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PubMed1997

The variability of shoulder motions recorded by means of palpation.

OBJECTIVE: The objective of this methodological study is the quantification of the sources of variability in the recorded three-dimensional motions of the shoulder mechanism for comparative purposes. BACKGROUND: The palpation and subsequent digitization of skeletal landmarks of the shoulder mechanism is a non-invasive and relatively easy method to quantify shoulder orientations. Comparison of individual motions is subject to the accuracy of the palpation method, the magnitude of kinematic redundancy of the shoulder mechanism and inter-subject differences in morphology and physiology. Quantification of these sources of variance, i.e. the palpation error, motoric noise and inter-subject differences, demonstrated the accuracy of the method and the potential validity of the descriptive motion parameters, e.g. Cardan angles, in intra- and inter-individual studies for clinical, ergonomical and biomechanical studies. METHODS: The orientations of the shoulder bones were recorded five times for each of five subjects by palpation and digitization of 12 skeletal landmarks for 10 equidistant arm elevation postures in the scapular plane. The orientations were described by means of Cardan angles. The palpation error was determined at a standardized initial rest position and expressed by Cardan angles for each recorded posture. Adding motoric noise and inter-subject differences gave the inter-individual variance. RESULTS: The palpation error was approximately 2 degrees. The major recorded variance originated from motoric noise (+/-33%) and inter-subject difference (+/-55%). CONCLUSIONS: The palpation method is an accurate means of recording the three-dimensional orientations of the shoulder mechanism and for intra-individual studies. However, inter-subject variability is large.

Journal Article↗

PubMed1993

[Palpation and sonography in after-care of head-neck tumor patients: comparison of ultrasound tumor entity parameters].

The ranking of postoperative palpation and sonography is examined in respect of imaging of neck lymph node enlargement and neck lymph node metastases or lymphomas, using a prospective study involving 127 patients whose head and neck tumours had already undergone treatment. These patients had been subjected to tumour aftercare for an average period of 26 months. Sonography is well suited for detecting the presence of enlarged neck lymph nodes, the accuracy being 97.5%. In this study palpation was clearly less safely defined, the accuracy being only 85%. The following results were obtained in respect of the specific imaging of metastases: sensitivity of palpation (75%) is below that of sonography (M/Q ratio) (93%). In respect of specificity palpation also yielded poorer results than sonography (M/Q ratio 94%) because of the relatively high proportion of false positive palpations (17%). The reason for this is non-differentiation between reactively enlarged lymph nodes and lymph nodes metastases. The advantage of sonography vs palpation by using the M/Q ratio is therefore the accuracy of the findings (94% sonography, 81% palpation) and hence the clear reduction in false positive and false negative findings. Furthermore, sonography can image the exact relationship to surrounding tissue and especially the vessels. The drawback of sonography is that lymph nodes < 9 mm maximal diameter cannot be assessed with the safety and accuracy mentioned above. Sonomorphological criteria such as the central marrow reflex and a widened lymphatic node cortex enhance diagnostic safety of the sonographic expansion parameters to yield an assessment of tumour status.

Adult↗

PubMed1999

Distal pulse palpation: is it reliable?

The aim of this study was to evaluate the reliability of distal pulse palpation. The dorsalis pedis and the tibialis posterior arteries of 25 patients with suspected lower limb arterial disease were independently palpated by three vascular surgeons and three medical students in the outpatient clinic and by two vascular nurses and one physician in the vascular laboratory. The palpation findings were compared to the ankle/brachial index (ABI). Palpable and unpalpable pulses were best separated with ABI 0.76 as the cutoff point. The degree of misdiagnosis was unacceptably high, with an underdiagnosis of more than 30%. The agreement was highest (kappa 0. 68, good) among the vascular laboratory personnel in the peaceful vascular laboratory and lowest (kappa 0.38, fair) among the vascular surgeons in the busy outpatient clinic. The poor agreement and the high proportion of misdiagnosis obtained in the outpatient clinic argue against the use of pulse palpation as a single diagnostic method. Palpable pulses with low ABIs clearly state the need for more objective measurements whenever ischemia is suspected. Yet, by carefully palpating both pedal arteries under good, nonhurried conditions the reproducibility and accuracy of pulse palpation can be tolerable.

