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PubMed1975

Clinical findings in relation to morphology in breast carcinoma.

In 117 women with breast cancer, breast size, tumour size, suspicion of malignancy and clinical stage (Columbia Clinical Classification) were assessed clinically by palpation. Tumour size, degree of differentiation, malignancy grading (Ackerman), co-existent cystic fibroadenosis and axillary node metastases were assessed histopathologically. Differentiation was also assessed cytologically. There was good agreement between clinical and pathological measurements of tumour size. Ackerman's histopathological grading of malignancy correlated with the other criteria better than some other systems of malignancy grading. A higher histopathological malignancy grade was found in larger tumours and older patients. There was no clear relationship between cytological and histopathological malignancy grading. Lymph node metastases occurred three times more often in large breasts than in small ones, in spite of relatively slight differences in tumour size. Cancers in breast with cystic fibroadenosis were smaller, less malignant histopathologically and had fewer lymph node metastases than cancers in breasts without cystic fibroadenosis. "Definite cancer" on palpation was more often associated with a highly malignant tumour than a less suspected palpatory finding.

Adult↗
PubMed2002

Trigger points: diagnosis and management.

Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.

Anesthetics, Local↗
PubMed2002

Temporomandibular disorders after whiplash injury: a controlled, prospective study.

AIMS: Whiplash injury to the neck is often considered a significant risk factor for development of temporomandibular disorders (TMD), and has been proposed to produce internal derangements of the temporomandibular joint (TMJ). Few studies, however, have examined TMD-related pain in acute whiplash patients compared with a matched control group. The aim of the present study was to assess pain and sensorimotor function in the craniofacial region in an unselected group of patients sustaining a motor vehicle accident involving a rear collision. METHODS: Prospectively, 19 acute whiplash patients exposed to a motor vehicle accident involving a rear collision participated in a study of TMD. The control group consisted of 20 age- and gender-matched ankle-injury patients. Participants were seen within 4 weeks and again at 6 months post-injury. The masticatory system was examined in accordance with the research diagnostic criteria. Participants underwent structured interviews, filled out the McGill Pain Questionnaire (MPQ), and had their masticatory system examined by a trained dentist, blinded to their diagnosis. Pain detection threshold (PDT) to pressure stimuli, and maximal voluntary occlusal force (MVOF) were obtained at each visit. RESULTS: One whiplash patient and 1 ankle-injury patient had jaw pain at the first visit. Palpation scores of the TMJ and the summated palpation scores only tended to be higher in patients sustaining a whiplash injury than in ankle-injury controls at the first visit. However, MPQ, TMD symptoms and signs, MVOF and PDT were not significantly different in whiplash-injury and ankle-injury patients after 4 weeks and 6 months. CONCLUSION: TMD pain after whiplash injury and ankle injury is rare, suggesting that whiplash injury is not a major risk factor for the development of TMD problems. Further studies are needed to identify which other factors may contribute to TMD pain.

Adult↗
PubMed2002

[Effects of the intensity of a post partum examination on the fertility performance of high yielding dairy cows].

Two methods for a scheduled post partum examination were compared on a commercial dairy farm. In Group 1, all cows (n = 601) were examined by rectal palpation between day 20 and 26 post partum for signs of endometritis (vaginal discharge, enlarged uterus). In Group 2, all cows (n = 652) were examined by external inspection for vaginal discharge as a sign for endometritis. In both groups all cows with endometritis were treated twice with prostaglandin F2 alpha (25 mg of dinoprost) in a 14-day interval. The proportion of cows with signs of endometritis was 33.3% and 17.2% in Group 1 and Group 2, respectively (p < 0.05). In Group 1, the conception rate (39.0% vs 49.3%) and the proportion of cows pregnant (60.5% vs 72.6%) were lower for cows with endometritis than for cows without endometritis. In Group 2, no significant differences were found in reproductive performance for cows with and without signs of endometritis. No significant differences in reproductive performance were found for cows with endometritis between the two groups. Also, for cows without endometritis no significant differences in reproductive performance were found between the groups. It is concluded that the post partum examination by rectal palpation was more sensitive in finding cows with endometritis. However, with regard to the reproductive performance the more sensitive method was not more effective than the method based on systematic external inspection.

Animals↗
PubMed1992

Cervicogenic dysfunction in muscle contraction headache and migraine: a descriptive study.

