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PubMed1992

Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: a study of 100 patients.

One hundred patients with chest pain and negative coronary arteriography were evaluated for musculoskeletal chest wall findings. Sixty-nine patients had chest wall tenderness. Typical chest pain was evoked by palpation in 16 patients. Tender areas were not found in a control group of patients without chest pain. A diagnosis of fibrositis could be made in five patients, including two in whom chest palpation reproduced typical chest pain. The sternal and xiphoid area, left costosternal junctions, and left anterior chest wall were the areas where tenderness was most common, but no significant differences were found comparing locations of tenderness in those with reproduction of typical pain. There was no significant difference in location, exacerbating factors, or other musculoskeletal symptoms among different groups of patients. Thus, most patients with noncardiac chest pain have chest wall tenderness that is not found in a control group without chest pain. However, reproduction of pain by palpation, a more specific diagnostic finding, is found in a minority of these patients.

Adult↗
PubMed2004

[Rectal tears in the horse: malpractice or an unfortunate accident?].

Rectal tears are a relatively rare complication of rectal palpation, mating or dystocia, and idiopathic spontaneous occurrence of rectal perforation has also been described. Rectal tears have been classified in a three or a four-grade system. Immediate recognition of the fact that a tear has been made and prompt action will improve the horses chance of survival, and is the best defence of the veterinarian against legislation. There is no clear explanation why rectal tears sometimes occur. A questionnaire of the Netherlands Equine Veterinary Association revealed that rectal tears occurred both to inexperienced veterinarians and to very experienced colleagues, working with or without a probe for ultrasonography. In the opinion of the authors, the approach in the legislation of rectal tears should be that a rectal tear is only considered 'malpractice' if the veterinarian obviously acted carelessly. However, this would create the ridiculous situation that it seems better for the veterinarian-client relationship when the veterinarian confesses to 'careless' rectal palpation. This point needs further clarification, and perhaps an 'insurance of the horse for rectal palpation' will be the solution. Further, retrospectively over the last ten years, the problem is often not 'making a rectal tear', but 'lacking recognition of making a tear'. Whenever a rectal tear is suspected, the veterinarian must assess its severity, discuss the problem openly with the owner and apply appropriate treatment including referral.

Animals↗
PubMed2005

Is there a difference in the reliable measurement of temporomandibular disorder signs between experienced and inexperienced examiners?

AIMS: To determine whether there is a difference in terms of reliability between experienced examiners and inexperienced examiners in the measurement of signs of temporomandibular disorders (TMD). METHODS: A total of 27 patients seen for treatment of TMD were rated blindly and in random sequence by 2 experienced and 2 inexperienced examiners. The examiners participated in a 4-hour calibration session on the day preceding the reliability study. Both experienced and inexperienced examiners participated in the calibration session to reduce the effect of examiner subjectivity and allow the study focus to be on the effect of experience. The rating followed the Research Diagnostic Criteria for Temporomandibular Disorders and included mandibular movements, joint sounds, and digital palpation of muscles and joints. Intraclass correlation coefficients and kappa statistics were calculated to estimate interrater reliability. The Wilcoxon signed rank test was performed to test for differences between experienced and inexperienced examiners' results, and the Friedman test was used for differences between all 6 examiner combinations. RESULTS: Excellent overall reliability was found for vertical mandibular motions, acceptable reliability was found for the summed muscle palpation pain sites, and moderate to poor reliability was found for excursive movements, joint sounds, and single muscle palpation pain sites. No significant differences in the measurement results could be found between the experienced examiners and the inexperienced examiners. CONCLUSION: Examiner calibration rather than professional experience seems to be the most important factor for reliable measurement of TMD symptoms.

Adolescent↗
PubMedDate not supplied

Anxiety and depression in adolescents and their relationship with signs and symptoms of temporomandibular disorders.