Adult↗

PubMed2004

Effectiveness of detection of intrauterine growth retardation by abdominal palpation as screening test in a low risk population: an observational study.

OBJECTIVE: To evaluate the performance of abdominal palpation as a screening test for intrauterine growth retardation (IUGR) in a low risk population, under standard practice conditions. STUDY DESIGN: Population based observational study of 6318 consecutive low risk singleton pregnancies. The Dutch obstetric system distinguishes low from high risk pregnancies. In the low risk group abdominal palpation as a screening test is performed by midwives. If a complication, like IUGR, during prenatal care is assessed, the women is referred to a consulted obstetrician. Ultrasound is performed by the consulted obstetrician. In case of sustained suspicion the women is selected as high risk. OUTCOME PARAMETERS: severe small for gestational age (SGA) birthweight below 2.3rd centile, all SGA birthweight below 10th centile, operative delivery, neonatal morbidity and perinatal mortality. Screening value of abdominal palpation, abdominal palpation combined with ultrasound, and the performance of high risk selection was assessed by conventional performance measures. RESULTS: Abdominal palpation as a screening test for IUGR is of limited value: the observed sensitivities were 28% for severe SGA and 21% for SGA p < or = 10, respectively. After ultrasound in case of sustained suspicion, the sensitivity in detection of severe SGA was 25% and positive predictive value (PPV) 16%. In detection of SGA p < or = 10 sensitivity was 15% and PPV 55%, which means 45% were false positives. The sensitivity of the Dutch obstetric system in selection of high risk pregnancies in detection of severe SGA was 53%, in detection of SGA p < or = 10 was 37%. Perinatal mortality was 0.9% (57/6318) and 32% of these cases were SGA. Six cases of fetal death were unrecognised during prenatal care (0.09%) and seem preventable. The prevalence of a 5 min Apgar Score < or = 7 was significantly higher in the SGA infants if SGA was defined as p < or = 10. CONCLUSIONS: The diagnostic performance of abdominal palpation as a screening test for IUGR detection in a low risk population is disappointing. However, various stratagems such as routine ultrasound do not improve detection rate or perinatal morbidity and mortality.

Female↗

PubMed2004

Which is important in the evaluation of metastatic lymph nodes in head and neck cancer: palpation, ultrasonography, or computed tomography?

OBJECTIVE: Evaluate palpation, ultrasonography (USG), and computed tomography (CT) with respect to their value for comparative determination of metastatic lymph nodes in head and neck cancer. STUDY DESIGN: A prospective study was conducted in a tertiary referral hospital. During September 1996 and April 1999, clinical investigation, USG, and CT were performed preoperatively on 48 patients who would undergo neck dissection for primary head and neck malignancy. The presence of metastatic lymph nodes in pathologic specimens were compared with the findings of palpation, CT, and USG. RESULTS: Twenty-two of the patients had positive lymph nodes on pathologic investigation. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for palpation are 64%, 85%, 74%, 78%, and 75% respectively. Respective values for USG and CT for sensitivity, specificity, negative predictive value, positive predictive value, and accuracy are 72%, 96%, 80%, 94%, and 85% and 81%, 96%, 85%, 90%, and 87%. CONCLUSION: All of the pretreatment evaluation methods, palpation, CT, and USG yield results that are significantly different from the histopathologic results, suggesting that no pretreatment study can accurately assess the requirement to histopathologically stage the neck. USG findings are more correlated with the pathologic findings than palpation, but CT gives the most effective and reliable results when it is combined with USG in neck staging. Preoperative USG and CT scanning of the neck by an experienced radiologist is essential and useful for diagnosis, staging, and therapy choices. SIGNIFICANCE: Statistical analysis was done with chi(2) test. The difference between histologic findings and palpation is significant (P = 0.0005). The difference between histologic findings and USG and CT is significant (P = 0.0001 and P = 0.0001).

