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PubMed1986

Reproducibility of a palpation test for the stomatognathic system.

Disadvantages of Helkimo's Clinical Dysfunction Index have led to the introduction of a palpation test of 20 sites for grading the severity of dysfunction of the stomatognathic system. The reproducibility of this palpation test was studied using two experienced dentists and two first grade dental students to examine the subjects. Measurements of maximal mouth opening were carried out for comparison. The intra- and interexaminer reproducibility was found to be satisfactory for both the dentists and the students, showing that for this test good training is as important as clinical experience. The palpation test has the advantage that it is fast (60 s) and is an interval scale, which is especially important for epidemiologic and correlational studies.

Adolescent↗

PubMed1987

Tuberculin reaction size measurement by the pen method compared to traditional palpation.

A prospective, double blind study was conducted to determine the degree of concordance of pen and palpation methods of measuring skin induration to Mantoux tuberculin tests. One hundred thirty-five skin tests were performed in patients with previously bacteriologically proved tuberculous disease. An experienced reader who was only able to see the forearm of the patient measured the induration by the palpation technique. The measurement was then repeated by the pen method under the same conditions, on the same day. Results of the study indicated that the pen method yielded statistically the same frequency distribution of indurations as the palpation method and the pen method appeared to be more sensitive.

Double-Blind Method↗

PubMed1991

Palpation vs pen method for the measurement of skin tuberculin reaction (Mantoux test).

In order to test the degree of concordance between ballpoint pen and palpation methods of measuring the skin induration after a Mantoux tuberculin test, we conducted a prospective, double-blind study. We performed a Mantoux skin test in 1,340 healthy subjects, aged 18 to 25 years, using the tuberculin PPD-RT 23, dose 2 IU, (1/5,000), of the Pasteur Institute, equivalent to 5 TU PPD-S. The same experienced reader, who was able to see only the site of the test (forearm), measured the induration after 48 hours by the palpation method, initially, and by the pen method later the same day, without knowing the identity of the examined person. Results of the study did not show any significant difference in any range of the measurements (p greater than 0.1) by the two methods. We conclude that the pen method is as reliable as the traditional palpation method. The sensitivity and the specificity of the two methods are comparable. Even though our study was not designed to investigate the effects with an inexperienced examiner, given the simplicity of the pen method, it could be the method of choice, especially for less experienced examiners.

Adolescent↗

PubMed2006

A new model to facilitate palpation of the level of the transverse processes of the thoracic spine.

STUDY DESIGN: Nonexperimental, normative research design. OBJECTIVES: To test a proposed model to locate the level of the transverse processes (TPs) of the thoracic spine through surface palpation. BACKGROUND: Palpation of the TPs of the thoracic spine is challenging because of their depth relative to the more superficial structures of the spine. Many clinicians use the more superficial spinous processes (SPs) of the thoracic spine to orient themselves for palpation of the TPs. In 1979, Mitchell described a "rule of threes," which attempted to predict the location of the level of the thoracic TPs relative to their corresponding SPs. We previously conducted a pilot study to investigate the validity of the rule of threes and concluded that it is not an accurate predictor of the level of the location of the TPs of the thoracic spine. Based on that previous work, we hypothesized that a more accurate model for predicting the level of the TPs would be that they are generally at the level of the SP of the adjacent cranial thoracic vertebra throughout the thoracic spine. METHODS AND MEASURES: We dissected 15 cadavers and measured the vertical distance between the transverse (horizontal) plane of the TPs of 1 vertebra and the SP of the adjacent cranial thoracic vertebra for all levels of the thoracic spine. RESULTS: Mean vertical distances ranged from 2.0 to 4.0 mm. The means for all thoracic vertebral levels except for T11 and T12 were significantly less than the normal 6-mm threshold of 2-point discrimination of the fingertips (P<.01). CONCLUSION: The results of this study indicate that the TPs of each thoracic vertebra are generally at the level of the SP of the vertebra 1 level above, throughout the thoracic spine. It may be more difficult to predict the location of the TPs of the 2 most caudal levels (T11 and T12), given their greater variability of position.

Aged↗

PubMed1995

Are tender point scores assessed by manual palpation in fibromyalgia reliable? An investigation into the variance of tender point scores.

To determine the reliability of tender point assessment by manual palpation in patients with fibromyalgia, and to investigate the sources of variance, tender point scores by manual palpation were obtained in 30 fibromyalgia patients by 2 investigators; the assessments were repeated after 1 week. Test-retest stability and inter-observer agreement of tender point scores was moderate to high. The most important sources of variance were inter-individual patient differences in (1) mean tenderness (pain thresholds) and (2) tender point profiles (consistent intra-individual differences between the 14 tender point scores), and (3) residual variance, not attributable to any systematic effect (error). It is concluded that the reliability of tender point assessment by manual palpation is acceptable. It seems to be not less than reliability of assessment by pressure algometer. Tender point scores in fibromyalgia reflect individual differences in mean pain thresholds as well as individual tender point profiles.

