount of interstitial fluid is determined by the balance of fluid homeostasis and the increased secretion of fluid into the interstitium. The word is from Greek οἴδημα oídēma meaning "swelling". The condition is also known as dropsy.

Pregnancy time when children develop inside the mothers body before birth

Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy can occur by sexual intercourse or assisted reproductive technology. Childbirth typically occurs around 40 weeks from the last menstrual period (LMP). This is just over nine months, where each month averages 31 days. When measured from fertilization it is about 38 weeks. An embryo is the developing offspring during the first eight weeks following fertilization, after which, the term fetus is used until birth. Symptoms of early pregnancy may include missed periods, tender breasts, nausea and vomiting, hunger, and frequent urination. Pregnancy may be confirmed with a pregnancy test.

Midwifery health science and profession that deals with pregnancy, childbirth, and the postpartum period (including care of the newborn)

Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period, in addition to the sexual and reproductive health of women throughout their lives. In many countries, midwifery is a medical profession. A professional in midwifery is known as a midwife.

Quantitative palpation of anatomical landmarks for measurements must occur according to strict protocols if one wishes to achieve reproducible measurements. Palpation protocols are usually based on well-described definitions for the location of anatomical, usually skeletal, landmarks.

Locating anatomical landmarks

Locating anatomical landmarks can be performed using two palpation protocols: 1) manual palpation that allows the spatial location of landmarks using hands combined or not with three-dimensional (3D) digitizing, and 2) virtual palpation on 3D computer models obtained, for example, from medical imaging.

Manual palpation of skeletal landmarks (illustrated here on a patient's shoulder, see left image). The palpating hand locates the palpated landmarks with a satisfactory accuracy (below 1 cm). Reflective markers are part of the scientific protocol and allow further quantified motion analysis for joint disorders follow-up.
Virtual palpation of skeletal landmarks located on a 3D bone model (illustrated here on a patient's knee model obtained from medical imaging, see right image). Colored spheres on bones indicate palpated skeletal landmarks. This method combined with quantified manual palpation allows subject-specific visualization of joint behavior during particular motion tasks (e.g., walking, stair climbing, etc.).

The above protocols can be used independently. Manual palpation is used in clinical activities for various aims: - identification of painful areas; - positioning of particular pieces of equipment (electromyography electrodes, auscultation, external landmarks used in clinical motion analysis or body surface scanning); or - measurements of morphological parameters (e.g., limb length). Virtual palpation alone is useful to quantify individual morphological parameters from medical imaging: - limb length; - limb orientation; - joint angle; or - distance between various skeletal locations.

Electromyography

Electromyography (EMG) is an electrodiagnostic medicine technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph to produce a record called an electromyogram. An electromyograph detects the electric potential generated by muscle cells when these cells are electrically or neurologically activated. The signals can be analyzed to detect medical abnormalities, activation level, or recruitment order, or to analyze the biomechanics of human or animal movement.

Motion analysis is used in computer vision, image processing, high-speed photography and machine vision that studies methods and applications in which two or more consecutive images from an image sequences, e.g., produced by a video camera or high-speed camera, are processed to produce information based on the apparent motion in the images. In some applications, the camera is fixed relative to the scene and objects are moving around in the scene, in some applications the scene is more or less fixed and the camera is moving, and in some cases both the camera and the scene are moving.

Medical imaging technique and process of creating visual representations of the interior of a body

Medical imaging is the technique and process of creating visual representations of the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to reveal internal structures hidden by the skin and bones, as well as to diagnose and treat disease. Medical imaging also establishes a database of normal anatomy and physiology to make it possible to identify abnormalities. Although imaging of removed organs and tissues can be performed for medical reasons, such procedures are usually considered part of pathology instead of medical imaging.

Combining data from both manual and virtual palpation protocols allows achieving supplementary analysis: - registration protocols aiming at building reference frames for motion representation according reproducible clinical conventions; - to modelize joint kinematics accurately during musculoskeletal analysis; - to align precisely orthopedic tools according to the individual anatomy of a patient; or - to wrap and to scale surface textures to motion data when creating animation characters.

Use of standardized definitions for the above activities allows better result comparison and exchange; [2] this is a key element for patient follow-up or the elaboration of quality clinical and research databases. Such definitions also allow acceptable repeat ability by individuals with different backgrounds (physiotherapists, medical doctors, nurses, engineers, etc.). If applied strictly, these definitions allow better data exchange and result comparison thanks to standardization of the procedure. Without anatomical landmark standardization, palpation is prone to error and poorly reproducible.

Elastography

Conventional ultrasonography (lower image) and elastography (supersonic shear imaging; upper image) of papillary thyroid carcinoma, a malignant cancer. The cancer (red) is much stiffer than the healthy tissue. Thyroid SSI Szczepanek-Parulska et al. 2013 papillary thyroid carcinoma elastography.png
Conventional ultrasonography (lower image) and elastography (supersonic shear imaging; upper image) of papillary thyroid carcinoma, a malignant cancer. The cancer (red) is much stiffer than the healthy tissue.