Adult↗

PubMed1993

Comparisons of dynamic infusion and delayed computed tomography, intraoperative ultrasound, and palpation in the diagnosis of liver metastases.

The purpose of this study was to determine whether delayed computed tomography (DCT) of the liver would more accurately detect hepatic malignancy when compared with bolus contrast-enhanced dynamic computed tomography (BCDCT). Fifty-one patients who required operation for intra-abdominal malignancy (92% with colorectal cancers) underwent preoperative BCDCT followed by DCT. At operation, palpation and intraoperative ultrasound (IOUS) examination of the liver were performed for localization and biopsy of tumor nodules. The standard for diagnosis was defined for this study as the combined results of IOUS, palpation, and biopsy. The sensitivities of BCDCT and DCT for hepatic metastases were 50% and 54%, respectively, with a corresponding specificity of 72% for each. DCT demonstrated no significant improvement over BCDCT in the detection of individual hepatic lesions. The sensitivity of palpation for the detection of metastases was 82%, equal to that of IOUS. Both palpation and IOUS were significantly superior to BCDCT or DCT in excluding false-positive and false-negative results (p < 0.001). IOUS failed to identify surface lesions less than 1.0 cm in diameter (sensitivity: 40%). Conversely, palpation was limited in the detection of subsurface tumors less than 1.0 cm in diameter (sensitivity: 33%). Combined IOUS and palpation were significantly more accurate in the detection of hepatic metastases than any single modality that was evaluated (p < 0.001).

Colorectal Neoplasms↗

PubMed2000

Accuracy of lymph node palpation to determine need for lymphadenectomy in gynecologic malignancies.

OBJECTIVE: To assess the accuracy of intraoperative lymph node palpation for identifying lymph node metastasis in gynecologic malignancies. METHODS: We prospectively evaluated 126 women who had lymphadenectomies for staging of various gynecologic malignancies from August 1995 to June 1997. Surgeries were done by obstetrician-gynecologists with subspecialty certification in gynecologic oncology from the American Board of Obstetrics and Gynecology, who had practiced gynecologic oncology for at least 5 years. Data were collected on gynecologic oncologists' opinions of lymph node status by palpation. Nodes believed to be positive were sent separately. We recorded operating time for lymphadenectomies, and intraoperative and postoperative complications. RESULTS: Mean (range) patient age was 55 (18-83) years. Mean (range) operating time was 188 (85-435) minutes. The mean (range) lymphadenectomy time was 46 (5-150) minutes. The total number of lymph nodes dissected was 2138. One hundred seven of 2138 (5%) nodes were positive for malignancy. Thirty-eight of 107 (36%) positive lymph nodes were missed by palpation. Fifty-six of 2031 (3%) negative lymph nodes were selected as positive. Sixty-nine of 107 (64%) positive lymph nodes were identified correctly. Sensitivity and specificity of palpation were 72% and 81%, respectively. The positive and negative predictive values of lymph node palpation were 56% and 89%, respectively. CONCLUSION: Intraoperative lymph node palpation has low sensitivity and positive predictive value even when done by experienced board-certified gynecologic oncologists.

Adolescent↗

PubMed2000

Relative accuracy of the identification of ovarian structures in the cow by ultrasonography and palpation per rectum.

