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Palpation

Palpation is a technique used by a physician or medical provider during a physical examination. By placing hands on a patient, data can be gathered that is otherwise unknown by visualization only.

What Information it Provides

Information such as the temperature of the skin, the moistness or dryness of the skin, the shape of a structure, the location of pain, the radiation of the pain, the quality of function, strength of a structure, amount of swelling, sensation, circulation and so much more. Each area palpated by the medical provider has its own unique expected results that the provider is familiar with. Usually, only the abnormal findings or pertinent negatives are recorded in the exam.

How it is Performed

In order to achieve reproducible measurements so that each physician or medical provider palpated exam results can be compared, anatomical landmarks are defined for each are of exam.  These essential protocols are usually based on well-described definitions for the location of anatomical, usually skeletal, landmarks.

One of the main areas of palpation is the thorax or the chest. This exam could be to assess pain, difficulty breathing, traumatic damage, poor circulation or well-check. The medical provider will first assess the symmetry of chest expansion during breathing by placing their hands with fingers spread apart on the sides of the chest, about 2 inches below the axilla. While monitoring the chest rising and falling on inspiration and expiration, the physician may listen to breath sounds as well. The provider will then palpate from one side of the chest to the other. They may use tacticle fremitus as an indicator. It is the vibration that is felt when a person is talking or breather on the chest walls with a flat hand. Tactile fremitus is normally found over the mainstem bronchi near the clavicles in the front or between the scapulae in the back. As the physician moves their hands downward and outward, fremitus should decrease. Less than the patient’s normal fremitus in areas where fremitus is normally expected indicates obstruction, pnemothorax, or emphysema. More than the patient’s normal fremitus may indicate compression or consolidation of lung tissue, as occurs in pneumonia.

The abdomen is palpated in four quadrants; left-upper, left-lower, right-upper, left-lower. These quadrants are palpated with one hand flat against the abdomen and the second hand pushing increasing on the flat hand. The size, outline, location and presence of pain are noted.

Other areas such as joints, extremities, and systems can be palpated for anatomical and functional accuracy.

When It is Performed

A palpated exam should be performed by a physician or medical provider for any well-check examination or when a complaint is expressed.

Other Uses

Palpation can also be used by medical providers to place equipment such as electrodes for cardiograms or intravenous catheters for fluids or medicines. It also is used for feeling for a pulse. A pulse in certain areas can immediately tell a provider quickly the patient’s estimated blood pressure or if an extremity is not being perfused.

All data gathered in a palpated exam should be recording including abnormalities and pertinent negatives. Palpation is one of the most important tools when assessing a patient.

Image Caption: A male doctor of the Vietnamese Army palpates a young girl’s abdomen in the bac Ninh Province of Vietnam. Credit: JoAnn Moravac, U.S. Army/Wikipedia

Palpation


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