Nowadays, the medical imaging modality of elastography can also be used to determine the stiffness of tissues. Manual palpation suffers from several important limitations: it is limited to tissues accessible to the physician's hand, it is distorted by any intervening tissue, and it is qualitative but not quantitative. Elastography is able to overcome many these challenges and improve on the benefits of palpation.

Elastography is a relatively new technology and entered the clinic primarily in the last decade. The most prominent techniques use ultrasound or magnetic resonance imaging (MRI) to make both the stiffness map and an anatomical image for comparison.

Computerized palpation

While not widespread amongst elastography methods, computerized palpation is of interest here because it essentially uses palpation to measure the stiffness, whereas other techniques will obtain data using other methods. Computerized palpation is also called "Tactile Imaging", "Mechanical imaging" or "Stress imaging", is a medical imaging modality that translates the sense of touch into a digital image. The tactile image is a function of P(x,y,z), where P is the pressure on soft tissue surface under applied deformation and x,y,z are coordinates where pressure P was measured. Tactile imaging closely mimics manual palpation, since the probe of the device with a pressure sensor array mounted on its face acts similar to human fingers during clinical examination, slightly deforming soft tissue by the probe and detecting resulting changes in the pressure pattern.

Palpation under general anesthesia

Palpation under general anesthesia is sometimes necessary, such as when there is a need to palpate structures deep in the abdominal or pelvic cavity, since it would otherwise cause considerable patient discomfort and subsequent contraction of the abdominal muscles which would make the examination difficult. [3] It is used, for example, in the staging of cervical cancer.

See also

Related Research Articles

Pathology study and diagnosis of disease

Pathology is the study of the causes and effects of disease or injury. The word pathology also refers to the study of disease in general, incorporating a wide range of bioscience research fields and medical practices. However, when used in the context of modern medical treatment, the term is often used in a more narrow fashion to refer to processes and tests which fall within the contemporary medical field of "general pathology," an area which includes a number of distinct but inter-related medical specialties that diagnose disease, mostly through analysis of tissue, cell, and body fluid samples. Idiomatically, "a pathology" may also refer to the predicted or actual progression of particular diseases, and the affix path is sometimes used to indicate a state of disease in cases of both physical ailment and psychological conditions. A physician practicing pathology is called a pathologist.

Medical ultrasound diagnostic imaging technique

Medical ultrasound is a diagnostic imaging technique based on the application of ultrasound. It is used to create an image of internal body structures such as tendons, muscles, joints, blood vessels, and internal organs. Its aim is often to find a source of a disease or to exclude pathology. The practice of examining pregnant women using ultrasound is called obstetric ultrasound, and was an early development and application of clinical ultrasonography.

Cytopathology

Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by George Nicolas Papanicolaou in 1928. Cytopathology is generally used on samples of free cells or tissue fragments, in contrast to histopathology, which studies whole tissues.

Compartment syndrome condition in which increased pressure within one of the bodys compartments results in insufficient blood supply to tissue within that space

Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the leg or arm are most commonly involved.

Elastography

Elastography is a medical imaging modality that maps the elastic properties and stiffness of soft tissue. The main idea is that whether the tissue is hard or soft will give diagnostic information about the presence or status of disease. For example, cancerous tumours will often be harder than the surrounding tissue, and diseased livers are stiffer than healthy ones.

Haptic technology Any form of interaction involving touch

Haptic technology, also known as kinesthetic communication or 3D touch, refers to any technology which can create a sense of touch by applying forces, vibrations, or motions to the user. This mechanical stimulation can be used to assist in the creation of virtual objects in a computer simulation, to control such virtual objects, and to enhance the remote control of machines and devices (telerobotics). Haptic devices may incorporate tactile sensors that measure forces exerted by the user on the interface. The word haptic, from the Greek: ἁπτικός (haptikos), means "pertaining to the sense of touch". Simple haptic devices are common in the form of game controllers, joysticks, and steering wheels.

Echocardiography sonogram of the heart

An echocardiogram, often referred to as a cardiac echo or simply an echo, is a sonogram of the heart. Echocardiography uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart.

Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists to treat musculoskeletal pain and disability; it most includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It's also used by occupational therapists, chiropractors, massage therapists, athletic trainers, osteopaths, and physicians

Percussion is a method of tapping on a surface to determine the underlying structures, and is used in clinical examinations to assess the condition of the thorax or abdomen. It is one of the five methods of clinical examination, together with inspection, palpation, auscultation, and inquiry. It is done with the middle finger of one hand tapping on the middle finger of the other hand using a wrist action. The nonstriking finger is placed firmly on the body over tissue. When percussing boney areas such as the clavicle, the pleximeter can be omitted and the bone is tapped directly such as when percussing an apical cavitary lung lesion typical of TB.

Myofascial trigger points, also known as trigger points, are described as hyperirritable spots in the skeletal muscle. They are associated with palpable nodules in taut bands of muscle fibers. They are a topic of ongoing controversy, as there is limited data to inform a scientific understanding of the phenomenon. Accordingly, a formal acceptance of myofascial "knots" as an identifiable source of pain is more common among bodyworkers, physical therapists, chiropractors, and osteopathic practitioners. Nonetheless, the concept of trigger points provides a framework which may be used to help address certain musculoskeletal pain.

