Palpation Skills Introduction 3

1/13/2014

GOLDEN RULES

1. Respect-at all times 2. Speak with a medical tongue Palpation Skills Introduction 3. Abbreviations are not allowed 4. We learn for life, we don’t memorize for an KIN 441 exam Spring 2014

Today’s objectives 5 Objectives of palpation

• Discuss palpation 1. Detect abnormal tissue texture 2. Evaluate symmetry in the position of • Learn different methods of palpating structures • Begin to learn what to expect when 3. Detect and assess variations in range and palpating different structures quality of motion, including end range 4. Sense the position in space of yourself and the patient 5. Detect and evaluate change in the palpated findings (improving or worsening) -Greenman, 1989

Dominant Eye PHYSIOLOGY!!!!!

• Make a triangle with your • Mechanoreceptors hands at arms length – Light and deep touch • Place an object in the • Proprioception hole – Muscle length • Close one eye – Muscle tension – Limb position – If the object stays = dominant eye • Nociceptors – If the object moves = non- – Pain dominant eye • Thermoceptors – Warmth – Cold

http://www.pc.rhul.ac.uk/staff/J.Zanker/PS1061/L6/mechano-rec-rev.jpg

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Localizing Dysfunction End-Feel • The characteristic feel of the limit of range of • Asymmetry motion based on various tissues • Range of motion/end feel End feel Description Normal Example • Tissue texture Soft Two muscle bellies Knee flexion, elbow in contact with one flexion • Tissue tenderness another

Firm Leathery or springy Ankle inversion, resistance from metacarpophalangeal capsule or ligament hyperextension Hard Abrupt end feel Elbow extension from two bones meeting each other Empty Pain; muscle Not Normal  guarding ends motion http://www.senseoftouchtherapeuticmassage.com/wp-content/uploads/2013/01/trigger-point-therapy.jpg

Principles of palpation Types of touch

1. Move slowly! • Smaller structures (carpal bones of the wrist) = use 1 or 2. Pressure is dependent on the structure and what you are 2 fingertips looking for. (Less is more) 3. Focus on what you are feeling. – If the structure you are palpating is • Larger structures (pelvis, sacrum, large muscle groups) = stationary, move your hands across it. If it is moving, keep your hands still. all fingers or whole hands – Practicing palpation will allow your hands to become your “eyes.”

Types of touch Touch and structures

• Use of two hands (abdomen)- one on top of the other • Skin: different body parts have different types of skin – Hand underneath palpates the structures and remains relaxed – ex) Hands - back of your hand skin is smooth and thin, palm – Hand above directs movement and depth and adjusts pressure side is thicker and rougher • Bone: easy to distinguish from other tissues because of it’s “solid” feel, though size and shape vary drastically. Bony prominences are often easily palpable and require less pressure to find. – ex) ASIS, ulnar styloid process

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Palpating different types of tissues Palpating different types of tissues

• Muscle: Vary widely in size, have a striated • Ligament: Dense, connective tissue (more unevenly configured than tendon tissue) that attaches bone to bone texture and fibrous quality. – ex) LCL of the knee – Relaxed - Soft, malleable quality • – Contracted - Firm, taut, solid feeling Fascia: 2 types: – Superficial- layering of adipose tissues, nerves, blood vessels, • Tendon- Dense, connective tissue shaped lymph and connective tissue into bundles of parallel collagen fibers that – Deep- Surrounds muscle bellies, fills space between muscles. attach muscle to bone – ex)biceps brachii tendon

Palpating different types of tissues Palpating different types of tissues

• Retinaculum: Transverse thickening of deep fascia that holds • Bursa: Small, fluid-filled sac that reduces friction between two organs or tissues in place structures. There are over 600 of these in the body! – ex) Retinaculum of the ankle stabilizes tendons of the ankle, – When bursa are inflamed (bursitis), they are more easily fibers run perpendicular to these tendons palpable • Arteries/ Veins: Some are extremely visible, others can become • Nerves: Tube shaped vessels that transmit impulses throughout more prominent if blood flow is occluded. Pulse can be felt in the body. arteries, but not veins. – Compression or impingement of these can cause sharp pains – If palpating for pulse, remember to use fingers and not or a shooting sensation locally or down an appendage. thumb!

Palpating different types of tissues Movement as a palpation tool

• Lymph nodes: Collect fluid from the lymphatic vessels. Vary •Having a person move in a certain way, or you moving them can widely in size and are located throughout the body. help locate certain structures. – In normal conditions, they are non-tender, but if they are • Active - Patient makes the motion. “Flex your elbow.” You can inflamed they will be tender and easy to locate. then palpate the biceps muscle. Have the person contract and relax to compare the muscle in both states. •Passive - You put the patient through the motion. This can be helpful if motion is restricted due to injury. •Resistive - Patient makes the motion and you resist it. “You flex your elbow and I’m not going to let you.” Always begin by applying gentle resistance.

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What we learned today

• Palpation is an important tool for all healthcare professionals. • Different structures have a different “feel” to them. • Practice, practice, practice!