PURPOSE: Several clinical studies suggest that psychologic factors may play an important role in the etiology and maintenance of temporomandibular disorder (TMD) signs and symptoms. The goal of this study was to verify the prevalence of anxiety and depression in adolescents, and their relationship with signs and symptoms of TMD. MATERIALS AND METHODS: The sample comprised 217 nonpatient adolescents between 12 and 18 years of age. The subjective symptoms and clinical signs of TMD were evaluated, respectively, using a self-report questionnaire and the Craniomandibular Index (CMI, which has 2 subscales), the Dysfunction Index, and the Palpation Index. The Hospital Anxiety and Depression Scale (HADS), a 14-item self-administered rating scale that was developed specifically to identify anxiety and depression in nonpsychiatric medical outpatients, assessed levels of anxiety and depression. RESULTS: In the total sample, anxiety and depression were present in 16.58% and 26.71% of subjects, respectively, including all levels of HADS. The results showed that there were positive correlations between CMI and Palpation Index and anxiety (HADSa) (P < .01) but not with depression (HADSd). An association between the number of TMD subjective symptoms and HADSa/HADSd was found (P < .01). CONCLUSION: Anxiety and depression, although of mild intensity, are common in adolescents. In this study both HADSa and HADSd were associated with an increasing number of TMD subjective symptoms. However, only anxiety was correlated with clinical signs of TMD (CMI), primarily muscle tenderness (Palpation Index).

Adolescent↗
PubMed2005

Oral parafunctions and positive clinical examination findings.

STATEMENT OF PROBLEM: Oral parafunctional activity can be fatigued and painful masticatory muscles and/or pain in the temporomandibular joints. There is controversial discussion in the literature as to what role parafunctional activity plays in the multi-causal pathologic process. PURPOSE: The purpose of this study was to determine any association between the level of parafunctional habits versus the level of mandibular dysfunction and to test the hypothesis that TMD/bruxer patients have significantly increased muscle tension and joint pain. MATERIAL AND METHODS: There were 307 subjects (140 males und 167 females) selected for this investigation. 299 subjects were examined regarding any relationships between clenching and the incidence of muscle sensitivity. The age of subjects ranged from 20 to 54 years old, with a mean age of 35.4. 114 subjects had at least one sign of temporomandibular disorders (tenderness/pain on palpation of the joints or muscles, TMJ sounds, pain or deviation during maximum mouth opening (active/passive). RESULTS: 81 subjects admitted to clenching, while 218 said they did not. Among the "non-clenchers", 68.8% had no sensitive muscles, 31.2% indicated sensitive masticatory muscles. Those who clenched their teeth were distributed as follows: 53.1% were diagnosed with bilateral masticatory muscle sensitivity, 46.9% showed no such indications. The two groups were not homogeneously divided, with regard to pain/discomfort (p = 0.001; Fisher's precision test). CONCLUSION: This study found a statistically solid relationship between the incidence of "clenching" and muscle palpation findings, as well as between sensitivity in the mandibular joints from lateral and to cranial and dorsal with positive muscle palpation findings. The agreement between sensitivity of the masticatory musculature and the mandibular joint demonstrates that intensive clenching can predominantly lead to pathologic phenomena in the muscles or joints.

Adult↗
PubMedDate not supplied

[The prevalence of incidentaloma--asymptomatic thyroid nodules in the Tricity (Gdansk, Sopot, Gdynia) population].

INTRODUCTION: The increased sensitivity of imaging devices raised number of incidentally discovered lesions in various organs of the human body. Thyroid gland is one of them. Reported prevalence of ultrasonographically detected thyroid nodules (incidentalomas) in general population ranges from 5.2 to 67.0%. Our study demonstrated occurrence of this clinical problem in the general population of the Tricity. MATERIAL AND METHODS: 135 healthy adults (95 women and 40 men) were examined. Neck palpation, ultrasonographic examinations of thyroid gland and serum tyreotropin (TSH) level measurement were made. RESULTS: In 8.9% of examine (12/135) persons nodules were palpable whereas in 14.8% (20/135) they were detectable only in ultrasonographic examination. Altogether thyroid ultrasound and palpation revealed nodules in 23.7% (32/135) of all cases. Multiple nodules were present in 12.0% of the cases. The pathology was more common in the elderly and in women. TSH serum level was within normal range in all cases of incidentaloma with otherwise normal thyroid gland. CONCLUSIONS: Prevalence of thyroid gland nodules (palpation--8.9% plus ultrasonography--14.8%) in healthy population of Gdansk, Gdynia and Sopot is close to data reported in southern Finland (27.0%) and Belgium (19.0%), where iodine deficiency is small, like in the Tricity area. The revealed lesions were over two times more frequent in the female population. Most of the nodules were not palpable.

