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PubMed1982

[Combined touching and palpation in parathyroid surgery].

The parathyroid glands may be located anywhere and hidden in the thick thyroid gland sheath, so that the duration of parathyroidectomy is impossible to predict. For accurate and rapid identification and assessment of the nodule to be dissected, the authors advocate a two-finger method: one index finger palpates the whole length of the posteromedial segment of the thyroid sheath, while the other index finger penetrates into the thyroid cavity. Fourteen parathyroid adenomas and 39/40 hypertrophied glands were detected by this method. Results were negative in 12 cases with unconfirmed biological diagnosis of hyperparathyroidism.

Humans↗
PubMed1995

Twin pregnancy diagnosis in Holstein cows: discriminatory powers and accuracy of diagnosis by transrectal palpation and outcome of twin pregnancies.

The objective of this prospective cohort study was to determine the sensitivity, specificity, accuracy, and predictive value of twin pregnancy diagnosis by rectal palpation and to examine fetal survival, culling rates, and gestational lengths of cows diagnosed with twins. In this prospective study, 5309 cows on 14 farms in California were followed from pregnancy diagnosis to subsequent abortion or calving. The average sensitivity, specificity, accuracy, and predictive value of twin pregnancy diagnosis were 49.3%, 99.4%, 96.0%, and 86.1%, respectively. The abortion rate for single pregnancies of 12.0% differed significantly from those for bicornual twin pregnancies and unicornual twin pregnancies of 26.2% and 32.4%, respectively (P < 0.05). The early calf mortality between cows calving with singles (3.2%) and twins (15.7%) were significantly different (P < 0.005). The difference in fetal survival between single pregnancies and all twin pregnancies resulted in 0.42 and 0.29 viable heifers per pregnancy, respectively. The average gestation for single, bicornual, and unicornual pregnancies that did not abort before drying-off was 278, 272, and 270 days, respectively. Results of this study show that there is an increased fetal wastage associated with twin pregnancies and suggest a need for further research exploring management strategies for cows carrying twins.

Abortion, Veterinary↗
PubMed1993

Comparison of two scales in the assessment of muscle and joint palpation tenderness in chronic temporomandibular disorders.

Following the guidelines of the Craniomandibular Index, 23 chronic patients had 42 muscle and temporomandibular joint sites palpated. Two- and four-point scales were generated in response to the patient's reactions. After 6 weeks of treatment, patients measured with the 2-point scale showed 6.39% improvement in muscle tenderness and patients measured with the 4-point scale showed a 14.99% improvement. These changes were significantly different. Correlation between scales was r = .88 originally and increased to r = .91 after 6 weeks. Results showed that the 4-point scale is significantly more able to detect clinical changes in muscle and joint tenderness than is the 2-point scale.

Adult↗
PubMed1993

Sensitivity of manual palpation in testing the neonatal hip.

Developmental dysplasia of the hip (DDH) is a term used to describe a group of disorders of the neonatal hip in which the head of the femur is unstable or incongruous in relation to the acetabulum. Early detection and treatment of the condition generally results in normal development, whereas late diagnosis has poor success. In Northern Ireland, despite all neonates being manually examined for hip disorders by a medical officer before hospital discharge, there is an unacceptable late diagnostic rate of almost 50% of all cases. To help reduce the number of late presentations, vibration arthrometry, a noninvasive form of screening for DDH, has been used to record hip vibration events during clinical testing. In a comparative study, 300 infants were examined by nurses and medical officers to establish the sensitivity of manual palpation to neonatal hip vibrations detected by the objective detection system. Experienced research nurses detected 86% of the signals; doctors in training detected less than 10%. This suggests that objective, noninvasive screening by vibration arthrometry would detect a higher proportion of vibration events in neonates during the early stages of DDH. More time should be invested in training medical officers and others involved in DDH screening.

Hip Dislocation, Congenital↗
PubMed1993

The effect of training on physical therapists' ability to apply specified forces of palpation.