Adult↗

PubMed2000

Relevance of carcass palpation in lambs to protecting public health.

We recently reviewed the Food Safety and Inspection Service's (FSIS's) inspection procedures for lambs. As a result, FSIS published a Federal Register notice informing the public of its intent to change from an inspection system that requires extensive carcass palpation to an inspection system that requires no carcass palpation for lambs. This decision was based on the following three points. (i) Extensive carcass palpation in lambs does not routinely aid in the detection of food safety hazards that result in meat-borne illnesses. (ii) Hands are capable of spreading or adding contamination to the carcasses. (iii) FSIS inspection systems must reflect science-based decisions as they pertain to meat-borne illnesses consistent with a Pathogen Reduction/Hazard Analysis and Critical Control Point environment.

Animals↗

PubMed2004

Technical observations on the assessment of thyroid volume by palpation and ultrasonography.

OBJECTIVE: The diagnosis of increased thyroid volume, in field studies of goiter prevalence, has been based on inspection and palpation of the thyroid. Because clinical examination, compared with ultrasonography, has a low positive predictive value for the presence of a goiter, it overestimates goiter prevalence. It also has the problem of marked interobserver variability. This led to the use of ultrasonographic scanners in field studies. The problem with the latter is the cost and skill required for the complicated linear measures and their translation to lobe volume and then thyroid volume. We studied patients to determine whether this complicated assessment could be simplified. METHODS: We studied palpation in 31 patients with thyroid disease in whom individual ultrasonographic linear dimensions were also obtained in their 62 thyroid lobes to determine their relationship to thyroid lobe volume. RESULTS: Palpation revealed poor discrimination of smaller thyroid sizes as determined by ultrasonography. Stepwise linear regression (backward selection) revealed that of the 3 thyroid dimensions, only the lateromedial dimension of the thyroid lobe had a significant correlation to lobe volume, accounting for 82.5% of the variability in lobe volume. The lobe volume (in milliliters) is given by the lobe lateromedial dimension (in centimeters) multiplied by 13 minus a constant of 15. CONCLUSIONS: A simple linear ultrasonographic measurement of the thyroid lateromedial dimension, which can be done with little training, is as good as more complicated measures of thyroid volume estimation by ultrasonography and is an ideal method for identifying goiters in field surveys.

Adult↗

PubMed1999

[Value of clinically established MRI procedures concerning the pretherapeutic evaluation of maximal tumor diameter in primary or recurrent cervix cancer in relation to palpation findings and histopathologic whole mount specimens].

OBJECTIVE: The maximal tumor diameter of cervical cancer is one of the most important prognosis factors concerning patients' survival. The purpose of this study was to investigate the efficiency of different MRI-procedures in relation to clinical palpation concerning pretherapeutic tumor diameter assessment. MATERIAL AND METHODS: Thirty-one patients with biopsy proven primary cervical cancer and its recurrence (n = 10), respectively, underwent dynamic and conventional MRI before further treatment. The results of maximal tumor diameters were compared to palpatory findings and then correlated to the whole mount specimen as gold standard. RESULTS: The contrast-enhanced dynamic and T2-weighted MRI allows a significantly better (p < 0.05) assessment of maximal tumor diameter of cervical cancer than the conventional T1-weighted MRI. The T2-weighted MRI showed the highest correlation (r = 0.83) in respect to the whole mount specimen up to FIGO-IIB disease. The contrast-enhanced dynamic MRI and the palpation were characterized by the highest correlation coefficients of r = 0.77, r = 0.70 respectively, in advanced cervical cancer > FIGO-IIB disease. CONCLUSIONS: The MRI procedures offer no evident advantage in relation to clinical palpation to determine the maximal tumor diameter of cervical cancer or its recurrency and seems not to be indicated generally.

Adult↗

PubMed1998

[Cervical lymph node metastasis: CT, ultrasound versus physical palpation].

