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At least 19 recordsLinked to original sources
PubMed1995

Pressure-controlled palpation: a new technique which increases the reliability of manual palpation.

The objective of the present study was to investigate whether the reliability of tenderness evaluation can be increased by using a new technique called "pressure-controlled palpation" (pcp). The technique has been made possible by a newly invented piece of equipment called a palpometer, with which a pressure-sensitive plastic film attached to the index finger records the pressure exerted. In 15 patients with chronic tension-type headache and in 15 healthy volunteers, 2 investigators studied myofascial tenderness using conventional palpation and pressure-controlled palpation. Tenderness was scored on a 4-point scale in each of the examined pericranial regions. The sum of tenderness scores recorded by two observers using conventional palpation differed significantly (p = 0.0003), while results did not differ between observers using pressure-controlled palpation (p = 0.89). During palpation with seven different pressure intensities a positive and linear relation between pressure and pain intensity was found (p = 0.00006). Pain intensity reported by the subjects correlated highly with tenderness scored by the observer (rs = 0.95, p < 0.0001). These results demonstrate for the first time that tenderness scores can be compared between observers if palpation pressure is controlled. Pressure-controlled palpation represents a major improvement on current palpation techniques and should be standard in future research on myofascial pain disorders.

Adult↗
PubMed2001

Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure.

BACKGROUND: Vaginal palpation is commonly used in clinical practice to teach and evaluate pelvic floor muscle strength, and several grading systems have been developed. The aim of the present study was to test inter-rater reproducibility of the modified Oxford grading system and compare results from vaginal palpation with squeeze pressure measurement. METHODS: Twenty female physical therapy students, mean age 25.1 years (range 21-38) participated in the study. Two experienced physical therapists conducted the palpation test in random order. Muscle strength was classified according to a 6-point scale (modified Oxford grading system). Results from the palpation test were compared with measurement of vaginal squeeze pressure using a vaginal balloon connected to a fiberoptic microtransducer (Camtech AS, Sandvika, Norway). To ensure validity of pressure measurement only contractions with simultaneous observation of inward movement of the perineum were registered. RESULTS: The inter-rater reliability for vaginal palpation was 0.70 measured by Spearman's rho (p<0.01). Cohen's Kappa was kappa=0.37 (SEM 0.16). There was agreement between the physical therapists in nine subjects (45%). In all but one subject the disagreement was one category. Mean maximal strength for the group was 19.7 cm H2O (95% CI: 16.5-22.9). There were no differences between weak, moderate, good and strong muscle contraction classified by palpation test when comparing results from the vaginal squeeze pressure (p=0.66). CONCLUSIONS: Vaginal palpation is mandatory when teaching correct pelvic floor muscle contraction. However, the present results indicate that the method is not reproducible, sensitive and valid to measure PFM strength for scientific purposes.

Adult↗
PubMed2001

Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players. Victorian Institute of Sport tendon study group.

BACKGROUND: Palpation is an important clinical test for jumper's knee. OBJECTIVES: To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality. METHODS: In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively. RESULTS: Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36-38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (p<0.001). Tender and symptomatic tendons were more likely to have ultrasound abnormality than tenderness alone (p<0.01). CONCLUSIONS: In this age group, palpation is a reliable test but it is not cost effective in detecting patellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal.

Adolescent↗
PubMed1975

The effect of rectal palpation on the fertility of cyclic mares.

The effect of rectal palpation of fertility of non-lactating, normal cyclic mares was studied over 3 years. During the first year (1971), the conception rates in mares after daily paplaption during oestrus only, and during oestrus and the first 50 days of pregnancy, were not significantly lower (P greater than 0-05) than the conception rates recorded in mares not palpated. No abortions could be attributed to palpation. Oestrus lasted longer (P less than 0-05) in non-palpated than palpated mares. During the second year (1972), first-cycle pregnancy rates in two groups of mares palpated daily during oestrus were lower (P less than 0-05) than those of mares not palpated. Daily palpation and insemination on the palpator's recommendation resulted in fewer (P less than 0-05) inseminations per cycle than in mares inseminated every other day of oestrus. During the third year (1973), the difference of first-cycle conception rates between mares palpated on alternate days of oestrus and those not palpated was not significant. Throughout the three years of the study, first-cycle conception rates following insemination with undiluted semen were higher (P less than 0-025) in non-palpated mares than in palpated mares (45-7 versus 79-2%).

