{"id":1774,"date":"2010-12-19T09:20:17","date_gmt":"2010-12-19T09:20:17","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/palpation-11\/"},"modified":"2023-07-25T16:38:14","modified_gmt":"2023-07-25T15:38:14","slug":"palpation-11","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-lower-extremities\/principles-of-the-examination\/palpation-11\/","title":{"rendered":"Palpation"},"content":{"rendered":"\n<p>Palpation should be performed <strong>after<\/strong> the inspection, the active and passive movement examination and the muscle tests. This sequence causes less inconvenience to the patient (pain provocation comes at a later stage of the examination). <\/p>\n\n\n\n<p>In the event of an <strong>abnormal<\/strong> finding, compare left and right. Palpation can be used to obtain <strong>specific<\/strong> additional information. <\/p>\n\n\n\n<p>The conditions for reaching the correct findings are the same as those stated for the inspection. An additional aspect is that the examiner must have <strong>clean<\/strong> and <strong>warm<\/strong> hands with fingernails <strong>cut short<\/strong>. Both the examiner and the patient should adopt a comfortable position for the examination. Usually an effort is made to ensure <strong>maximum muscle relaxation<\/strong> in the patient, although sometimes it is useful to palpate both <span style=\"text-decoration: underline;\">tensed<\/span> and <span style=\"text-decoration: underline;\">relaxed<\/span> muscles (<em>e.g. to differentiate between a muscle hernia and a lipoma<\/em>). In many cases, the pain experienced makes it impossible for the patient to relax completely.<\/p>\n\n\n\n<p>The following qualities can be investigated by means of palpation:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Skin temperature (<em>preferably using the back of the hand<\/em>).<\/li>\n\n\n\n<li>Humidity of the skin.<\/li>\n\n\n\n<li>Structure and elasticity of the skin.<\/li>\n\n\n\n<li>The characteristics of any swelling\/tumour (<em>perimeters, shape, surface, size, mobility<\/em>). Sometimes it is useful, especially if it is not clear whether there is a lipoma or a (<em>muscle<\/em>) hernia, to have the patient tense the group of muscles. A lipoma will remain fairly <strong>mobile<\/strong>, whereas a hernia will <strong>harden<\/strong>. Also, tensing the muscles often makes the location of <em>tendons<\/em> and <em>intramuscular<\/em>\/<em>intermuscular<\/em> <em>septa<\/em> <span style=\"text-decoration: underline;\">clearer<\/span>.<\/li>\n\n\n\n<li>Location of tissues (<em>muscle tissue, tendon tissue, nerve tissue, bone tissue, cartilage tissue, ligaments, blood vessels<\/em>) and the nature of these tissues (<em>tone of a muscle<\/em>). Bone tissue feels hard and cannot be impressed. How a muscle feels varies with the degree of <span style=\"text-decoration: underline;\">stretch<\/span> and <span style=\"text-decoration: underline;\">contraction<\/span> and is dependent on the stiffness of the <strong>fascia<\/strong>. Muscle tension is palpated by placing the fingertips transversely over the course of the fibres. Herniations (<em>consequence of fascia defects<\/em>) and dimples\/pits (<em>consequence of a muscle rupture<\/em>) can be detected by placing the tips of the palpating fingers along the longitudinal axis of the muscle.<\/li>\n\n\n\n<li>Location of pain. In the case of (<em>suspected<\/em>) inflammatory processes and acute traumas, the point where the pain is <strong>most intensely<\/strong> experienced precisely indicates the location of the process. However, the examiner should be aware that in the case of <em>diffuse pain patterns<\/em> or more <em>chronic problems<\/em>; palpation sometimes yields misleading information (<em>referred pain<\/em>).<\/li>\n\n\n\n<li>Pain upon axial compression. If a <strong>fracture<\/strong> is suspected, it is important to ascertain whether pushing along the long axis of the structure concerned (<em>performed by the examiner<\/em>) elicits pain at the location where the fracture is suspected. If so, a fracture is <em>likely<\/em>. In practice, if there is a clear suspicion of a fracture based on the history-taking, pain upon axial pressure is often determined before the basic function examination to avoid performing any <em>further aggravating examinations<\/em>.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Palpation should be performed after the inspection, the active and passive movement examination and the muscle tests. This sequence causes less inconvenience to the patient (pain provocation comes at a later stage of the examination). In the event of an abnormal finding, compare left and right. Palpation can be used to obtain specific additional information. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[61],"tags":[144],"class_list":["post-1774","post","type-post","status-publish","format-standard","hentry","category-principles-of-the-examination","tag-the-examination-of-the-lower-extremities"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Palpation - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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