The role of palpation in medicine.


Palpation is the process of using a hand or fingers to locate a disease or injury in the body or at the site of pain. Doctors use it to determine the size, shape, density, or location of an abnormality that indicates disease.

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This could include:

  • Feel the texture of the skin for swelling or inflammation.
  • Assessment of the location and severity of pain.
  • Exam for lumps or irregularities that indicate a tumor, hernia , or fracture.
  • Determination of anatomical landmarks to detect structural abnormalities such as joint dislocation or disc displacement.
  • Determine the position of the fetus during pregnancy.

Palpation is generally used to examine the abdomen or chest (thorax), but can be applied to any part of the body, including the mouth, vagina, and anus. By the strictest definition, measuring a person's pulse can be considered a form of palpation.

Types of palpation

The sense of touch is as important as sight on a physical exam. As part of their training, practitioners learn to recognize problems on or below the surface of the skin just by touch. They do this by applying general pressure with the hand or fingers to detect subtle changes that might otherwise go unnoticed by the layman.

The methods used for palpation may vary depending on the part of the body being examined, as well as the purpose of the examination (for example, screening or diagnosis). Only some of the examples are shown below.

Palpation of the thorax

Chest palpation is commonly used to diagnose problems with the chest or spine. It involves touching the superficial and deep tissues to assess the position of the vertebra, edema (tumor) or lymphadenopathy (swollen lymph nodes) or any lumps on the ribs, sternum, or spine .

Palpation can be performed sitting, supine (face up) or face down (face down).

Palpation also helps to evaluate the work of the heart. The location, size, and strength of the heart pulse on the chest wall can help determine if the heart is functioning normally, and abnormal vibrations can indicate the presence of a heart murmur.

Palpation of the abdomen

Deep palpation of the abdomen is performed by placing the palm of the hand against the abdominal wall and applying firm and constant pressure. Two-handed palpation : in which the upper hand is used to apply pressure and the lower hand to feel. – it is usually useful to evaluate the abdominal mass.

Palpation can even help diagnose an abdominal aortic aneurysm . To do this, place both hands on your stomach, index fingers on either side of the aorta (located just above and to the right of the navel). If there is an abdominal aortic aneurysm, the fingers separate with each beat of the heart.

By palpating the abdomen, doctors monitor not only pain or lump formation, but also other important features that can be felt with the fingers. Some of these include:

  • Stiffness: Stiffness is an involuntary contraction of the abdominal muscles that makes the muscles feel hard or rigid. This often indicates a serious problem such as peritonitis.
  • Protection: Unlike rigidity, protection is the voluntary contraction of the abdominal muscles by the patient who fears that palpation will be painful.
  • Rebound pain – an extremely important result (Blumberg's sign) when examining the abdominal cavity is detected not during palpation of the abdomen, but after its completion. When evaluating rebound sensitivity, the doctor feels the abdomen deeply and then abruptly releases the pressure. A significant increase in pain in a patient often indicates an acute abdominal process, such as appendicitis.

Palpation of the uterus

Another two-handed procedure is the bimanual examination of the pelvic organs, also known as manual uterus palpation. It consists of squeezing the lower part of the abdomen with one hand and feeling the tissues inside the vagina with the fingers of the other hand.

Palpation of the breast

Palpation of the breast is done with flat palms and fingers. The procedure is systematic and includes a clockwise examination of the breasts and nipples to check for consistency and lump formation. The nipples are palpated for elasticity and gently squeezed for discharge.

Hernia palpation

Palpation is part of the process involved in the diagnosis and characterization of an inguinal hernia (type located in the lower abdomen or groin). The size of the hernia can be estimated by asking the patient if they are coughing, as the flat surfaces of the fingers are placed against the raised tissue. The back of the hand will be used to assess the temperature of the skin compared to the surrounding tissue.

Palpation of the hand and wrist.

Injuries to the hand or wrist are usually diagnosed by palpation . Palpation may involve slight rotation of the joint, as the fingers show subtle signs such as crepitus (crackling sounds and sensations), decreased range of motion, or increased heat and swelling, indicating inflammation.

Similar techniques can be applied to other joints such as the knee, ankle, elbow, or shoulder.

Dental palpation

Palpation can be used in dentistry to identify inflammatory conditions such as periodontitis , causes of malocclusion (dental occlusion), or the development of a dental abscess or oral lesion . This is usually done with a fingertip, looking for changes in the texture, color, temperature, or consistency of the gum.

In addition to intraoral examination, palpation of the jaw muscles can be used to detect clicks or irregularities in the bite. This is usually done by pressing the muscles of the jaw with the fingers of both hands during the bite of the person.

The same method can be used to diagnose diseases of the temporomandibular joint (TMJ) .

Palpation on physical examination

A physical exam, along with your medical history, is often the first step a doctor takes when diagnosing a medical condition or conducting a routine physical exam.

The physical exam has four main components. They are not necessarily used on all parts of the body, but generally include:

  • Inspection , visual inspection of the body.
  • Palpation , touching the body.
  • Percussion , tapping the body to assess the size and consistency of an organ or to check for fluid.
  • Auscultation , listening for heart and bowel sounds with a stethoscope
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