BACKGROUND AND PURPOSE: The aim of this study was to evaluate whether postgraduate physical therapy students studying manipulation could learn to accurately produce specific forces during palpation of an intervertebral joint. SUBJECTS: The 12 subjects (7 female, 5 male), aged 26 to 36 years (X = 29.5, SD = 2.9), had each completed a 4-year degree course in physical therapy and had worked between 3 and 10 years in clinical practice. All subjects were enrolled in a 12-month postgraduate manipulative therapy diploma course. METHODS: Subjects in the experimental group (n = 6) trained to apply specific forces of 1, 5, 10, 15, 20, and 25 kiloponds using bathroom scales. They practiced for 10 minutes per day for 30 days. Their ability to produce these forces on command was measured using a force platform as they applied posteroanterior passive accessory intervertebral joint movements to the lumbar spine of the healthy subjects. This testing was done prior to training (pretest), immediately after training (posttest), and 1 month following cessation of training (retention test). The control group subjects (n = 6) had no training with scales but were also students of the postgraduate manipulative physical therapy course. RESULTS: In comparison with the control group, the experimentally trained group showed reduced error in force production both immediately after training and 1 month later. This improvement was significant for the retention test. For the retention test, the experimental group subjects were also tested on the trained task (ie, their ability to apply specific forces to the scales). They developed higher levels of accuracy than did the control group. CONCLUSION AND DISCUSSION: Experimental training, therefore, was an effective addition to normal training, suggesting that therapists can learn to quantify applied forces, with significant implications for communication and evaluation of joint behavior.

Adult↗
PubMed1995

Physical examination of the adult patient with respiratory diseases: inspection and palpation.

Inspection of the thorax identifies the breathing position adopted by the patient, the shape of the thorax, the dynamics of respiration (breathing pattern, symmetry of expansion, mechanics and synchrony of rib cage and abdominal movements). Inspection of the neck adds useful information, particularly with respect to the dynamics of breathing. Palpation ascertains the signs suggested by inspection with respect to the mechanics of breathing. It also assesses the state of the pleura and pulmonary parenchyma by studying the tactile fremitus. It integrates extrarespiratory signs, such as enlarged lymph nodes or breast abnormalities. Extrathoracic respiratory signs should also be systematically looked for, including cyanosis, finger deformation, pulsus paradoxus, and pursed lips breathing. Interobserver agreement about respiratory signs has repeatedly been studied, and generally found to be low, as are clinical-functional correlations. However, some data on chronic obstructive pulmonary disease (COPD), asthma or pulmonary embolism are available. From the description of some signs and the current knowledge about their operative values, it appears that much clinical research remains necessary to better define the precise diagnostic value of a given sign. The impact of training on diagnostic performance also has to be defined. Both of these aspects should allow clinicians to optimize the way in which they use their hands and eyes to conduct respiratory diagnosis, as well as the way they teach respiratory symptomatology.

Adult↗
PubMedDate not supplied

Comparison of high frequency (20 MHz) ultrasound and palpation for the assessment of skin involvement in systemic sclerosis (scleroderma).

BACKGROUND AND OBJECTIVES: Systemic sclerosis (SSc) is a connective tissue disease characterized by microvascular changes and fibrosis of the skin and internal organs. Increased skin thickness proximal to the metacarpophalangeal joints is the single major diagnostic criterion. The aim of this study was to evaluate high frequency (20 MHz) ultrasound for the assessment of skin thickness in patients with SSc of different disease durations. METHODS: Skin thickness was measured with high frequency (20 MHz) ultrasound equipment (Dermascan) in 41 patients with SSc (23 women and 18 men) and in 41 controls. Twenty-five patients had limited cutaneous systemic sclerosis (ISSc), 12 had diffuse cutaneous systemic sclerosis (dSSc) and 4 had suspected SSc. RESULTS: Skin thickness of the forearm was inversely correlated to disease duration. Compared to controls, skin thickness was increased over the proximal phalanx of the right second finger and over the forearm in patients with a disease duration of 2 years or less. Assessments of skin thickness in 10 controls by 2 independent investigators showed an inter-observer variability of 1.0% for the proximal phalanx and 0.0016% for the forearm. Patients whose ultrasound showed increased skin thickness on the hand and forearm also had thickened skin by palpation. CONCLUSION: High frequency (20MHz) ultrasound is a feasible method for measuring skin thickness in SSc, and may be useful for diagnosis, long-term follow-up, and assessment in therapeutic studies.