Abdominal examination

An abdominal examination is a portion of the physical examination which a physician or nurse uses in order to interrogate the abdomen of a patient for signs of disease. The physical examination typically occurs after a thorough medical history is taken, that is after the physician asks the patient the course of their symptoms. The abdominal examination is conventionally split into four stages different stages: first, inspection of the patient and the visible characteristics of their abdomen. Auscultation of the abdomen with a stethoscope. percussion of the patient's abdomen and abdominal organs. Finally, palpation of the patient's abdomen. Depending on the need to test for specific diseases such as ascites, special tests may be performed as a part of the physical examination. An abdominal examination may be performed because the physician suspects a disease of the organs inside the abdominal cavity, or simply as a part of a complete physical examination for other conditions. In a complete physical examination, the abdominal exam classically follows the respiratory examination and cardiovascular examination.

In medicine, physiotherapy, chiropractic, and osteopathy the hip examination, or hip exam, is undertaken when a patient has a complaint of hip pain and/or signs and/or symptoms suggestive of hip joint pathology. It is a physical examination maneuver.

In health care, a simulated patient (SP), also known as a standardized patient, sample patient, or patient instructor, is an individual trained to act as a real patient in order to simulate a set of symptoms or problems. Simulated patients have been successfully utilized for education, evaluation of health care professionals, basic, applied and translational medical research.

The cardiovascular examination is a portion of the physical examination that involves evaluation of the cardiovascular system. The exact contents of the examination will vary depending on the presenting complaint but a complete examination will involve the heart, lungs, belly and the blood vessels.

Computed tomography of the abdomen and pelvis

Computed tomography of the abdomen and pelvis is an application of computed tomography (CT) and is a sensitive method for diagnosis of abdominal diseases. It is used frequently to determine stage of cancer and to follow progress. It is also a useful test to investigate acute abdominal pain. Renal stones, appendicitis, pancreatitis, diverticulitis, abdominal aortic aneurysm, and bowel obstruction are conditions that are readily diagnosed and assessed with CT. CT is also the first line for detecting solid organ injury after trauma.

Medial knee injuries

Medial knee injuries are those to the medial side – the inside of the knee – are the most common. The medial ligament complex of the knee is composed of the superficial medial collateral ligament (sMCL), deep medial collateral ligament (dMCL), and the posterior oblique ligament (POL). These ligaments have also been called the medial collateral ligament (MCL), tibial collateral ligament, mid-third capsular ligament, and oblique fibers of the sMCL, respectively. This complex is the major stabilizer of the medial knee. Injuries to the medial side of the knee are most commonly isolated to these ligaments. A thorough understanding of the anatomy and function of the medial knee structures, along with a detailed history and physical exam, are imperative to diagnosing and treating these injuries.

A well woman examination is an exam offered to women to review elements of their reproductive health. It is recommended once a year for most women. The exam includes a breast examination, a pelvic examination and a pap smear but may also include other procedures. Hospitals employ strict policies relating to the provision of consent by the patient, the availability of chaperones at the examination, and the absence of other parties.

Non-invasive procedure

A medical procedure is defined as non-invasive when no break in the skin is created and there is no contact with the mucosa, or skin break, or internal body cavity beyond a natural or artificial body orifice. For example, deep palpation and percussion are non-invasive but a rectal examination is invasive. Likewise, examination of the ear-drum or inside the nose or a wound dressing change all fall outside the definition of non-invasive procedure. There are many non-invasive procedures, ranging from simple observation, to specialised forms of surgery, such as radiosurgery. Extracorporeal shock wave lithotripsy is a non-invasive treatment of stones in the kidney,gallbladder or liver, using an acoustic pulse. For centuries, physicians have employed many simple non-invasive methods based on physical parameters in order to assess body function in health and disease, such as pulse-taking, the auscultation of heart sounds and lung sounds, temperature examination, respiratory examination, peripheral vascular examination, oral examination, abdominal examination, external percussion and palpation, blood pressure measurement, change in body volumes, audiometry, eye examination, and many others.

X-ray motion analysis is a technique used to track the movement of objects using X-rays. This is done by placing the subject to be imaged in the center of the X-ray beam and recording the motion using an image intensifier and a high-speed camera, allowing for high quality videos sampled many times per second. Depending on the settings of the X-rays, this technique can visualize specific structures in an object, such as bones or cartilage. X-ray motion analysis can be used to perform gait analysis, analyze joint movement, or record the motion of bones obscured by soft tissue. The ability to measure skeletal motions is a key aspect to one's understanding of vertebrate biomechanics, energetics, and motor control.

References

  1. "the definition of palpation". Dictionary.com. Retrieved 10 April 2018.
  2. Van Sint Jan S, Della Croce U 2005 Identifying the location of human skeletal landmarks: why standardized definitions are necessary – a proposal. Clinical Bio mechanics 20:659-660.
  3. Pelvic examination under anesthesia at Uptodate. Author: William J Mann, Jr, MD. This topic last updated: Oct 8, 2012.