OBJECTIVE: The prevalence and nature of findings of cervicogenic dysfunction is explored in subjects with muscle contraction/tension-type (MCH) headache and common migraine without aura (CM). DESIGN: Descriptive survey. SETTING: Chiropractic outpatient research clinic. PATIENTS: Forty-seven (47) subjects, aged 18-55 with two categories of benign headache, were studied: MCH (tension-type) n = 19 (6 males, 13 females) and CM (without aura), n = 28 (3 males, 25 females). Subjects were recruited as part of an intervention trial and, thus, form a consecutive sample of patients. The present findings were elicited as part of the initial assessment. INTERVENTION: No therapeutic intervention is reported. MAIN OUTCOME MEASURES: Standardized headache history; plain film and dynamic spinal X rays; motion palpation; and pressure algometry. RESULTS: For CM, the most prevalent headache locations were frontal (81%) and occipital (78%). Neck pain and upper back pain accompanied headache in 90% and 41% of subjects, respectively. For MCH, the most prevalent headache locations were occipital (87%) and frontal (81%). Neck and upper back pain accompanied headache in 100% and 27%, respectively, of all subjects. For the total group, 77% of all subjects and 89% of females exhibited a marked reduction, absence or reversal of the normal cervical lordosis. Ninety-seven percent of all subjects exhibited, on dynamic X-ray studies, at least one significant abnormality of segmental mobility from C1 to C7, while 43% exhibited abnormalities at four or more segments. Segmental motion at C0-C1 was reduced in 90% of subjects in flexion and 70% of subjects in extension. On motion palpation, 84% of CM and MCH subjects were found to have at least two major fixations from C0 to C2. On pressure algometry, 92% of CM and 85% of MCH had at least one verifiable tender point (TP) in the upper cervical region. The most common locations for TPs were mid-cervical (C2-C3), lateral occipital and suboccipital. CONCLUSIONS: Both MCH and CM subjects demonstrate high occurrences of: a) occipital and neck pain during headaches; b) tender points in the upper cervical region; c) greatly reduced or absent cervical curve; and d) X-ray evidence of joint dysfunction in the upper and lower cervical spine. These findings support the premise that the neck plays an important, but largely ignored role in the manifestation of adult benign headaches. A case-control study should be conducted to confirm the greater prevalence of cervicogenic dysfunction in headache as compared to nonheadache subjects.

Adolescent↗
PubMed1959

Hypertrophic pyloric stenosis.

Hypertrophic pyloric stenosis, a relatively common condition, is caused by hyperplasia of the musculature of the pylorus. The diagnosis is made by a history of projectile vomiting and failure to gain weight, the observation of gastric peristaltic waves, and the palpation of a pyloric "tumor." A method of palpating this tumor is described in detail. Roentgenological studies are rarely indicated. Pylorotomy for treatment of hypertrophic pyloric stenosis was not successful until the development of necessary supporting measures. Preparation for operation consists of intravenous administration of fluids and electrolytes and sometimes serum or whole blood. The position of the tumor governs the choice between two different incisions. The operative procedure herein described is essentially that devised by Ramstedt many years ago, with modifications to facilitate the procedure.

Body Fluids↗
PubMed2004

Symptoms and signs of temporomandibular disorders in individuals with chronic whiplash-associated disorders.

The purpose of this study was to compare the prevalence of temporomandibular disorders (TMD) between individuals with chronic whiplash-associated disorders (WAD) and a group of age- and sex-stratified patients attending a Public Dental Service (PDS) clinic. Fifty-four individuals diagnosed with chronic WAD that were referred to a rehabilitation centre constituted the WAD group. The control group consisted of 66 patients at a PDS clinic (C group). Both groups underwent a standardised examination of the masticatory system comprising a questionnaire and a clinical examination. Eighty-nine per cent of the individuals in the WAD group had severe symptoms of TMD according to Helkimo's anamnestic index of dysfunction (A1) compared with 18% in the C group (p < 0.001). The individuals in the WAD group had also more signs of TMD. The maximum mouth opening capacity was 48 mm in the WAD group and 54 mm in the C group (p < 0.001). In the WAD group 17% had a mouth opening capacity < 40 mm compared with 2% in the C group (p < 0.05). Pain on palpation of the jaw muscles and on lateral palpation of the temporomandibular joints was more common in the WAD group (p < 0.001). Pain on mandibular mobility was reported by 30% in the WAD group and by 3% in the C group (p < 0.001). In conclusion, the prevalence of TMD was higher among individuals with chronic WAD compared with an age- and sex-stratified cohort of patients in a general dental practice. The results indicate that trauma to the neck also affects temporomandibular function.

Adult↗
PubMed2005

Evaluation of female pelvic-floor muscle function and strength.