Animals↗
PubMed1983

Carotid palpation and heart rate changes in postmyocardial infarction patients.

Forty cardiac rehabilitation patients were selected to determine the effects of carotid artery palpation at different time periods during rest, exercise, and recovery on the bicycle ergometer and following jogging-in-place. Fifteen-second carotid artery palpation was performed twice during minutes 1 and 3. The experimenter palpated during minute 1 while the subject palpated during minute 3. A significant decrease in resting heart rate occurred during minute 1 when the experimenter palpated, but no significance was evident during minute 3 when the subject palpated. During exercise with experimenter palpation, a significant decrease in HR occurred during the second 15 seconds of minute 1. Subject palpation during minute 3 did not significantly influence exercise heart rate. Both experimenter and subject palpation during minutes 1 and 3, respectively, of recovery 1 (on the bike) resulted in significant decrease in recovery heart rate. Jogging-in-place (recovery 2) was not influenced by experimenter or subject palpation. The significance of these findings lies in the fact that, although carotid palpation had a significant influence on heart rate, the differences were too small to be determined by a 10- or 15-second count. Thus, carotid palpation cannot be considered a threat to the postmyocardial infarction patient's safety.

Carotid Arteries↗
PubMed1999

Relationships between results of the Ortolani method of hip joint palpation and distraction index, Norberg angle, and hip score in dogs.

OBJECTIVE: To determine whether results of the Ortolani method of hip joint palpation in dogs were related to distraction index (DI), Norberg angle, or radiographic hip score. DESIGN: Cross-sectional study. ANIMALS: 459 clinically normal dogs. PROCEDURE: Dogs were sedated for radiography and palpation of the hip joints. Results of hip joint palpation were classified as negative, mild positive, moderate positive, or severe positive. Distraction indices were measured for all dogs. Norberg angles were measured for 380 dogs for which ventrodorsal hip-extended radiographic projections were available. Hip scores assigned by the Orthopedic Foundation for Animals (OFA) were available for 95 dogs. RESULTS: Age, weight, and sex were not significantly associated with results of hip joint palpation. There was moderate correlation between results of hip joint palpation and DI (r = 0.636), low-moderate correlation between results of hip joint palpation and OFA hip scores (rs = 0.437), and weak negative correlation (r = -0.236) between results of hip joint palpation and Norberg angle. For joints without degenerative joint disease (DJD), there was a significant linear relationship between results of hip palpation and DI; however, for joint with DJD, there was not. Results of hip joint palpation were 5.3-fold as likely to be negative for dogs with DJD as for dogs without. CLINICAL IMPLICATIONS: Results of hip joint palpation were at best moderately correlated with radiographic measures of hip joint laxity. Therefore, hip joint palpation should be combined with hip-extended and stress radiography when assessing hip joint quality.

Animals↗
PubMed2002

Palpation of the upper thoracic spine: an observer reliability study.

OBJECTIVE: To assess the intraobserver reliability (in terms of hour-to-hour and day-to-day reliability) and the interobserver reliability with 3 palpation procedures for the detection of spinal biomechanic dysfunction in the upper 8 segments of the thoracic spine. DESIGN: A repeated-measures design was used in all substudies. SETTING: Department of Nuclear Medicine, Odense University Hospital, Denmark. PARTICIPANTS: Two chiropractors examined 29 patients and 27 subjects in the interobserver part and 1 chiropractor examined 14 patients and 15 subjects in the intraobserver studies. INTERVENTION: Three types of palpation were performed: Sitting motion palpation and prone motion palpation for biomechanic dysfunction and paraspinal palpation for tenderness. Each dimension was rated as "absent" or "present" for each segment. All examinations were performed according to a standard written procedure. RESULTS: Using an "expanded" definition of agreement that accepts small inaccuracies (+/-1 segment) in the numbering of spinal segments, we found--based on the pooled data from the thoracic spine--kappa values of 0.59 to 0.77 for the hour-to-hour and the day-to-day intraobserver reliability with all 3 palpation procedures. Kappa coefficients were 0.24 and 0.22 for the interobserver reliability with prone and sitting motion palpation and 0.67 and 0.70, respectively, with paraspinal palpation for tenderness. CONCLUSION: With expanded agreement we found good hour-to-hour and day-to-day intraobserver reliability with all 3 palpation procedures and good interobserver reliability for paraspinal tenderness. The interobserver reliability was unacceptably poor with prone and sitting motion palpation.