Adolescent↗
PubMed1990

Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality.

The interexaminer reliability of noninvasive methods of examining lumbar spinal segments is not well established. In this project the interexaminer reliability of three experienced chiropractic examiners, who evaluated 21 symptomatic and 25 asymptomatic subjects, was explored. Eight noninvasive segmental examination strategies (dimensions) were employed at each spinal segment from T11/T12 through L5/S1. Marginal to good agreement beyond chance was noted for palpatory pain over osseous structures and in paraspinal soft-tissues. Weaker and less frequently, significant concordance between examiners was noted for detection of temperature differences (greater than or equal to 1.5 degrees F) between adjacent segments and for visual inspection for segmental abnormality. Little significant agreement between examiner was found for active and passive motion palpation, muscle tension palpation and misalignment palpation. This study suggests that "subjective" findings (pain) may be among the most reliable of conservative spinal observations. Weak but significant correlations were found when positive findings for the eight dimensions at each lumbar segment were summed to form a composite joint abnormality index. When the multidimension index was developed using the four most reliable dimensions, slightly stronger correlations were found. The strongest agreement between examiners tended to be found in the lower lumbar spine.

Adult↗
PubMed1989

Interexaminer concordance in detecting joint-play asymmetries in the cervical spines of otherwise asymptomatic subjects.

Interexaminer concordance for motion-based palpation of the middle and lower cervical spine was investigated. The palpatory task consisted of determining whether end-range joint resistance on lateral flexion was greater on one side of a given cervical segment when compared to that of the contralateral joint. Palpators also were asked to indicate the relative magnitude of the asymmetry, when detected. All experiments were carried out using reasonably healthy, pain-free, chiropractic college students. Three series of experiments involving two pairs of practitioners and a total of 270 subjects were carried out. Interexaminer agreement rates with respect to the side of greatest fixation were not found to be significantly different from those expected by chance alone. Furthermore, this was the case regardless of whether palpators had rated the magnitude of the asymmetry as being slight, moderate or severe. These poor agreement rates did not appear to be due to significant interexaminer differences with respect to the distributions of right vs. left calls, to a preponderance of agreements occurring more on one side over the other, or to differences with respect to the distribution of severity ratings. More importantly, there appeared to be no consistent relationships between the degree of severity indicated by the first examiner and that indicated by the second, nor were there any significant correlations between right vs. left agreement rates obtained for various combinations of severity ratings.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Comparison of palpable corpora lutea with serum progesterone concentrations in cows.

Serum progesterone concentrations were used to evaluate rectal palpation of corpora lutea as a method for assignment of postpartum beef cows to prostaglandin treatment and nontreatment groups. On the basis of 124 evaluations, 18% of the cows were assigned incorrectly to the treatment group and 37% of the cows were assigned incorrectly to the nontreatment group. The inability of palpators to accurately select cows with a mature corpus luteum may diminish the success of estrus synchronization regimens that use rectal palpation of corpora lutea for selection of cows for prostaglandin therapy.

Animals↗
PubMed1985

[Value of ultrasound study in lymphomas of the neck].

In order to determine the value of high resolution ultrasonic procedures in the diagnosis of lymphomas of the neck, a comparative study of palpation, sonography and the surgical findings was undertaken. 42 patients were studied and 210 criteria evaluated. The error incidence was found to be 23.8% for palpation, 4.8% for the sonography and 1% for the combination of the two methods. The suprasonic procedure can detect a lymphoma from 5 mm. on, whereas palpation is only possible upward of 15 mm. Therefore, high resolution sonography enables a more precise evaluation and diagnosis of lymphomas of the neck. It facilitates the locating of the lymphomas during surgery and also allows the differentiation to the large vessels of the neck preoperatively. Thus, sonography of the neck is of high informative value there is no physical inconvenience or stress for the patient, and it is easy and quick to administer.

Adolescent↗
PubMed1982

Chiropractic biomechanical evaluations: validity in myofascial low back pain.