Evaluation of pelvic-floor muscle (PFM) function and strength is necessary (1) to be able to teach and give feedback regarding a woman's ability to contract the PFM and (2) to document changes in PFM function and strength throughout intervention. The aims of this article are to give an overview of methods to assess PFM function and strength and to discuss the responsiveness, reliability, and validity of data obtained with the methods available for clinical practice and research today. Palpation, visual observation, electromyography, ultrasound, and magnetic resonance imaging (MRI) measure different aspects of PFM function. Vaginal palpation is standard when assessing the ability to contract the PFM. However, ultrasound and MRI seem to be more objective measurements of the lifting aspect of the PFM. Dynamometers can measure force directly and may yield more valid measurements of PFM strength than pressure transducers. Further research is needed to establish reliability and validity scores for imaging techniques. Imaging techniques may become important clinical tools in future physical therapist practice and research to measure both pathophysiology and impairment of PFM dysfunction.

Electromyography↗
PubMed2005

[Diagnosis and treatment of 23 cases with stylohyoid syndrome].

PURPOSE: To assess the diagnosis and treatment of stylohyoid syndrome. METHODS: The clinical data of 23 patients with stylohyoid syndrome were analyzed retrospectively,the symptoms,age,gender, length of styloid process, and clinical signs were investigated in their relationship to the disease onset , the value of styloidectomy via transoral and extraoral approach was compared. RESULTS: (1) Pain and foreign body sensation in oropharyngeal area accounted for 83%(19/23) of the symptoms ,followed by 43%(10/23) of headache, tongueache and periauricular discomfort. (2) Females were more often affected than males. The age peak was 50s and 30s ,accounting for 43%(10/23) and 30%(7/23) respectively. (3) 91%(21/23) of the excised styloid processes were longer than 3cm in length, 9% (2/23) of them shorter than 3cm but with abnormality in shape. (4) 57%(13/23) of the elongated styloid processes could be palpated transorally. (5) Through extraoral approach, all kinds of diseased styloid processes could be excised thoroughly and safely. CONCLUSIONS: Stylohyoid syndrome is one of the causes of head and neck pain. A complete medical history , careful palpation of the oral pharyngeal area, and radiographic examination are essential for the diagnosis. Styloidectomy by extraoral approach is effective for curing of the disease.

Adolescent↗
PubMed2005

[Influence of time of initiation of a prostaglandin F2alpha protocol in dairy cows with puerperal endometritis].

A field trial was conducted to elucidate the effect of the time of initiation of a repeated PGF2alpha-application in a 14 day interval for treatment of endometritis in dairy cows. On a commercial dairy farm in Brandenburg, Germany, a total of 494 dairy cows were examined by rectal palpation and adspection for signs of endometritis (vaginal discharge, enlarged uterus) between day 20 to 26 post partum (dpp). We performed two further examinations by rectal palpation and external adspection to monitor the puerperal phase (34.-40. dpp, 55.-61. dpp). All cows with symptoms of an endometritis were treated with PGF2alpha (0.15 mg R-Cloprostenol, Preloban, Intervet Deutschland GmbH Unterschleissheim) twice in a 14-day interval. In the group "Early" (n = 146) the first injection of Cloprostenol was administered at time of the 1st examination. In the group "Late" (n = 129) an identical treatment was administered in cows with endometritis, however it was started 14 days later (34.-40. dpp). The incidence of endometritis was 57.7% in the group "Early" and 53.5% in the group "Late" at the first time of examination. The 1st service conception rates for treated cows were 34% in the group "Early" vs. 37% in the group "Late". In the group "Early" differences were found in days open between treated cows with endometritis and untreated controls without symptoms of endometritis (99.1 d vs. 110.8 d, p > 0.05). In the group "Late", days open for treated (106.8 d) and untreated cows (108.0 d) were similar. The severity of endometritis influenced the percentage of cows pregnant at 200 dpp. Regarding cows with a severe endometritis (E2 and E3) the percentage of pregnant cows 200 dpp was higher in the group treated early (E2: 78.4%; E3: 80.0%) than in the group with the late initiation of the treatment (E2: 68.6%; E3: 54.5%, p < 0.05). Cows with a moderate endometritis (E1) had a similar percentage of pregnant cows (200 dpp) as the untreated cows without endometritis. It is concluded that application of PGF2alpha in the 4th and 6th week post partum in a 14 day interval in cases of severe endometritis is more effective than the application of the same treatment two weeks later.

Animals↗
PubMed2005

Pressure pain threshold of the lateral pterygoid muscles in TMD patients and controls.