OBJECTIVE: To evaluate the accuracy of CT, ultrasonography and manual palpation in the diagnosis of cervical lymph node metastasis and to identify the value of CT and ultrasound in the diagnosis of occult cervical lymph node metastasis. METHODS: Sixty patients (74 sides) were studied double-blindedly by CT and ultrasonography prior to cervical lymphadenectomy, and the results were correlated with histo-pathologic findings. RESULTS: According to histologic examination of the dissected specimens, in 56 of 74 sides there were cervical lymph node metastases, 46 of the 56 sides with metastatic nodes were diagnosed by manual palpation(sensitivity, 82.1%; specificity, 83.3%; accuracy, 82.4%). However, lymphnode metastases in 53 sides were revealed by CT(sensitivity, 94.6%; specificity, 94.4%; accuracy, 94.6%), i.e., CT discovered 70% of the occult metastatic nodes in this series. Lymph node metastases were diagnosed accurately in 51 sides by ultrasonography (sensitivity, 91.1%; specificity, 94.4%; accuracy, 91.9%), and 50% of the occult metastatic nodes were found by ultrasound. CONCLUSION: CT, ultrasound examinations are superior to physical palpation in ascertaining cervical lymph node metastasis, as 50%-70% of the occult cervical metastatic nodes can be diagnosed.

Adolescent↗

PubMed1975

Endotracheal tube placement in infants determined by suprasternal palpation: a new technique.

In order to decrease complications of improper endotracheal tube positioning, a method of placing the tube by palpation within the suprasternal notch was devised. The method proved to be simple and effective. The accuracy was verified by fluoroscopy and a clinical study comparing this technique with others is reported. No complications of the technique were noted. Once palpation was reliable, the proper position of the tube tip was defined. From measurements taken from routine inspiratory chest radiographs on 142 infants, it was found that a point midway between the medial ends of the clavicle (IMP) was a good position because it approximates the true tracheal midpoint and, therefore, is a good landmark on a chest radiograph. This point allows for movement of the tube tip with head positioning and of the carina with respiration. The tube tip can be placed near the IMP by the suprasternal palpation technique. This method, therefore, is useful in emergency situations or on initial intubations to avoid improper position of the tube tip prior to radiograph verification.

Auscultation↗

PubMed2002

[Localization of impacted maxillary canines by palpation and orthopantomography].

In orthodontic practice occurred problems associated with labio-palatal localization of impacted permanent maxillary canines. Not always is possible to determinate labio-palatal location of these teeth on the basis of palpation, therefore clinical examination aided by radiographic investigation. Orthopantomogram is the most widely used radiograph in orthodontics. The purpose of present study-test diagnostic value of palpation and orthopantomography in cases of maxillary canines impaction on the basis of evaluation of migration and inclination of impacted teeth. Thirty nine patients of Clinic of Orthodontics, Kaunas University of Medicine, orthopantomograms were available for analysis. Forty two impacted canines were investigated. Only 64% of canines could be palpated. It depended on the vertical position of the tooth. Distribution of the values of canine inclination to the middle of upper jaw was too big for more precise statistical analysis. Canines, which were medial to the 3th horizontal sector (these canines overlapped longitudinal axis of the lateral incisor), were located palatally.

Adolescent↗

PubMed1999

[Evaluation of N staging of cervical lymph nodes with positive palpation in laryngeal carcinoma].

OBJECTIVE: To evaluate N staging of cervical lymph nodes with positive palpation objectively. METHOD: Serial sections of lymph nodes of neck dissections with transparent methods were observed under light microscope. RESULT: 81 lymph nodes with pathological metastases were verified in 100 patients with 114 palpation positive lymph nodes. The correspondent rate was 71.1%. The correspondent rate of clinical N via pathological N staging was N1 35.6%, N2a 25.0%, N2b 58.3%, N2c 75.0%, N3 100.0% respectively. CONCLUSION: N staging judged only by palpation is not sufficient in clinic. It should be combined with other examinations.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

[Comparison of the data of palpation and ultrasonic examination in assessing the dimensions of the thyroid gland].

Comparison of the thyroid-sizes estimated by palpation and ultrasonic scanning in 282 women and 178 men has shown that if the thyroid is small (from 0 to 2nd degree, according to O. V. Nikolayev's classification), its size cannot be estimated by palpation and this method fails to assess the endemic goiter in epidemiologic surveys. Correlation between the thyroid size estimated by palpation and its ultrasonically assessed volume has made up 0.346 (p < 0.001) in women and 0.193 (p < 0.01) in men. Ultrasonic assessment of the thyroid volume appears useful both for clinical and epidemiologic studies.

Female↗

PubMed1992

Comparison of two breast self-examination palpation techniques.