Manual palpation or ultrasonographic examination of the cow's genital tract are currently used by veterinarians involved in reproductive management, but knowledge of the potential and the limitations of both methods is important to obtain an optimal accuracy in the diagnosis of physiological and pathological ovarian structures. This review presents the main features of manual and ultrasonographic characteristics of follicles, corpora lutea (with or without a cavity), follicular and lutenized cysts and the reliability of the two methods is compared. Manual diagnosis of follicles <10 mm is rather inaccurate, but ultrasound offers the possibility to diagnose follicles <5 mm and to measure their inner diameter. The predictive values of the presence or absence of a corpus luteum as determined by palpation are similar (78 vs. 75%). Manual or ultrasonographic diagnosis of the growing or regressing corpus luteum is rather difficult. The positive predictive value of a mature corpus luteum diagnosed by ultrasonography is lower (87%) than the negative predictive value (92%). Compared to manual palpation, ultrasonography permits a better estimation of the number and to determine more precisely the size of the mature corpus luteum. The positive values for follicular cysts diagnosed by palpation or by ultrasonography are 66 and 74% respectively, and for luteal cysts, the values are 66 and 85%, respectively.Manual palpation or ultrasonography are useful tools to diagnose ovarian structures in the cow. The accuracy of such methods can be enhanced by securing information on the reproductive history of the animal, palpation of uterine horns, vaginal examination or progesterone determinations.

Animals↗

PubMed2000

Magnetic resonance imaging versus clinical palpation in evaluating cervical metastasis from head and neck cancer.

We prospectively compared the value of MRI and clinical palpation for detecting cervical metastases in patients with primary cancer of the head and neck. Sixty patients with squamous cell carcinoma of the upper aerodigestive tract were evaluated with MRI and clinical palpation before undergoing a total of 81 neck dissections. The results of preoperative clinical palpation and MRI were compared with the histopathologic outcome. The sensitivity and specificity were 75.6% and 97.5%, respectively, for clinical palpation and 73.2% and 95%, respectively, for MRI. The rate of occult cervical metastasis was 24% with clinical palpation and 26.8% with MRI. The use of MRI did not improve the rate of early detection of occult metastasis, nor did it improve the detection of extracapsular spread. Our findings show that we could not depend on palpation or MRI alone to determine the need for elective neck dissection. However, MRI can be used to improve the preoperative grading of cervical lymph nodes. In selected cases, this may direct surgeons to convert the treatment plan to choose a more conservative neck dissection or, after sentinel node sampling and frozen-section control, to convert the treatment to a more radical dissection.

Head and Neck Neoplasms↗

PubMedDate not supplied

Transdeltoid palpation (the rent test) in the diagnosis of rotator cuff tears.

The purpose of this study was to assess the diagnostic accuracy of transdeltoid palpation (the rent test) for the diagnosis of full thickness rotator cuff tear. Clinical and arthroscopic findings were documented prospectively for 109 consecutive patients undergoing shoulder arthroscopy by the senior author. A retrospective analysis was then performed on these data to assess the accuracy of transdeltoid palpation in the diagnosis of full thickness rotator cuff tear. Transdeltoid palpation was found to have a sensitivity of 95.7% and specificity of 96.8% for the diagnosis of full thickness rotator cuff tear. The positive and negative predictive values for transdeltoid palpation were 95.7% and 96.8%, respectively. Overall, the diagnostic accuracy of transdeltoid palpation was 96.3%. We conclude that transdeltoid palpation is highly accurate for the clinical diagnosis of full thickness rotator cuff tear.

Adult↗

PubMed1988

Accuracy of digital palpation for size assessment of the prostate evaluated by transrectal sonography.

In order to clarify how precisely digital palpation gives information on prostatic size, evaluation of the size measurement of the prostate by means of transrectal sonography was performed on 1,543 subjects with various prostatic disorders. There was little agreement between the assessment of prostatic size by digital palpation and the ultrasonic measurement. The larger the prostate the less accurate was digital palpation. The prostatic size assessed by digital palpation was particularly dispersed widely in the prostate of 'hen's egg' size. It was proved that the size assessment by digital palpation was only effective statistically in a two-step differentiation, 'hen's egg' size and smaller. More complicated size classification was of little clinical value in digital palpation.