OBJECTIVES: The aim of this experiment was to detect pressure pain threshold (PPT) differences on intra-oral palpation of the lateral pterygoid muscle (LPM) between subjects diagnosed with temporomandibular disorders (TMD) and controls. METHODS: Thirty-one consecutive female TMD patients and 31 age and gender matched controls underwent palpation of the LPM using an algometer made with a queue-tip connected to a digital scale, and PPT was measured. RESULTS: Mean PPTs of the right and left LPM of the controls were respectively 191g (49KPa) and 200g (51KPa), and mean PPTs of the right and left LPM of TMD patients were respectively 245g (62KPa) and 256g (63KPa). ANOVA between the four PPT measurements showed significant difference only between the PPT readings of the right LPM of the controls and the left LPM of the patients (p<0.05). CONCLUSIONS: The findings of this study suggest that PPT measured by means of the described algometer is not decreased in TMD patients as compared to control subjects.

Adult↗
PubMed2005

A comparison of pressure pain detection thresholds in people with chronic low back pain and volunteers without pain.

BACKGROUND AND PURPOSE: Palpation is often utilized in the physical examination of patients with low back pain. The purpose of this study was to compare the pressure pain detection threshold (PPDT) of people with chronic low back pain (CLBP) and subjects without pain. SUBJECTS AND METHODS: Thirty female subjects with CLBP were recruited from the offices of primary care physicians and physical therapists and compared with 30 female volunteers without pain for differences in PPDT at 6 sites tested bilaterally. RESULTS: A significantly lower mean PPDT was found for all test site groups in subjects with CLBP compared with subjects without pain. A lower global PPDT was found in subjects with CLBP compared with subjects without pain (5.6 lb/cm(2) versus 6.9 lb/cm2). This also was the case for PPDT for the group of test sites unrelated to the lumbar spine (5.1 lb/cm(2) versus 6.1 lb/cm(2)) and for PPDT related to the lumbar spine (5.9 lb/cm(2) versus 8.0 lb/cm(2)). DISCUSSION AND CONCLUSION: Neurobiological or biopsychosocial influences may have contributed to the lower PPDT evident in subjects with CLBP. Subjects with CLBP demonstrated a lower global PPDT compared with subjects without pain, which should be taken into account when interpreting findings of pain or tenderness from palpation.

Adult↗
PubMed2006

Intraoperative physical diagnosis in the management of anal fistula.

This report reviews a prospective database applying a systematic fistulomy technique in 101 patients requiring surgery for fistula in ano at LAC+USC Medical Center during a 15-month period. Data were collected for the reliability of primary crypt palpation, success of tract injection with peroxide/methylene blue, and the accuracy of Goodsall's rule. Time to healing, recurrence, and incontinence according to type of procedure were also recorded. Palpation of the primary crypt was possible in 93 per cent. Hydrogen peroxide/methylene blue injection successfully delineated the tract in 83 per cent. Goodsall's rule was correct in 81 per cent. Each fistula was categorized as intersphincteric (n = 72), transphincteric (n = 33), extrasphincteric (n = 1), or submucosal (n = 6). At a mean follow-up period of 44 weeks, 89.2 per cent of patients were cured. Reasons for recurrence included wound bridging (n = 6), misdiagnosis of the tract (n = 3), and two blind-ended fistulae (n = 2). Time to healing in weeks was (mean, range): simple fistulotomy (12, 3-21), seton (16, 4-28), Hanley procedure (28, 8-48). Patients with a marsupialized tract healed at an average of 6 weeks (range 4-8). Four (3.9%) patients reported postoperative incontinence (1 gas, 3 liquid, 0 solids).

Diagnosis, Differential↗
PubMed2006

[The results of thyroid ultrasound examination in randomly selected schoolchildren].