In this randomized clinical trial, we compared the vertical strip (VS) and the concentric circle (CC) patterns of breast palpation in order to determine which pattern provided the most thorough self-examination and the best lump detection in breast models. The sample consisted of 34 adult women from a Veterans Outpatient Clinic in the Northwest who were assigned according to breast size (large or small) to one of two groups. Subjects were pretested and randomly taught one method of palpation. Proficiency in the palpation technique, area covered, and number of lumps detected were evaluated. Interrater reliability for proficiency evaluation was 86%. During breast self-examination, the VS group covered significantly more area than the CC group (t = 2.72, p = 0.01). Breast size did not affect breast area covered. Lump detection using breast models did not differ between the two groups. Though this study did not support the conclusion that increased thoroughness leads to increased lump detection, there is support in the literature. Lack of difference in lump detection in this study may have been due to the constraints of the breast models used. However, further research is needed.

Breast↗

PubMedDate not supplied

Femoral pulse palpation before and after exercise: a guide to occult iliac stenosis?

Iliac artery stenosis may produce significant haemodynamic impairment in the absence of any visible iliac narrowing on uniplanar arteriography. Such stenoses may be unmasked by the use of biplanar angiography or by direct femoral pressure measurements before and after papaverine. The aim of this study is to determine whether simple femoral pulse palpation is a reliable guide to haemodynamic impairment in the radiologically normal aorto-iliac segment, and in particular whether occult iliac stenosis can be unmasked by noting a reduction in the palpable pulse after exercise. Twenty-nine limbs with normal aorto-iliac segments on uniplanar angiography were examined at rest and after exercise and the femoral pulses were graded clinically. Haemodynamic assessment was performed by direct femoral pressure measurements before and after intra-arterial papaverine injection. Significant haemodynamic impairment was noted in 8 out of 29 limbs. Six of these 8 limbs had normal resting femoral pulses and 4 of the 8 limbs had a diminished pulse after exercise. Four out of the 21 limbs with normal haemodynamic studies had diminished pulses after exercise. Resting femoral pulse palpation is a poor guide to radiologically occult but haemodynamically significant iliac stenosis although pulse palpation after exercise may help to unmask a proportion of such stenoses.

Aorta, Abdominal↗

PubMed2005

Validation of a bovine rectal palpation simulator for training veterinary students.

Bovine rectal palpation is a necessary skill for a veterinary student to learn. However, lack of resources and welfare issues currently restrict the amount of training available to students in this procedure. Here we present a virtual reality based teaching tool -- the Bovine Rectal Palpation Simulator -- that has been developed as a supplement to existing training methods. When using the simulator, the student palpates virtual objects representing the bovine reproductive tract, receiving feedback from a PHANToM haptic device (inside a fibreglass model of a cow), while the teacher follows the student's actions on the monitor and gives instruction. We present a validation experiment that compares the performance of a group of traditionally trained students with a group whose training was supplemented with a simulator training session. The subsequent performance in the real task, when examining cows for the first time, was assessed with the results showing a significantly better performance for the simulator group.

Animals↗

PubMed2005

Diagnostic accuracy of palpation-guided and image-guided fine-needle aspiration biopsy of the thyroid.

We conducted a retrospective study to compare the sensitivity and specificity of traditional palpation-guided fine-needle aspiration biopsy (FNAB) performed by clinicians and pathologists with that of image-guided FNAB performed by radiologists for the evaluation of thyroid nodules. We reviewed the medical records of 89 patients who had undergone thyroid FNAB and subsequent surgical excision and pathology. Of this group, 58 patients had undergone palpation-guided FNAB performed by a clinician, 20 had undergone palpation-guided FNAB performed by a pathologist, and 11 had undergone image-guided FNAB performed by a radiologist. The sensitivity of the three techniques was 86, 100, and 100%, respectively, and the specificity was 78, 94, and 44%; there were no statistically significant differences in sensitivity or specificity among the three groups. Our data indicate that FNAB of the thyroid can be performed with equal reliability by clinicians, pathologists, and radiologists.

Adult↗

PubMed1992

Peripheral pulse palpation: an unreliable physical sign.

Fifty observers, including two fully trained vascular surgeons, were asked to determine the presence or absence of the femoral and distal pulses of four patients with peripheral vascular disease and one asymptomatic subject (50 pulses assessed). Pulses felt by both vascular surgeons were deemed to be palpable. Among the other observers, the sensitivity of palpation was 95% or over for the femoral pulse, but 33% to 60% for observers of varying experience feeling for the posterior tibial pulse. Up to 20% false-positive observations were reported. Disease was diagnosed in over 10% of examinations of healthy limbs and was missed in over 10% of symptomatic limbs. The accuracy of pulse palpation was strongly correlated with the systolic blood pressure in the underlying artery. Accuracy was greater among more experienced observers, suggesting that careful teaching of this skill is likely to be beneficial. Even so, pulse palpation alone is an unreliable physical sign and should only be used in combination with objective measurements as a guide to clinical management.

Blood Pressure↗