Evaluation Studies as Topic↗

PubMedDate not supplied

[Comparison of palpation, ultrasound and computed tomography in the valuation of lymphatic neck metastasis].

OBJECTIVES: We evaluated the diagnostic value of palpation, ultrasonography (US), and computed tomography (CT) in detecting neck metastasis in head and neck cancers. PATIENTS AND METHODS: The study included 35 patients (34 men, 1 woman; mean age 59 years; range 35 to 72 years) with laryngeal carcinoma. In addition to neck palpation, 17 patients and 27 patients had neck examinations by US and CT, respectively. Histopathologic results of the neck specimens were compared with those obtained from palpation, US, and CT. RESULTS: The accuracy of CT, US, and palpation in the evaluation of lymph nodes of the neck were 85%, 65%, and 80%, respectively. Ultrasonography was found to have the highest sensitivity (100%), but the least specificity (33%). The highest false positive and false negative results were obtained by US (42%) and palpation (10%), respectively. CONCLUSION: Computed tomography proved superior to palpation and US in the evaluation of neck metastasis in patients with head and neck tumors.

Adult↗

PubMed1992

The reliability of lumbar motion palpation.

OBJECTIVE: This review surveys the literature regarding reliability studies of lumbar motion palpation. DATA SOURCES: Using the indexing terms motion palpation lumbar spine and palpation, the following English language databases were surveyed: a) Medline, including back file; b) Embase; c) Cinahl; and d) Epic. Additionally, a manual search of the Chiropractic Research Archives Collection and JMPT was performed and researchers at Western States Chiropractic College were consulted. Pertinent references cited in bibliographies of retrieved papers were included if contributory. STUDY SELECTION: Studies pertaining to intra- and interexaminer reliability of lumbar motion palpation were reviewed. DATA EXTRACTION: Statistical analysis, subject selection, method of palpation and sources of error are discussed. DATA SYNTHESIS: Multiple variations were noted in type of palpation, subjects examined, statistical analysis and experience of examiners. CONCLUSIONS: To date, most studies have demonstrated marginal to poor interexaminer reliability, while good to moderate intrarater reliability has generally been reported.

Back Pain↗

PubMedDate not supplied

Accuracy and reliability of palpation and percussion for detecting hepatomegaly: a rural hospital-based study.

BACKGROUND: Palpation and percussion are standard bedside techniques used to diagnose hepatomegaly. Ultrasonography is a noninvasive and accurate method for measurement of liver size, but many patients in developing countries have limited access to it. We compared the accuracy of palpation and percussion in a rural population in central India, using ultrasonography as a reference standard. METHODS: The study design was a blinded, cross-sectional analysis of a hospital-based case series. Three physicians, blind to clinical data and to each other's results, independently used palpation and percussion to detect hepatomegaly. Diagnostic accuracy was measured by computing sensitivity, specificity, and likelihood ratio values. Inter-physician agreement was assessed using the kappa statistic. RESULTS: Of the 180 study patients, 36 (20%) had enlarged liver on ultrasonography. The likelihood ratios for findings at both palpation (2.2, 3.0, and 2.5 for the three physicians, respectively) and percussion (1.1 for all three physicians) as predictors of true hepatomegaly were low. The kappa values for inter-observer agreement between three physicians for the presence of hepatomegaly at palpation (=0.44-0.53) and percussion (=0.17-0.33) were low, indicating poor reliability of these techniques. CONCLUSION: Clinical assessment of hepatomegaly by palpation and percussion lacks both accuracy and reliability.

Adult↗

PubMed1992

Should we palpate foot pulses?

