Palpation
Encyclopedia
Palpation is used as part of a physical examination
in which an object is felt (usually with the hands of a healthcare practitioner) to determine its size, shape, firmness, or location. Palpation should not be confused with palpitation
, which is an awareness of the beating of the heart.
, osteopathic medicine
, physical therapists, occupational therapists, and massage therapists
, to assess the texture of a patient's tissue (such as swelling or muscle tone), to locate the spatial coordinates of particular anatomical landmarks (e.g., to assess range and quality of joint
motion), and assess tenderness through tissue deformation (e.g. provoking pain with pressure or stretching). In summary, palpation might be used either to determine painful areas and to qualify pain felt by patients, or to locate three-dimensional coordinates of anatomical landmarks to quantify some aspects of the palpated subject.
Palpation is typically used for thoracic
and abdominal examinations, but can also be used to diagnose edema
and to measure the pulse
. It is used by veterinarians to check animals for pregnancy
, and by midwives
to determine the position of a fetus
.
Quantitative palpation of anatomical landmarks for measurements must occur according strict protocols if one wishes to achieve reproducible measurements. Palpation protocols are usually based on well-described definitions for the location of anatomical, usually skeletal, landmarks.
Manual palpation of skeletal landmarks (illustrated here on a patient's shoulder, see left image). The gauntlet on the palpating ha (left) allows to locate the spatial coordinates of the palpated landmarks with a satisfactory accuracy (below 1 cm). Reflective markers are part of the scientific protocol and allow further quantified motion analysis for joint disorders follow-up.
Virtual palpation of skeletal landmarks located on a 3D bone models (illustrated here on a patient's knee model obtained from medical imaging, see right image). Coloured spheres on bones indicate palpated skeletal landmarks. This method combined with quantified manual palpation allows subject-specific visualisation of joint behavior during particular motion tasks (e.g., walking, stair climbing, etc).
The above protocols can be used independently. Manual palpation is used in clinical activities for various aims: - identification of painful areas; - positioning of particular pieces of equipment (electromyography
electrodes, auscultation, external landmarks used in clinical motion analysis
or body surface scanning); or - measurements of morphological parameters (e.g., limb length). Virtual palpation alone is useful to quantify individual morphological parameters from medical imaging
: - limb length; - limb orientation; - joint angle; or - distance between various skeletal locations.
Combining data from both manual and virtual palpation protocols allows achieving supplementary analysis: - registration protocols aiming at building reference frames for motion representation according reproducible clinical conventions; - to modelize joint kinematics accurately during musculoskeletal analysis; - to align precisely orthopaedic tools according to the individual anatomy of a patient; or - to wrap and to scale surface textures to motion data when creating animation characters.
Use of standardized definitions for the above activities allows better result comparison and exchange; this is a key element for patient follow-up, or the elaboration of quality clinical and research databases. Such definitions also allow acceptable repeatability by individuals with different backgrounds (physiotherapists, medical doctors, nurses, engineers, etc). If applied strictly, these definitions allow better data exchange and result comparison thanks to standardization of the procedure. Without anatomical landmark standardization, palpation is prone to error and poorly reproducible.
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
in which an object is felt (usually with the hands of a healthcare practitioner) to determine its size, shape, firmness, or location. Palpation should not be confused with palpitation
Palpitation
A palpitation is an abnormality of heartbeat that causes a conscious awareness of its beating, whether it is too slow, too fast, irregular, or at its normal frequency. The word may also refer to this sensation itself...
, which is an awareness of the beating of the heart.
Uses
Palpation is used by various therapists such as medical doctors, practitioners of chiropracticChiropractic
Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
, osteopathic medicine
Osteopathic medicine
Osteopathic medicine is a branch of the medical profession in the United States. Osteopathic physicians, known as DOs, are licensed to practice medicine and surgery in all 50 states and are recognized in forty-seven other countries, including most Canadian provinces.Frontier physician Andrew Taylor...
, physical therapists, occupational therapists, and massage therapists
Massage
Massage is the manipulation of superficial and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle"...
, to assess the texture of a patient's tissue (such as swelling or muscle tone), to locate the spatial coordinates of particular anatomical landmarks (e.g., to assess range and quality of joint
Joint
A joint is the location at which two or more bones make contact. They are constructed to allow movement and provide mechanical support, and are classified structurally and functionally.-Classification:...
motion), and assess tenderness through tissue deformation (e.g. provoking pain with pressure or stretching). In summary, palpation might be used either to determine painful areas and to qualify pain felt by patients, or to locate three-dimensional coordinates of anatomical landmarks to quantify some aspects of the palpated subject.