Adult↗
PubMed1994

Muscle palpation with controlled finger pressure: new equipment for the study of tender myofascial tissues.

While manual palpation is the most important method for evaluation of tender myofascial tissues, it lacks reliability. Therefore, we have developed an instrument, called a 'palpometer', which allows the measurement of pressure exerted during palpation. The palpometer consists of a thin pressure-sensitive plastic device attached to the palpating finger, and of a scale recording the pressure applied to the device. Known forces were applied to the pressure sensitive device under various experimental conditions and the corresponding values were read on the palpometer scale. Then 14 observers, blinded to the palpometer scale, palpated the temporal muscle on the same subject twice, with an interval of 1 week. A highly significant correlation was found between palpometer recordings and forces applied to the pressure-sensitive device (P < 0.0001). Exerted force at a given palpometer value varied 3.1% within and 7.2% between 2 observers. During palpation of the temporal muscle pressure intensities within the 14 observers did not differ significantly from week to week (P = 0.68). Between the 14 observers pressure intensities varied considerably with a range of 73.5-196 arbitrary units. Thus, a reliable instrument for measuring pressure intensities during palpation of myofascial tissue has been developed. The large variation in palpation pressures between observers indicates that palpation of tender myofascial tissue may be considerably improved by use of the palpometer. This instrument will be indispensable in research studies employing palpation and in the training of physicians to diagnose myofascial pain disorders.

Adult↗
PubMed1998

Sensitivity and cost minimization analysis of radiology versus olive palpation for the diagnosis of hypertrophic pyloric stenosis.

BACKGROUND/PURPOSE: Two strategies are commonly used for the initial diagnosis of hypertrophic pyloric stenosis (HPS): (1) physical examination and (2) radiologic evaluation using upper gastrointestinal series (UGI) or sonography. The authors wished to determine the sensitivity and relative cost of each strategy. METHODS: The charts of 234 patients presenting over 3 years with a history suggestive of HPS were reviewed retrospectively. Cost, expressed as mean diagnostic charges (MDC) and mean total charges (MTC), was calculated according to two theoretical models. In model A, all patients first are examined by a surgeon. If an olive is palpable, they proceed to surgery. If not, they are sent to radiology. In model B, all patients have radiologic investigation first, and then surgical evaluation if the study result is positive. RESULTS: Of the 234 patients, 150 had HPS (64%). Olives were appreciated in 111 of these (palpation sensitivity of 74%). There was one false-positive olive (0.7%) and no false-negatives. Sonography and UGI were equally accurate (sensitivity of 100%, 0.5% false-positive). Equations were generated to estimate MDC and MTC for our patient population under each model. In model A, MDC = $507 - ($221 x palpation sensitivity) and MTC = $2,543 ($240 x palpation sensitivity). In model B, MDC = $449 and MTC = $2,454, and costs were independent of ability to feel an olive. When cost was plotted against palpation sensitivity, model A yielded a lower MDC than model B if palpation sensitivity was at least 26%, and a lower MTC if palpation sensitivity was at least 37%. Because our palpation sensitivity was 74%, approximately $100 per patient would be saved by sending all infants suspected of having HPS to a surgeon for examination as an initial step. CONCLUSIONS: Although highly sensitive, imaging is superfluous if an olive is palpable. Children suspected of having HPS should have a surgical consultation before a radiology study as long as the surgeon's palpation sensitivity for an olive is at least 37%. Improved palpation skills will result in maximum financial savings.

