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PubMed1992

The reliability of lumbar motion palpation.

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

Back Pain↗

PubMedDate not supplied

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

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

Adult↗

PubMed1992

Should we palpate foot pulses?

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

Adult↗

PubMed1983

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

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

Chiropractic↗

PubMedDate not supplied

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

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

Adolescent↗

PubMed1999

Manipulative physiotherapists can reliably palpate nominated lumbar spinal levels.

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

Analysis of Variance↗

PubMed1996

Postexercise heart rates and pulse palpation as a means of determining exercising intensity in an aerobic dance class.

OBJECTIVE: To establish the accuracy of the traditional method of measuring the intensity of exercise in aerobic dance classes, that is, intermittent pulse palpation performed during a brief cessation of activity. METHODS: A short wave telemetry system was used to record heart rates during a class in a group of 12 healthy women aged 26 (SD 6) years. Subjects palpated their pulses for 10 s following high and low intensity exercise [78(8)% and 69(9)% of mean predicted maximum heart rate respectively]. Recorded exercising heart rates, averaged over 60 s preceding pulse palpation [ExHR(rec)], were compared with the recorded postexercise heart rates averaged over the 10 s palpation period [PostExHR(rec)] and with the palpated counts (PalpHR). Differences were assessed using Student's t test and Wilcoxon signed rank test. RESULTS: Differences between ExHR(rec) and PostExHR(rec) following high and low intensity exercise [3(6) beats.min-1 and 5(7) beats.min-1 respectively] were not significant. However, the wide variation between subjects means that a postexercise heart rate is unreliable as a measure of individual exercise intensity. PalpHR was significantly lower than ExHR(rec) (P < 0.01). Every individually palpated count underestimated the exercising heart rate (range 9 to 95 beats.min-1). CONCLUSIONS: While postexercise heart rate adequately represents the exercise heart rate for a group, the individual variation is too wide for this to be a useful measurement.

Adult↗

PubMed2005

Ultrasonography using simple diagnostic criteria vs palpation for the detection of regional lymph node metastases of melanoma.

OBJECTIVES: Our aims were (1) to compare the respective ability of ultrasonography and palpation to detect nodal metastasis during initial staging and follow-up in patients having melanomas and (2) to assess, we believe for the first time, which ultrasound criteria should be used to define metastasis in cases of cutaneous or mucosal melanoma. DESIGN: Prospective single-center study. Nodal metastasis was confirmed by histopathologic evaluation. SETTING: Dermatology and radiology departments of a university hospital. PATIENTS: A total of 160 new consecutive patients with stage I to stage III melanoma. INTERVENTION: Experienced operators independently performed 391 paired palpation and ultrasonographic examinations. MAIN OUTCOME MEASURES: Firm enlarged nodes found on palpation were considered metastatic. On ultrasonographic examination, circular or oval hypoechoic lymph nodes lacking hyperechoic hila were considered metastatic (stringent criteria). Nodes with 2 or fewer of these patterns and other published signs of metastasis (ie, intranodal nodular hypoechoic focus and irregularity of the node margin) were considered suspicious. RESULTS: Over the 6-year study period 33 patients developed nodal metastasis. For palpation and ultrasonography using the stringent criteria, respectively, sensitivity was 41.5% (95% confidence interval [95% CI], 29.6-53.5) and 76.9% (95% CI, 66.7%-87.2%) (P<.001) and specificity was 95.7% (95% CI, 93.5%-97.9%) and 98.4% (95% CI, 97.1%-99.8%) (P<.05). Including ultrasonographically suspicious lymph nodes significantly lowered specificity (86.2% [95% CI, 82.5-89.9]) (P<.05) without improving sensitivity. Previous lymphadenectomy had little impact on ultrasonographic findings. CONCLUSION: Ultrasonography using stringent criteria of nodal metastasis, which are easy to identify and reliable, is superior to palpation for early detection of regional lymph node metastases of melanoma.

Adult↗

PubMed2006

The assessment of levator trauma: a comparison between palpation and 4D pelvic floor ultrasound.