Adult↗
PubMed1997

[What is the value of palpation and auscultation?].

In the diagnosis of heart disease--as in other domains of medicine--an integral approach to the patient complaints is essential. Careful observation and evaluation of his personality during medical history taking as well as an optimal clinical examination by palpation and auscultation of the heart, great vessels and lungs may lead to a semiquantitative diagnosis specially in valvular and congenital heart disease. The results of select imaging techniques may therefore be anticipated in these conditions by skilled clinical judgment alone. The palpatory and auscultatory findings are easily explained by the underlying hemodynamics. This article summarizes the most relevant clinical diagnostic clues in valvular and some congenital heart diseases.

Diagnosis, Differential↗
PubMed2001

Advancing intravascular ultrasonic palpation toward clinical applications.

This paper describes the first reported attempt to develop a real-time intravascular ultrasonic palpation system. We also report on our first experience in the catherization laboratory with this new elastographic imaging technique. The prototype system was based on commercially available intravascular ultrasound (US) scanner that was equipped with a 20-MHz array catheter. Digital beam-formed radiofrequency (RF) echo data (i.e., 12 bits, 100 Hz) was captured at full frame rate from the scanner and transferred to personal computer (PC) memory using a fast data-acquisition system. Composite palpograms were created by applying a one-dimensional (1-D) echo tracking technique in combination with global motion compensation and multiframe averaging to several pairs of RF echo frames that were obtained in the diastolic phase of the cardiac cycle. The quality of palpograms was assessed by conducting experiments on vessel phantoms and on patients. The results demonstrated that robust and consistent palpograms could be generated in almost real-time using the proposed system. Good correlation was observed between low strain values and regions of calcification as identified from the intravascular US (IVUS) sonograms. Although the clinical results are clearly preliminary, it was concluded that the prototype system performed sufficiently well to warrant further and more in-depth clinical investigation.

Calcium↗
PubMed2000

Intraluminal ultrasonic palpation: assessment of local and cross-sectional tissue stiffness.

Many intravascular therapeutic techniques for the treatment of significant atherosclerotic lesions are mechanical in nature: examples are angioplasty, stenting and atherectomy. The selection of the most adequate treatment would be advantageously aided by knowledge of the mechanical properties of the lesion and surrounding tissues. Based on the success of intravascular ultrasound (IVUS) in accurately depicting the morphology of atheromatous lesions, ultrasonic tissue characterisation has been proposed as a tool to determine the composition of atheroma. We describe the addition of local compliance information to the IVUS image in the form of a colour-coded line congruent with the lumen perimeter. The technique involves analysis of echo signals obtained at two or more states of incremental intravascular pressure. Using vessel phantoms and specimens, we demonstrate the utility of intravascular compliance imaging. The palpograms are able to identify lesions of different elasticity independently of the echogenicity contrast, because the information provided by the elastograms is generally independent of that obtained from the IVUS image. Thus, the palpogram can complement the characterisation of lesion from the IVUS image. We also describe cross-sectional measures of elasticity that are based on the elastogram. Finally, natural extensions of intravascular palpation to other endoluminal ultrasound applications are proposed.

Arteriosclerosis↗
PubMed1993

Preoperative staging of breast cancer by palpation, mammography and high-resolution ultrasound.

In breast cancer preoperative determination of the tumor size is important for planning breast-conserving operations. In 100 patients with breast cancer, the preoperative tumor size was measured using clinical, mammographic and sonographic examinations and correlated with the results of a subsequent histological examination. Using a high-resolution real-time system, 98 tumors were visible. It was possible to detect not only early tumors under 1 cm in diameter, but also intraductal tumor components. This contributed greatly to the accuracy of the diagnosis. The sonographic measurement of tumor size demonstrated a correlation coefficient of 0.91 and was thus superior to mammography (0.79) and palpation (0.77). Measurement of the total tumor spread, including 39 multicentric lesions, showed an overestimation of 5% for the mammographic measurements and an overestimation of 4% for the sonographic measurements. Tumor extension was underestimated in 33% of the mammograms but in only 3% using ultrasound examination. The results, along with those of other studies, highlight the role of sonography in the diagnosis of breast cancer.