UNLABELLED: Iodine deficiency is an actual problem of public health and mostly manifests as enlargement of the thyroid (goiter). OBJECTIVE: The aim of the study was to determine the prevalence of goiter using different evaluation criteria and to establish the relationship between changes in thyroid volume and dimensions of the body. MATERIAL AND METHODS: Thyroid palpation and ultrasound examination were performed in 310 (7-11-year-old) randomly selected schoolchildren from two Lithuanian nearby small towns (Birzai and Rokiskis) in the district with lowest urinary iodine excretion (5.4 and 4.5 microg/dl). The size of thyroid gland was determined by inspection and palpation using the World Health Organization criteria. All children were examined ultrasonographically; thyroid volume was assessed by two criteria: F. Delange (1997) and M. B. Zimmermann (2004). RESULTS: There were no differences in means and medians of age and all body parameters (height, weight, body surface area, body mass index) in boys and girls of the same age. Higher means and medians of the body surface area in all age groups were found in Birzai as compared to Rokiskis (p<0.05). Comparing body mass index of all investigated schoolchildren with upper limits (97th percentile) of body mass index of normal British children, no statistically significant difference in the prevalence of obesity between towns was observed (1.9% - in Rokiskis, 5.0% - in Birzai; p>0.05). Grouping the children according to age revealed a higher prevalence of goiter in Birzai as compared to Rokiskis (88% vs. 63%, respectively, according to M. B. Zimmermann and 25% vs. 10%, respectively, according to F. Delange; p<0.05). There was no significant difference in the prevalence of goiter between the towns when children were grouped by body surface area. In all groups by age and body surface area, the mean thyroid volume exceeded 97th percentile by M. B. Zimmerman and did not exceed by F. Delange. CONCLUSIONS: The prevalence of goiter, assessing the thyroid volume in 7-11-year-old children by the different criteria, is significantly different. We recommend using the criteria based on body surface area in order to evaluate the constitutional characteristics of individual child's development.

Age Factors↗
PubMed1991

[Detection of early prostatic cancer in mass screening program].

Since 1975 up to 1988, we have performed a mass screening program (MS) for prostatic diseases using transrectal ultrasonography (TRS) in the primary study. In our study, 42 cases of prostatic cancer (0.6%) was detected among 6,674 examinees. Out of 42 cases of cancer, 24 (57.1%) were diagnosed as early prostatic cancer (Stage A 1, Stage B 23). The detection rate of cancer in MS and the ratio of early stage of cancer among them were higher than those in the outpatient clinic of our department. Diagnostic accuracy of TRS, palpation and tumor markers in MS were studied respectively through our series of MS. TRS was useful for MS especially in low false negative rate. On the other hand, palpation was characteristic in low false positive rate. Prostatic specific antigen (PSA) among tumor markers was effective to detect early prostatic cancer. However, there were some problems about distinguishing early prostatic cancer from BPH, because of the high false positive rate.

Aged↗
PubMed1991

Trigger point of the posterior iliac crest: painful iliolumbar ligament insertion or cutaneous dorsal ramus pain? An anatomic study.

A trigger point is frequently found over the iliac crest at 7 to 8 cm from the midline in low-back-pain syndromes. Previously, this was described as either a painful insertion site of the iliolumbar ligament or pain in the distribution of the cutaneous dorsal ramus of the first or second lumbar nerve. The authors performed 37 dissections, and they report their anatomic findings. The iliac insertion of the iliolumbar ligament is inaccessible to palpation, being shielded by the iliac crest. The dorsal rami of L1 or L2 nerve roots, however, cross the crest at 7 cm from the midline, and this distance closely correlates with the dorsal projection of the iliolumbar ligament insertion. These rami are superficial and dorsal to the crest, easily accessible to palpation. In two of the 37 dissections performed, some rami were found to be narrowed as they crossed through an osteofibrous orifice over the crest, thus being susceptible to an entrapment neuropathy. The authors conclude that the trigger point sometimes localized over the iliac crest at 7 cm from the midline likely corresponds to elicited pain from a cutaneous dorsal ramus originating from the thoracolumbar junction rather than from the iliac insertion of the iliolumbar ligament.

Back Pain↗
PubMed1991

The clinical diagnosis of splenomegaly.

Assessing for the presence of splenomegaly is an important component of the physical examination. Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. We review the literature comparing various physical examination techniques with noninvasive imaging modalities and conclude that palpation and percussion of the spleen are complementary but frequently insensitive and that further studies are needed to evaluate the efficacy of specific diagnostic methods.

Evaluation Studies as Topic↗
PubMed1991

[Methods for ensuring correct tracheal intubation. A review].

To confirm correct intubation of the trachea, the literature mentions the following methods: Auscultation of thorax, the sensation of normal ventilation, gastric and thorax movement, condensation of water vapor in the tube lumen, external palpation on the patient's neck of the tube and the cuff, tactile palpation through the patient's mouth of the tube, x-ray of thorax and detection of hemoglobin oxysaturation with pulse oximetry. These methods can be used, but cannot be recommended, because they are not reliable. The following methods are recommended in the literature as reliable: Repeated laryngoscopy when there are direct visualization of the vocal cords, fiberoptic bronchoscopy, suction on the tube with a 60-ml syringe, auscultation of the upper abdomen and lungs and end-tidal carbon dioxide measurement. For the daily routine, control, of the endotracheal tube placement, by auscultation over the epigastrium, then in the right and left axilla, and continuous measurement of carbon dioxide in the expired air are recommended.

Auscultation↗