AIMS: Major morphological abnormalities of the pubovisceral muscle are observed in 10-20% of women symptomatic of pelvic floor disorders. Such defects arise in childbirth and are associated with prolapse. While they are clearly evident on 3D ultrasound and MR imaging, such defects can be difficult to detect clinically. We intended to compare findings on palpation with the results of ultrasound imaging. MATERIAL AND METHODS: Fifty-five women were recruited in a prospective observational study and assessed by interview, vaginal examination by a trained pelvic floor physiotherapist, and 3D/4D pelvic floor ultrasound. The vaginal examination involved digital assessment of muscle strength (modified Oxford grading) and morphological abnormalities. The ultrasound examination involved acquisition of volume datasets taken at rest, on Valsalva and pelvic floor muscle contraction. Assessments were undertaken supine and after voiding. Ultrasound operator and physiotherapist were blind to each other's findings. RESULTS: A comparison of 3D ultrasound and palpation was possible in 54 cases. Average Oxford grading was weakly associated with reduction in hiatal dimensions on contraction (r = -0.32, P = 0.024). A marked increase in hiatal dimensions detected on palpation was associated with increased hiatal area on Valsalva (P = 0.027). Defects were observed in 7/54 (13%) on ultrasound and in 10/55 (18%) on palpation. There was poor agreement between the methods, with only two defects picked up equally by both methods. CONCLUSIONS: Palpation of the pubovisceral muscle correlates poorly with 3D/4D pelvic floor ultrasound imaging for the assessment of muscular defects.

Aged↗

PubMed2005

Can an instruction video or palpation aid improve the effectiveness of breast self-examination in detecting tumors? An experimental study.

INTRODUCTION: Although large randomized trials have not shown benefits for breast self-examination (BSE), many organizations still endorse the practice. This study aimed to determine whether an instruction video or palpation aid improved the effectiveness of BSE. METHODS: A total of 100 volunteers (50 men and 50 women) with no previous experience of BSE and/or clinical breast palpation were randomly assigned to the following intervention: instruction video seen versus not seen and use of palpation aids versus aids not used. Participants completed psychological trait and previous knowledge questionnaires before the intervention and/or breast examination. Examination was carried out on 24 different sized silicone breast forms, into 20 of which had been inserted tumor equivalents measuring 0.8-3.0 cm in diameter. The dependent variable was the rate of accurate tumor detection--the mean sum of correct positive hits (CPH)--defined as tumors detected within 20 s. Mean CPH values were then analyzed in relation to the interventions and other variables including gender and psychological measures (ANOVA and COVAR). RESULTS: Neither the instruction video nor interaction effects between gender and the instruction video influenced the mean CPH value. Furthermore, the palpation aid was strongly and significantly associated with a reduced detection (p=0.00003). CONCLUSION: Using an instruction video or palpation aid did not improve the effectiveness of breast examination in detecting tumors--a finding which supports results from large randomized studies. It is difficult to understand why BSE is still promoted by various groups.

Adult↗

PubMed2005

Measurement of the pressure applied during motion palpation and reliability for cervical spine rotation.

OBJECTIVE: To measure the pressure applied during motion palpation for cervical spine rotation and to verify its effect on reliability when the kinematics of the test are standardized. METHODS: The pressure of palpation used during the test of cervical spine rotation was measured by means of flexible and extra-fine pressure sensors linked to an electronic interface. Seven pressure measurements (left rotation from C1 to C7) for each of 24 examiners were taken. In addition, the examiners were asked to detect the presence of intervertebral fixation while palpating. RESULTS: Pressure of palpation varied from 4.0 to 41.0 N/cm2 among the examiners. Standardization of the kinematics of the test establishes a strong reliability of identifying a fixation (kappa varying from 0.701 to 0.748). CONCLUSIONS: The pressure applied during motion palpation for cervical spine rotation is light to moderate. It can vary tenfold (4-41 N/cm2) and remain reliable for identifying a fixation as long as the kinematics of the test are standardized.

Adult↗

PubMedDate not supplied

Motion palpation of the lumbar spine--a problem with the test or the tester?

OBJECTIVES: The purpose of this study is to investigate if it is possible to recognize whether a specific lumbar motion segment was manipulated or not by using motion palpation (MP) as a diagnostic tool in ordinary clinic patients and by using teams of practitioners with various levels of experience. METHODS: Two teams were created: team A had an experienced doctor of chiropractic who palpated the patients and an inexperienced doctor who performed the treatment, whereas team B had the opposite composition. One chiropractor in each of the 2 teams identified a fixation with the help of MP and specified the treatment of his or her choice for this fixation. A few minutes later, the second chiropractor then randomly either manipulated or did not manipulate the indicated segment, according to the first chiropractor's instruction. Blinded, the first chiropractor repalpated the segment and determined whether or not treatment was provided. Results were compared with (1) chance findings, (2) the clinicians' own pre hoc and specific expectations in relation to the treated cases, and (3) our expectation in relation to the untreated cases. RESULTS: Team A failed to reach their own standards in relation to treated segments, not even being better than chance, and was also unable to detect the untreated cases. The palpating chiropractor in team B was able to identify the manipulated segments in 87% of 15 cases (P < .05) and in 80% of 11 nonmanipulated cases (not significant). The successful palpator, therefore, reached the team's general standard of 85% success rate but not the specific standard of a 100% success rate. None reached our standard of identifying 100% of all untreated segments. CONCLUSION: It is possible for some practitioners to identify treated segments using MP. Gold standard palpators should therefore be used to calibrate other persons' ability to perform MP, both in the clinical setting and in future research studies.