Costs and Cost Analysis↗
PubMed1997

How accurate is the assessment of thyroid volume by palpation? A prospective study of 316 patients.

Goitre is the cardinal symptom of most thyroid diseases and treatment is often influenced by the evaluation of thyroid size. Quantitative palpation of the thyroid gland could offer a quick and easy initial examination method for discovering most thyroid diseases. However, this clinical technique is frequently underestimated and its accuracy is not evaluated. Therefore, we examined the question whether thyroid volume can be determined with sufficient precision by manual palpation. 316 patients with suspected thyroid diseases were selected at random at our hospital and prospectively studied. Thyroid volume of each patient was assessed by palpation followed by ultrasonically scanning. The examinations were performed by two physicians: an endocrinologist (A) and a resident (B) who had undergone a structured palpation training. Ultrasonic scanning of 99 thyroid glands revealed a high level of agreement (r2 = 0.87) between both physicians. Examiner A evaluated 111 patients by palpation and ultrasonic scanning. The mean volume determined by ultrasound was 35.9 ml (SD = 27.1 ml) with a range of 4-152 ml. This correlated well with the results of palpation (r2 = 0.872). Examiner B evaluated 215 patients. These ultrasonically determined volumes had a mean value of 37.3 ml (SD = 24.2 ml; range 4-145 ml) and correlated well with the results obtained by palpation (r2 = 0.856). A total of 53 patients were examined by both physicians. The interobservers' comparison of the palpation results yielded an excellent correspondence (r2 = 0.893). We conclude that the manual palpation technique yields sufficiently precise quantitative results for clinical purposes and can be taught. Clinical assessment of thyroid size on a routine basis should result in better diagnostic strategies for thyroid diseases and in cost savings.

Adolescent↗
PubMed2002

Motion palpation findings and self-reported low back pain in a population-based study sample.

BACKGROUND: Although the clinical usefulness of motion palpation has not been established, it is one of the most commonly used diagnostic methods by chiropractors. Notably, its sensitivity, specificity, and validity in general have not been adequately studied, and most study samples have consisted of student volunteers. OBJECTIVE: To determine the prevalence of positive motion-palpation findings (so-called fixations and spontaneous pain response) in relation to self-reported low back pain status and to determine the sensitivity and specificity of the motion-palpation technique carried out on the sacroiliac and lumbar joints. DESIGN: Study subjects were examined by 1 examiner (out of 7 possible), who was unaware of their low back pain status. Information on low back pain was then collected in a self-report questionnaire. SETTING: Research laboratory at the Odense University Hospital, Denmark. PARTICIPANTS: One hundred eighty-four twins, consisting of a subset of healthy twins taken from a panel of population-generated twins aged 19 to 42 years, made up the study sample. Examiners consisted of 7 biomechanics (chiropractic) students from the University of Southern Denmark who were proficient in motion palpation. MAIN OUTCOME MEASURES: The prevalence rates of motion palpation-determined fixations and of spontaneous pain reactions in response to motion palpation were studied in relation to anatomic area, self-reported low back pain status, and each other. RESULTS: The point period prevalence of low back pain was 14%. Fixations were found in 43% of the study sample, and 25% appeared to have a painful reaction to motion palpation. There was no logical pattern of fixations and spontaneous pain reactions in relation to the low back pain status. The sensitivity was generally low (always below 60%) for fixations and pain, whereas the specificity was higher, significantly so for pain in the mid lumbar area. There was no strong association between fixations and the examiners' interpretation of a spontaneous pain reaction in response to motion palpation. CONCLUSION: Motion palpation does not appear to be a good method to differentiate persons with or without low back pain. It is possible to dissociate the findings of fixations and those of pain reactions.

Adult↗
PubMed1993

Fetal loss associated with palpation per rectum to diagnose pregnancy in cows.

