Palpation

Procedure

• The patient sits at a table or examination table with the lower arms and palms placed on the surface.
• Sit down opposite the patient.
• Palpate using the fingertips.
• Ask the patient to indicate precisely where and when it is painful. In the case of abnormal findings, compare left and right.
• Note:
  • Any swelling and its characteristics.
  • The muscle tone (fingers transverse to the direction of the muscle fibres).
  • Abnormal mobility.
  • Abnormal structures.
  • Discontinuity.
• The following bones and joints are accessible for palpation:
  • Distal part of the radius (fracture, epiphysiolysis)
  • Styloid process of the radius (brachioradialis tendon attachment)
  • Distal part of the ulna (rheumatoid arthritis)
  • Distal radioulnar joint
  • Wrist joints (particularly the radiocarpal joint) (distortion) [Figure 130]
  Figure 130
  • Scaphoid bone = navicular bone (dorsally in the anatomical snuff box,
    on the palm this is at the tubercle of the scaphoid bone)
    fracture, pseudoarthritis [Figure 131] 
  Figure 131
  • 1st carpometacarpal joint (osteoarthritis)
  • Lunate bone (lunatomalacia or Kienbock’s disease) [Figure 132] 
  Figure 132
  • Capitate bone (fracture) [Figure 133] 
  Figure 133
  • Pisiform bone (fracture) [Figure 134] 
  Figure 134
  • Hamate bone (fracture) [Figure 135] 
  Figure 135
  • Metacarpal bones I through to V (fractures)
  • Metacarpophalangeal joints I through to V (dislocation, rheumatoid arthritis)
  • Phalanges (fractures)
  • Proximal and distal interphalangeal joints II through to V (rheumatoid arthritis, osteoarthritis,  dislocation)
  • 1st interphalangeal joint (dislocation)

    NB. When a fracture is suspected, it is important to determine the presence of pain upon axial pressure.

    Grip: With one hand proximally fix the structure that is to be examined and with the other hand on the distal side gently push the structure in question in the direction of its longitudinal axis.  If the patient indicates pain at the examined location, the axial pressure pain test is positive. [Figure 136] shows the grip for a suspected fracture of the 3rd metacarpal bone and/or the lunate bone and/or the capitate bone.

  Figure 136
  The following soft tissues are accessible for palpation:
• Skin (Raynaud’s syndrome, scleroderma)
• Muscles: In principle, most of the muscles mentioned in the previous paragraph are accessible for palpation.
• Tendons and tendon sheaths:
  • Of the flexors: At the palm, wrist and the distal lower arm (rupture, agenesesis, phlegmon, trigger finger, rheumatoid arthritis).
  • Palmar fascia: At the palm (Dupuytren’s contracture).
  • Of the extensors: At the back of the hand (extensor carpi radialis longus and brevis muscles, extensor digitorum muscle), fingers (extensor digitorum muscle) and thumb (extensor pollicis longus and brevis muscles, abductor pollicis longus muscle) (De Quervain’s syndrome, rheumatoid arthritis).