Chiropractic↗

PubMed1999

Gynecological examination and pregnancy diagnosis in small ruminants using bimanual palpation technique: a review.

A palpation technique using both hands was developed by the author and used for examination of internal reproductive organs, pregnancy diagnosis, and assessment of approximate stages of gestation in small ruminants. The study was conducted in 4 stages on 87 female goats and 30 slaughterhouse source ewes First, 20 doelings and 15 does with no recent history of insemination were examined by two hand method for palpability and structural integrity of internal reproductive organs. Next 52 goats (28 doelings and 24 does) were examined at 28 to 30 d post insemination for pregnancy. Among those diagnosed pregnant, 20 goats were examined at 15 d intervals to assess the palpable changes of pregnancy. Preslaughter palpation followed by post-slaughter verification of the findings were performed in 30 ewes. The two hand method was effective for palpating the reproductive tract in the nonpregnant goats irrespective of parity status. Gross palpation of the ovaries was possible in 83% of the goats. Of the 52 goats examined for pregnancy at 28 to 30 d, 29 (56%) had clear distension of uterus while 23 (44%) did not. The results were confirmed by kidding date or returning to service. Changes of the reproductive tract were monitored in 20 goats at biweekly intervals and the findings categorized by the stage of gestation. Post slaughter verification of preslaughter findings based on two handed palpation indicates that this technique can be used for early pregnancy diagnosis and assessment of the stage of gestation in goats and ewes.

Animals↗

PubMed2003

Palpation for muscular tenderness in the anterior chest wall: an observer reliability study.

OBJECTIVE: To asses the interobserver and intraobserver reliability (in terms of day-to-day and hour-to-hour reliability) of palpation for muscular tenderness in the anterior chest wall. DESIGN: A repeated measures designs was used. SETTING: Department of Nuclear Medicine, Odense University Hospital, Denmark. PARTICIPANTS: Two experienced chiropractors examined 29 patients and 27 subjects in the interobserver part, and 1 of the 2 chiropractors examined 14 patients and 15 subjects in the intraobserver studies. INTERVENTION: Palpation for muscular tenderness was done in 14 predetermined areas of the anterior chest wall with all subjects sitting. Each dimension was rated as absent or present for tenderness or pain for each location. All examinations were carried out according to a standard written procedure. RESULTS: Based on a pooled analysis of data from palpation of the anterior chest wall, we found kappa values of 0.22 to 0.31 for the interobserver reliability. For the intraobserver reliability, we found kappa values of 0.21 to 0.28 for the day-to-day reliability and 0.44 to 0.49 for the hour-to-hour reliability. CONCLUSION: Our results indicated great variations between experienced chiropractors palpating for intercostal tenderness or tenderness in the minor and major pectoral muscles in a population of patients with and without chest pain. This may hamper the ability of clinicians to diagnose and classify the musculoskeletal component of chest pain if based exclusively on palpation of the anterior chest wall.

Case-Control Studies↗

PubMed2001

Palpation of the lateral pterygoid region in TMD--where is the evidence?

OBJECTIVE: Palpation of the lower head of the lateral pterygoid muscle is included in many study protocols and examination schemes of the masticatory system. The aim of this investigation was to search the medical/dental literature to find evidence for the validity and reliability of this diagnostic procedure. METHODS: A systematic search was carried out using different electronic databases (Medline Ovid, PubMed, Cochrane Library, Embase, Current Contents Connect, Science Citation Index, Web of Science, Japana Centra Revuo Medicina), supplemented by handsearch in selected journals and by examination of the bibliographies of the identified articles. RESULTS VALIDITY: As far as the palpability of the inferior head of the lateral pterygoid muscle is concerned, five publications representing four studies could be identified. According to these investigations, the lateral pterygoid muscle is practically inaccessible for intraoral palpation due to topographical and anatomical reasons. Other anatomical structures, such as the superficial head of the medial pterygoid muscle, may be palpated instead in this region. Reliability: Determination of the palpability of the lateral pterygoid muscle is characterized by poor interexaminer agreement. Studies investigating the presence of pain in response to palpation of the lateral pterygoid area revealed a moderate intra- and interindividual reliability. Because of the tenderness of the lateral pterygoid region even among healthy subjects, positive findings may lead to wrong conclusions with regard to the need of treatment. CONCLUSIONS: Considering the lack of validity and reliability associated with the palpation of the lateral pterygoid area, this diagnostic procedure should be discarded.