Palpation is typically used for thoracic
Chest
The chest is a part of the anatomy of humans and various other animals. It is sometimes referred to as the thorax or the bosom.-Chest anatomy - Humans and other hominids:...
and abdominal examinations, but can also be used to diagnose edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
and to measure the pulse
Pulse
In medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the...
. It is used by veterinarians to check animals for pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
, and by midwives
Midwifery
Midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding....
to determine the position of a fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...
.
Quantitative palpation of anatomical landmarks for measurements must occur according strict protocols if one wishes to achieve reproducible measurements. Palpation protocols are usually based on well-described definitions for the location of anatomical, usually skeletal, landmarks.
Locating anatomical landmarks
Locating anatomical landmarks can be performed using two palpation protocols: 1) manual palpation that allows spatial location of landmarks using hands combined or not with three-dimensional (3D) digitizing, and 2) virtual palpation on 3D computer models obtained, for example, from medical imaging.Manual palpation of skeletal landmarks (illustrated here on a patient's shoulder, see left image). The gauntlet on the palpating ha (left) allows to locate the spatial coordinates of the palpated landmarks with a satisfactory accuracy (below 1 cm). Reflective markers are part of the scientific protocol and allow further quantified motion analysis for joint disorders follow-up.
Virtual palpation of skeletal landmarks located on a 3D bone models (illustrated here on a patient's knee model obtained from medical imaging, see right image). Coloured spheres on bones indicate palpated skeletal landmarks. This method combined with quantified manual palpation allows subject-specific visualisation of joint behavior during particular motion tasks (e.g., walking, stair climbing, etc).
The above protocols can be used independently. Manual palpation is used in clinical activities for various aims: - identification of painful areas; - positioning of particular pieces of equipment (electromyography
Electromyography
Electromyography is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle...
electrodes, auscultation, external landmarks used in clinical motion analysis
Motion analysis
Motion analysis is a topic in computer vision, image processing, and machine vision that studies methods and applications in which two or more consecutive images from an image sequences, e.g., produced by a video camera, are processed to produce information based on the apparent motion in the images...
or body surface scanning); or - measurements of morphological parameters (e.g., limb length). Virtual palpation alone is useful to quantify individual morphological parameters from medical imaging
Medical imaging
Medical imaging is the technique and process used to create images of the human body for clinical purposes or medical science...
: - limb length; - limb orientation; - joint angle; or - distance between various skeletal locations.
Combining data from both manual and virtual palpation protocols allows achieving supplementary analysis: - registration protocols aiming at building reference frames for motion representation according reproducible clinical conventions; - to modelize joint kinematics accurately during musculoskeletal analysis; - to align precisely orthopaedic tools according to the individual anatomy of a patient; or - to wrap and to scale surface textures to motion data when creating animation characters.
Use of standardized definitions for the above activities allows better result comparison and exchange; this is a key element for patient follow-up, or the elaboration of quality clinical and research databases. Such definitions also allow acceptable repeatability by individuals with different backgrounds (physiotherapists, medical doctors, nurses, engineers, etc). If applied strictly, these definitions allow better data exchange and result comparison thanks to standardization of the procedure. Without anatomical landmark standardization, palpation is prone to error and poorly reproducible.
See also
- Physical examinationPhysical examinationPhysical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
- Inspection (medicine)Inspection (medicine)In medicine, inspection is the thorough and unhurried visualization of the client. This requires the use of the naked eye.During inspection, the examiner observes:External signs:...
- Percussion (medicine)Percussion (medicine)Percussion is a method of tapping on a surface to determine the underlying structure, and is used in clinical examinations to assess the condition of the thorax or abdomen. It is one of the four methods of clinical examination, together with inspection, palpation and auscultation...
- AuscultationAuscultationAuscultation is the term for listening to the internal sounds of the body, usually using a stethoscope...
- Motion analysisMotion analysisMotion analysis is a topic in computer vision, image processing, and machine vision that studies methods and applications in which two or more consecutive images from an image sequences, e.g., produced by a video camera, are processed to produce information based on the apparent motion in the images...
- Medical imagingMedical imagingMedical imaging is the technique and process used to create images of the human body for clinical purposes or medical science...