The Role of Palpation in Medicine

How Touch Is Used in a Physical Examination

Palpation is the process of using one's hand or fingers to identify a disease or injury of the body. It is used by medical practitioners to determine the size, shape, firmness, or location of an abnormality suggestive of disease.

This may include:

  • Feeling the texture of the skin for evidence of swelling or inflammation
  • Assessing the location and severity of pain
  • Examining for lumps or irregularities suggestive of a tumor, hernia, or fracture
  • Locating anatomical landmarks to identify structural irregularities, such as a joint dislocation or slipped disk
  • Determining the position of the fetus during pregnancy

Palpation is commonly used for abdominal or thoracic (chest) exams but can be applied to any part of the body, including the mouth, vagina, and anus. By its strictest definition, taking a person's pulse may be considered a form of palpation.

Types of Palpation

The sense of touch is just as important as the sense of sight in a physical examination. As part of their training, medical practitioners learn how to recognize problems on or below the surface of the skin by touch alone. They do so by applying general pressure with the hand or fingers to detect subtle changes that might otherwise go unnoticed by a layperson.

The techniques used for palpation can vary by the body part being examined, as well as the aims of the exam (i.e., screening vs. diagnosis). The below are just a few of the examples.

Thoracic Palpation

Thoracic palpation is typically used to diagnose problems of the chest or spine. It involves the touching of superficial and deep tissues to assess the position of the vertebra, the presence of edema (swelling) or lymphadenopathy (swollen lymph nodes), or any protrusion in the ribs, sternum, or spinal column.

The palpation may be performed in a seated position or when lying in a supine (face-up) or prone (face-down) position.

Palpation is also helpful in evaluating the function of the heart. The location, size, and force of the cardiac impulse on the chest wall can help determine whether the heart is working normally, and abnormal vibrations can indicate the presence of a cardiac murmur.

Abdominal Palpation

Deep palpation of the abdomen is performed by placing the flat of the hand on the abdominal wall and applying firm, steady pressure. Two-handed palpation—wherein the upper hand is used to exert pressure, while the lower hand is used to feel—is often useful in evaluating an abdominal mass.

Palpation may even help diagnose an abdominal aortic aneurysm. This is done by placing both hands on the abdomen with index fingers on each side of the aorta (located just above and to the right of the navel). If an abdominal aortic aneurysm is present, the fingers would separate with each heartbeat.

Uterine Palpation

Another two-handed procedure is the bimanual pelvic exam, also known as manual uterine palpation. It involves the compression of the lower abdomen with one hand and the palpation of tissues inside the vagina with the fingers of the other hand.

Breast Palpation

Palpation of the breasts is performed with the flats of the hand and fingers. The procedure is systematic and involves the clockwise assessment of the breast and nipples to check for consistencies and lumps. The nipples themselves would be palpated for elasticity and gently squeezed to check for discharge.

Hernial Palpation

Palpation is part of the process involved in the diagnosis and characterization of an inguinal hernia (the type situated in the lower abdomen or groin). The size of the hernia can be assessed by asking the subject to cough as the flats of fingers are placed against the bulging tissue. The back of the hand would be used to assess the temperature of the skin in comparison to the surrounding tissue.

Hand and Wrist Palpation

Hand or wrist injuries are typically diagnosed with palpation. The palpation might involve the gentle rotation of a joint as the fingers detect subtle signs such as crepitus (cracking sounds and sensations), diminished range of motion, or increased warmth and swelling indicative of inflammation.

Similar techniques may be applied to other joints, such as the knee, ankle, elbow, or shoulder.

Dental Palpitation

Palpitation can be used in dentistry to ascertain inflammatory conditions like periodontitis, the causes of a bite discrepancy (dental occlusion), or the development of a tooth abscess or oral lesion. This is typically carried out with the tip of the finger, looking for changes in texture, color, temperature, or gum consistency.

In addition to an intraoral examination, palpation may be used on the jaw muscles to feel for clicks or bite irregularities. This is typically performed by pressing the fingers of both hands on jaw muscles as the person bites down.

The same technique can be used to help diagnose temporomandibular joint (TMJ) disorders.

Palpation in Physical Exams

A physical examination, along with the review of your medical history, is usually the first step a doctor will take when diagnosing a medical condition or performing a routine physical.

There are four core components of a physical exam. They are not necessarily used on every body part but generally include:

  • Inspection, the visual examination of the body
  • Palpation, the touching of the body
  • Percussion, the tapping of the body to evaluate the size and consistency of an organ or check for the presence of fluid
  • Auscultation, listening to heart and bowel sounds with a stethoscope
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