UNLABELLED: Palpation of foot pulses is traditionally used to evaluate patients with arterial disease. This study investigated observer variation in assessment of pedal vessels by pulse palpation and Doppler auscultation. A series of 33 claudicant patients and five controls were examined by a consultant, registrar, SHO and nurse. Dorsalis pedis (DP) and posterior tibial (PT) pulses were palpated and were then examined by Doppler with measurement of systolic pressures. CONTROL GROUP: No disagreement in DP pulses. However, all observers agreed on the presence of a PT pulse in only 70% of limbs. Claudicants: There was better agreement in palpation of the DP pulse (all observers agreed in 67% of limbs), than the PT pulse (all agreed in 53%). This suggests that the DP pulse is easier to palpate than the PT (P less than 0.05). By contrast there was better agreement on Doppler signals from the PT artery, all agreed in 78% of limbs; compared with the DP artery, all agreed in 58% (P less than 0.01). Pressure measurements by the observers agreed to within +/- 0.15 in 88% of claudicant and 100% of control limbs. Pedal pulse palpation in patients with arterial disease is subject to substantial observer error. Doppler pressure measurement is preferable unless pulses are bounding.

Adult↗

PubMed1983

Diagnostic palpation of the spine: a review of procedures and assessment of their reliability.

Spinal palpation as employed by practitioners of manipulative therapy is a common diagnostic tool used to identify manipulable lesions. Three methods of diagnostic palpation are static palpation, active motion palpation and passive motion palpation. As a diagnostic technique, spinal palpation suffers from a lack of research on its statistical reliability. Assessment of the clinical efficacy of manipulative therapy would be better addressed if a statistically reliable method of palpatory diagnosis were developed.

Chiropractic↗

PubMedDate not supplied

[Ultrasonographic evaluation of the thyroid palpation method in determining its dimensions in children and adolescents].

The authors analyze the diagnostic value of thyroid palpation method (two modifications) comparing its results with those of ultrasonographic volumetry. The study involved 118 children aged 5 and 14 of both sexes living in regions endemic for goiter. The thickness of thyroid isthmus was found virtually the same no matter how greatly the gland was enlarged. The results proved the necessity of age-specific corrections in the criteria of current interpretation of palpation data: the first degree in preschool children was most often indicative of thyroid hypertrophy whereas in the pubertal age it was just a variant of normal size. Interpretation with due account of these amendments improved the reliability of diagnostic value of palpation, its sensitivity being 63 +/- 6, specificity 67 +/- 6, and accuracy 65 +/- 4%. When the results of palpation are adequately interpreted, the examinees' age and sex and the method of examination proper do not influence the data accuracy. The sensitivity of palpation in detection of nodules up to 10 mm in diameter proved to be null (in 6 of the 81 examined adolescents sonographic signs of encapsulated formation were seen in the thyroid). Bearing all this in mind, the authors discuss differentiated approaches to management of children and adolescents with the first degree of palpated enlargement of the thyroid.

Adolescent↗

PubMed1999

Manipulative physiotherapists can reliably palpate nominated lumbar spinal levels.

Palpating a nominated spinal level is a prerequisite to more complex tasks such as palpating the level most likely to be the source of the patient's symptoms. The aim of this study was to investigate the reliability of physiotherapists with a post-graduate qualification in manipulation (manipulative physiotherapists) in palpating the lumbar spines of patients in a clinical setting. Three pairs of manipulative physiotherapists palpated the randomly-nominated lumbar spinal levels of 20 patients presenting to their practices for treatment of low-back pain. Each therapist marked the skin overlying the spinous process of the nominated spinal level with an ultraviolet pen and these marks were transcribed onto transparencies for analysis. The therapists obtained an overall weighted kappa of 0.92 indicating almost perfect agreement for locating the nominated spinal level. The results of this study indicate that manipulative physiotherapists can reliably palpate nominated lumbar spinal levels, suggesting further training in spinal therapy enhances the palpatory skills of physiotherapists in palpating nominated lumbar spinal levels.

Analysis of Variance↗