Journal Article↗
PubMed1992

A field study of patterns of unobserved foetal loss as determined by rectal palpation in foaling, barren and maiden thoroughbred mares.

Records of 1,009 pregnancies in 574 foaling, barren and maiden Thoroughbred mares on a single stud farm, over a period of 12 years were examined. The farm is situated in the eastern Cape Province of South Africa, at an elevation of 1,800 m, and in an area of climatic extremes. Records of 604 pregnancies in 249 foaling Thoroughbred mares were examined. For these purposes, those pregnancies in which a mare conceived in the same breeding season during which she had foaled were considered as pregnancies in foaling mares. Pregnancy was confirmed by rectal palpation by a single experienced practitioner. Of the 604 pregnancies examined, conceptus attachment occurred in the horn opposite the previously gravid horn in 345 cases (57%), and in the previously gravid horn in 259 cases (43%; P less than 0.005). Unobserved foetal loss after pregnancy diagnosis amounted to 30 (9%) in the former group, while in the latter group (pregnancy established in the postgravid horn) 46 pregnancies were lost (18%; P less than 0.005). This study confirmed that conceptus attachment tends to occur in the uterine horn opposite the previously gravid horn in foaling Thoroughbred mares conceiving during the same season. A significantly higher incidence of foetal loss accompanied conceptus attachment in the postgravid horn. Of 242 pregnancies in 162 previously barren mares, 95 (39%) occurred in the left uterine horn and 147 (61%) in the right horn (P less than 0.005). The incidence of pregnancy failure in this group was 7%. The side of attachment did not affect the rate of loss. Evaluation of the records of 163 maiden mares revealed that conceptus attachment occurred in the left uterine horn in 58 (36%) pregnancies and in the right horn in 105 (64%) pregnancies (P less than 0.005), which is consistent with previously reported observations. Pregnancy failure was recorded in 4% of maiden mares. Side of attachment did not influence rate of loss in this group.

Animals↗
PubMed1989

An evaluation of tympanometry, otoscopy and palpation for assessment of the canine tympanic membrane.

Three techniques for the assessment of the integrity of the canine tympanic membrane were evaluated experimentally. Tympanometry, an objective technique, was shown to be very accurate for the evaluation of the integrity of the ear drum. Otoscopic examination by experienced personnel was shown to be moderately accurate under controlled conditions when the external ear canal was not inflammed. However, under field conditions when otitis externa was present, visual inspection of the tympanic membrane was seldom possible even after lavage of the ear. Palpation of the tympanic membrane with a blunt probe was shown to be very inaccurate and led to rupture of the tympanic membrane in a high proportion of cases. These results imply that two widely used techniques for the examination of the canine tympanic membrane are unsatisfactory. Furthermore, they suggest that previous reports of the prevalence of ear drum perforations in dogs may need reappraisal. Tympanometry is a non-invasive, objective and practical technique for the assessment of ear drum integrity which is worthy of further evaluation.

Acoustic Impedance Tests↗
PubMed1975

The significance of palpation by the maxillary palps of Locusta migratoria (L): an electrophysiological and behavioural study.

Palpation increases the amount of sensory input reaching the central nervous system compared with that obtained from sustained contact but that increase is not essential to allow discrimination. During a meal on favoured food, phagostimulatory input from the palps is not needed to drive feeding. When less favoured food is taken, phagostimulatory input from the palps may enhance feeding. Even with favoured food, the palps are important in registering inhibitory substances.

Action Potentials↗
PubMed2003

The accuracy of the Palpation Meter (PALM) for measuring pelvic crest height difference and leg length discrepancy.