In this study, 58 subjects with myofascial low back pain and 26 asymptomatic controls were evaluated according to a protocol of biomechanical analysis involving the plumbline, lateral bending dynamic roentgenograms, sacro-iliac motion palpation, lumbar motion palpation and straight-leg-raising. The outcomes of each test were blinded as to group assignment and the data was assessed statistically to derive each test's independent scores of sensitivity, specificity, predictive value and accuracy. It was observed that plumbline analysis and lateral bending dynamic roentgenograms produced the most accurate prediction of correct diagnoses. Sacro-iliac and lumbar motion palpation were nearly equivalent in predicting which cases were not symptomatic.

Adult↗
PubMed1983

Use of milk progesterone enzyme immunoassay for differential diagnosis of follicular cyst, luteal cyst, and cystic corpus luteum in cows.

In 160 cows with ovarian cysts as determined by rectal palpation, differentiation was made of follicular cyst, luteal cyst, and cystic corpus luteum on the basis of milk progesterone concentrations estimated by an enzyme immunoassay before and at 10 days after cows were treated with gonadotropin-releasing hormone. Cows having a progesterone concentration in skim milk less than 1.0 ng/ml were considered to have follicular cysts and those with concentrations of 1.0 ng/ml or higher were regarded as the cases of luteal cyst or cystic corpus luteum. Luteal cyst was characterized by progesterone values remaining high in the cows for 10 days after treatment, and cystic corpus luteum was characterized by a decrease in progesterone concentration after cows were treated. By the rectal palpation procedure it was impossible to differentiate luteal cyst and cystic corpus luteum from follicular cyst. The frequencies of follicular cyst, luteal cyst, and cystic corpus luteum were 65%, 19%, and 16%, respectively. Of 104 cows with follicular cysts as defined by milk progesterone assay result, 73 (70%) responded to the treatment with gonadotropin-releasing hormone, the milk progesterone concentration increasing from 0.7 +/- 0.2 ng/ml (mean +/- SD) to 1.8 +/- 1.1 ng/ml. The accuracy of rectal palpation 10 days after treatment for judgment of luteinization of follicular cyst confirmed by milk progesterone analysis was only 30% (48 cows of 160).

Animals↗
PubMed1984

[Initial results of echographic staging in cervical cancer].

Twenty women with invasive carcinoma of the cervix were investigated by means of rectal sonography. A radical Wertheim's operation was performed in all cases. Ultrasound investigation was more accurate than rectovaginal palpation. Comparison between ultrasound or rectovaginal palpation with the pathohistological findings confirm that ultrasound is factual while palpation still includes bias. However, it is not yet possible to differentiate between inflammatory and carcinomatous infiltration of the parametria. The size of carcinomas restricted to the cervix can be estimated by means of ultrasound.

Female↗
PubMed1982

Evaluation of an ultrasonic amplitude depth analysis technique for pregnancy diagnosis in the cow.

Beef and dairy cows (n = 1,053) were tested for pregnancy on 7 farms by ultrasonic scanning. Accuracy was verified by comparison with rectal palpation. Rectal palpation was done 40 to 75 days after breeding and was considered 100% accurate for comparison purposes. Although diagnostic accuracy of the ultrasonic scanning technique was less than 100%, a confidence interval no larger than 2.3% indicated a high degree of precision for pregnant cows. The confidence interval in the nonpregnant category ranged from 9.2% to 11.8%, which was small in relation to the variation in ultrasonic scanning accuracy. However, considering the large number of cows and the experimental bias that was purposely introduced, the lower accuracy of the ultrasonic method was not unexpected. Cystic ovaries, partially involuted uteri, metritis, and high milk production prevalent at one location accounted for much of the variation observed and lowered the overall accuracy for all cows tested. The ultrasonic analyzer has potential in testing cows for pregnancy; however, technical improvements in machine configuration must be made and additional testing in controlled experiments and field trials must be conducted before an accurate analysis of this method can be made. At the present state of development, ultrasonic amplitude depth analysis cannot replace rectal palpation for diagnosis of pregnancy in cattle.

Animals↗
PubMed1995

A new method for identifying the depth of insertion of tracheal tubes.