A prospective observational study was performed to determine whether palpation per rectum of cows in the first 6 weeks of gestation to diagnose pregnancy contributed to fetal attrition. Pregnancy diagnoses were made by private practitioners as part of their routine herd-health service on 9 dairies in the San Joaquin Valley of California. To determine whether there was an association between abortion and fetal age at time of palpation, the probability of abortion was tested as a function of fetal age at palpation, controlling for possible modifying and confounding effects of herd, age at conception, gravidity, parity, and number of days-in-lactation at conception. Results of logistic regression analyses for 19,411 pregnancies followed for up to 90 days after palpation indicated that, during the 28- to 42-day period, palpation of fetuses earlier in the period was associated with a significantly (P < 0.0001) low probability of abortion, compared with that for palpation later in the period. An association between abortion and palpation of fetuses > 42 days of age was not found. Results were suggestive that, given conditions and techniques typical of private practice, fetal death may not be a usual manifestation of early palpation of cows to diagnose pregnancy, rather, that there may be a slight increase in risk of fetal death as the fetal age at palpation increases from 28 to 42 days.

Abortion, Veterinary↗
PubMed2004

A randomized trial of suprasternal palpation to determine endotracheal tube position in neonates.

OBJECTIVE: To compare suprasternal palpation, a previously described bedside technique, with standard chest radiography for correct positioning of the endotracheal tube (ETT) in newborn infants. STUDY DESIGN: A randomized single-blinded study in an academic medical center. Preterm and term newborn infants requiring intubation were eligible, provided that they had not had their initial chest roentgenogram (CXR). Infants were randomized to ETT palpation and non-adjustment (Controls), or to ETT palpation and adjustment (Treatment), following digital palpation of the ETT tip in the suprasternal notch. ETT position was considered correct when only the tip of the ETT was palpable in the suprasternal notch. ETT position by CXR was blindly assessed by an experienced pediatric radiologist. RESULTS: Fifty-five infants were enrolled in the delivery room or neonatal intensive care unit. Correct tube placements improved from 48% pre-study to 85 and 93% in the Control and Treatment arms, respectively. The majority of incorrect estimations were that the ETT position using palpation was judged to be too low when it was, in fact, in correct position, as noted in 11 infants. ETT palpation had a 70% concordance with the position determined by CXR. No difficulties or complications were associated with the use of suprasternal palpation. CONCLUSIONS: Suprasternal palpation is a simple, safe, teachable, method of confirming ETT position in neonates when CXR is unavailable, and may especially helpful during neonatal resuscitation prior to surfactant administration.

Female↗
PubMed2000

Classification of thyroid size by palpation and ultrasonography in field surveys.

BACKGROUND: Goitre surveys are used to assess the degree of iodine deficiency in a population. The change of goitre classification made by WHO in 1994 implied that a smaller thyroid size should be regarded as goitre. Furthermore, the acceptable goitre prevalence was lowered from 10% to 5%, and ultrasonography was recommended as a more precise method for diagnosis of goitre. We studied the effects of the change of palpation system, and compared the precision of the old and new systems with that of ultrasonographic examination. METHODS: We studied 225 schoolchildren (aged 7-14 years) in a highland village in Tanzania. The size of the thyroid was assessed in duplicate by ultrasonography and by WHO's 1960 and 1994 palpation systems. The latter were done by three examiners. Variations within and between examination methods and examiners were assessed, and measurement errors by ultrasonography were assessed from duplicate examinations. The sensitivity and specificity of the two palpation systems were calculated, with diagnosis by ultrasonography as the gold standard. Apparent palpation prevalences were calculated at a "true" 5% prevalence. FINDINGS: The lowered criterion for goitre resulted in an extra 20-33% of children being diagnosed as having goitre by palpation. The variation between repeat examinations was only slightly smaller by ultrasonography (kappa=0.63) than by experienced examiners (kappa=0.57-0.58). The variation between thyroid volume estimation by ultrasonography and the true volume was about 50% due to both measurement error and variation in the shape of thyroid lobes. The new goitre criterion decreased specificity from 76% to 29%, whereas sensitivity rose from 56% to 80%. In contrast, a suggested sharpening of the old criterion increased specificity to 90%. INTERPRETATION: A return to the old (1960) palpation criterion for goitre: "lobes larger than the terminal phalanxes of thumbs" and to an accepted palpation goitre prevalence of 10% can allow affordable monitoring of thyroid size through palpation in field surveys.

Adolescent↗