Databases as Topic↗

PubMed2003

Diagnostic value of magnetic resonance imaging in Peyronie's disease--a comparison both with palpation and ultrasound in the evaluation of plaque formation.

OBJECTIVE: To compare the value of magnetic resonance imaging (MRI) with palpation and ultrasound in the evaluation of plaque formation in Peyronie's disease. METHODS: 57 patients underwent a standardized diagnostic procedure to evaluate plaque formation consisting of palpation and ultrasonography (7.5 MHz). MRI was performed during flaccidity and during erection induced by Prostaglandin E(1) including intravenous application of Gadolinium-diethylenetriaminepentaacetic acid (Gd-DPTA). RESULTS: With all methods, 93 plaques have been detected in 57 patients. 85 plaques (91.4%) have been evaluated by palpation alone. Using ultrasound, 52 of these 93 plaques (55.9%) were detectable. This is equivalent to 61.1% of the palpable plaques. MRI confirmed 58 of the palpated plaques (68.2%) and exposed 8 primarily not palpable plaques at the penile basis. MRI revealed more palpable plaques than ultrasound, but this finding was not significant (p = 0.083). By means of sonography, calcification was evident in 14 plaques. MRI failed in revealing any calcification. After application of Gd-DPTA, 5 of 57 patients (9%) demonstrated contrast enhancement indicating local inflammation. None of these patients reported on penile pain. CONCLUSIONS: Penile palpation in combination with ultrasound represents the method of choice to diagnose plaque formation in Peyronie's disease. MRI provides better information on plaque formation at the penile basis. Calcification can only be proven by ultrasound, not by MRI. There may be additional information by MRI about local inflammation. A prospective study comparing the histological and MRI findings should be performed to answer the question, if pain is really associated with inflammation.

Adult↗

PubMed1992

The role of inexperience in measuring tuberculin skin reaction (Mantoux test) by the pen or palpation technique.

We have shown previously that experienced readers can use the palpation or pen method for reading the Mantoux tuberculin skin test with accuracy. In order to investigate if the inexperienced reader can use both methods with the same degree of accuracy, we performed Mantoux tests in 539 healthy subjects, aged 20-57 years (mean 33 years), using the PPD-RT 23 in dose 2 I.U. (1/5000). In random order and a double-blind fashion, an experienced and an inexperienced reader measured the induration after 48 h by the palpation method initially and then by the pen method, without knowing the identity of the subject. Results of the study did not show any significant difference in any range of measurements by the two readers, using either the pen or palpation method (P greater than 0.1). A highly statistically significant linear relationship was found between the measurements by the pen method used by experienced and inexperienced readers (r = 0.823, P less than 0.0001) and between the palpation measurements by the two readers (r = 0.939, P less than 0.0001). We conclude that the effects of an inexperienced examiner in the measurement of of tuberculin skin induration are minimal. Inexperienced readers can use the pen method as accurately as the traditional palpation method.

Adult↗

PubMed2004

Inter- and intraexaminer reliability in palpation of the "primary respiratory mechanism" within the "cranial concept".

Inevitable subjectivity makes interexaminer reliability of manual assessment procedures a special matter of concern. The cranial concept (CC), one aspect of osteopathy, deals with very subtle changes that have to be palpated. One of the main principles of the CC is the primary respiratory mechanism (PRM), which is hypothesized to be a palpable physiological phenomenon that occurs in rhythmic cycles, called flexion- and extension-phase, which are independent from cardiac and respiratory rates. Palpation of the PRM is one of the first steps in assessment within the CC. An inter- and intraexaminer reliability study design for repeated measures was used in this study. Forty nine healthy subjects were palpated simultaneously twice, once at the head and once at the pelvis. PRM-frequency (f), the mean duration of the flexion phase and the mean ratio of flexion- to extension-phase were used as the main outcome measures. Inter- and intraexaminer reliability and correlations to the respiratory rates were analysed for all three parameters. Inter- as well as intraexaminer agreement could not be described beyond chance agreement, as the range within the 95% limits of agreement (e.g. for f=6.6 cycles/90 s) for all cases resembled the total range of values (e.g. for f=7 cycles/90 s) that were produced. A significant effect of the examiners' respiration was found for both examiners at the pelvis (P=0.004 for one examiner, P <0.0001 for the other examiner), and for one examiner only at the head (P=0.0017). No correlation could be found for the subjects' respiratory rates. In conclusion, PRM-rates could not be palpated reliably and under certain conditions were influenced by the examiners' respiratory rates. These results do not support the hypotheses behind the PRM. The role of PRM palpation for clinical decision making and the models explaining the PRM should therefore be rethought.

Adult↗