When a patient's lungs require mechanical ventilation, a plastic breathing tube (tracheal tube, TT) must be inserted through the vocal cords and into the trachea. Although insertion of the TT is a routine procedure, determining the correct depth of insertion is difficult clinically, and may require a chest radiograph. We investigated the accuracy of a simple clinical method for inserting a TT to the correct depth. Typically, an inflatable cuff surrounds the distal circumference of the TT to occlude the gap between TT and tracheal wall. Our technique involves pressing gently with one finger on the front of the lower part of the neck to locate the center of the cuff. We hypothesized that a) a palpating finger can identify the cuff through the tracheal wall, and b) if placed using this technique, the TT will be correctly positioned in the trachea. We studied 79 patients in whom TTs were inserted for general anesthesia. TTs were inserted to a depth determined by the palpation technique. We developed a stylet incorporating a magnetic reed switch which could be inserted through the TT. A magnet with specific field characteristics was passed along the front of the neck to locate the reed switch and confirm the location of the cuff. The TT position in the trachea was then examined with a fiberoptic scope. The palpation technique resulted in optimal positioning of the TT in all subjects and could save approximately $14,268/year in chest radiograph costs in our institution.

Adult↗
PubMed1994

Ultrasound evaluation of thyroid abnormalities and volume in Chinese adults without palpable thyroid glands.

Typical examination of the thyroid gland involves palpating the patient. If goiter is found, thyroid ultrasonography and/or aspiration cytology is usually performed in addition to assay of thyroid hormones and antibodies. However, palpation may not be sensitive enough to detect thyroid lesions. The purpose of this study was to evaluate the prevalence of thyroid abnormalities detected by ultrasonography in Chinese adults without palpable thyroid glands admitted for health examination. Two hundred and seventy-seven patients (aged 17 to 79 years; mean, 52 years) admitted to National Taiwan University Hospital for health examinations were included in this study. The thyroid was first palpated by a thyroidologist. Goiter was detected in 77 out of 277 patients (27.8%). Two hundred patients who had no palpable goiter underwent thyroid ultrasonography. Thyroid abnormalities were detected in 37 out of 200 patients (18.5%). These included 18 cases of thyroid cyst, 13 cases of solid nodule, and six cases of multiple nodules with ill-defined margins. Patients with thyroid abnormalities were older than those without lesions [59.3 +/- 9.2 years (mean +/- SD) vs 50.1 +/- 12.8 years, p < 0.001]. In addition, we also calculated the thyroid volumes of 163 patients who had neither palpable goiter nor lesions detected by ultrasonography. The thyroid volumes were 7.7 +/- 3.3 mL and positively correlated to the body mass index (BMI, r = 0.17, p < 0.05) and body weight (r = 0.28, p < 0.005). Males (n = 115) had larger thyroid volume than females (n = 48) (8.3 +/- 3.3 vs 6.1 +/- 2.6 mL, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

[Detection of liver metastases in colorectal neoplasms: use of intraoperative echography].

Fifty patients were consecutively operated on for colorectal cancer. Preoperative ultrasonography and intraoperative palpation were compared to intraoperative ultrasonography to determine their relative capacities in the detection of liver metastases. Preoperative ultrasonography detected metastases in three patients (6%), intraoperative palpation in four (8%) and intraoperative ultrasonography in 5 (10%). The number of metastases detected were 7, 19 and 19 respectively. The comparison failed to yield significant differences. From statistical viewpoint, both preoperative ultrasonography and intraoperative palpation were found to be as effective as intraoperative ultrasonography in detecting liver metastases.

Aged↗
PubMed1996

Prospective evaluation of different diagnostic techniques for the detection of liver metastases at the time of primary resection of colorectal carcinoma.

OBJECTIVE: To evaluate preoperative and operative methods of detecting liver metastases in patients undergoing primary resection for colorectal carcinoma. DESIGN: Prospective, open study. SETTING: Teaching hospital, Germany. SUBJECTS: 51 Patients with confirmed primary colorectal carcinoma. INTERVENTIONS: Computed tomography during arterial portography (CT-AP), percutaneous ultrasonography (US), operative palpation and examination of the liver, operative US, and computed tomography (CT) follow-up 6-12 months postoperatively. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive value, and accuracy. RESULTS: Overall accuracy was worst for CT during portography, because of the diagnosis of many false positive lesions. Exploration and palpation of the liver had the highest sensitivity (83%) and specificity (100%), and operative US did not give any useful additional information. CONCLUSIONS: Preoperative percutaneous US is recommended as the best non-invasive screening test; otherwise careful inspection and palpation during operation are sufficient for the evaluation of the liver during primary resection for colorectal carcinoma.

Colonic Neoplasms↗