STUDY DESIGN: Test-retest reliability and validity. OBJECTIVE: To determine the validity and reliability of the Palpation Meter (PALM). BACKGROUND: Leg length discrepancy (LLD) has been associated with a variety of musculoskeletal disorders. Therefore, the clinical measurement of LLD has become a routine and important part of the physical examination. The PALM is an instrument that was recently developed to indirectly measure LLD, but little is known about its measurement properties. METHODS AND MEASURES: Fifteen healthy and 15 symptomatic subjects with suspected LLD participated in this study. Measurements of pelvic crest height difference (PD) were obtained by 2 examiners using the PALM. A standing antero-posterior (AP) radiograph of each subject's pelvis was taken, and PD and LLD (femoral head height difference) were determined from the radiograph for comparison with the PALM values. Intraclass correlation coefficients (ICCs) were calculated to determine the validity and reliability estimates of the PALM. RESULTS: For all subjects, the validity estimates (ICC2,3) of the PALM for PD were excellent (0.90 for rater 1 and 0.92 for rater 2) when compared with the standing AP radiograph of the pelvis. The PALM was less accurate (ICC2,3 of 0.76 and 0.78 for rater 1 and 2, respectively) as an indirect estimate of LLD. Intrarater reliability for each rater was excellent (ICC3,3 = 0.97 and 0.98) and interrater reliability was very good (ICC2,3 = 0.88). CONCLUSION: The PALM is a reliable and valid instrument for measuring PD. Clinicians should consider this convenient, cost-effective clinical tool as an alternative to radiographic measurement of pelvic crest height difference.

Adult↗
PubMed2005

How does soft tissue distribution affect anteversion accuracy of the palpation procedure in image-free acetabular cup navigation? An ultrasonographic assessment.

Navigation of the acetabular cup in total hip replacement (THR) is used to improve the reproducibility of acetabular component positioning. When the palpation of anatomic landmarks, which is necessary to determine the pelvic coordinate system, is performed epicutaneously, the question as to how uneven soft tissue distribution can influence navigation accuracy arises. To obtain data, the questionable soft tissue thickness was measured in 72 patients scheduled for THR. In addition, distances between the landmarks were recorded. On the basis of this information, we were able to calculate the expected misinterpretation of the anteversion given by a navigation system for each patient. The calculations suggest that a navigation system would have underestimated the anteversion on average by 2.8 degrees +/- 1.8 degrees. The median of anteversion misinterpretation was 2.4 degrees and its 95% confidence interval was calculated to be 2.2 degrees -3.0 degrees. No correlation with substantial significance between anteversion misinterpretation and the patients' biometrical data could be found. According to the current knowledge, acetabular cups in THR should be positioned within a range of 30 degrees -50 degrees of inclination and 10 degrees -30 degrees of anteversion. In comparison with these permitted +/- 10 degrees windows, the amount of misinterpretation that was found due to uneven soft tissue distribution seems to be acceptable.

Acetabulum↗
PubMed1983

[Rhythmic echographic palpation. Echosismography. A new technic of differentiating benign and malignant tumors by ultrasonic study of tissue elasticity].

The echographic rhythmic palpation (echosismography) is a new method which completes classical sonography. It studies the elastic behaviour of the tissues after their mechanical excitation which are analysed in the T.M. mode. When displayed in classical sonographic technique the lesion is located with calipers. Calipers allow the recognizing of the tumor level at any moment in time motion mode. Vibrations are then applied on the skin as near as possible to the lesion. A regular frequency of 1,5 impulsion per second at a constant pressure of 500 gr on 4 cm2 is used. The response of resonating tissues to vibratory excitation is recorded and characterized by the amplitude of the oscillations (sinusoïdal shape). Benign tumors always gave sinusoïdal type oscillations. Most of this kind of tumors were semi-liquid or solid. Malignant tumors gave typical flat curves in 84% cases. Some malignant tumors (16%) gave benign type sinusoïdal oscillations. They had a small size, less then 2 cm diameter. Some of them where to superficial so they had easily induced oscillations over the excitation level. Echosismography enables to improve the diagnosis when compared with classical sonography in about 20% of cases.

Diagnosis, Differential↗