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American Journal of Obstetrics and... Nov 2018Myofascial pain is characterized by the presence of trigger points, tenderness to palpation, and local or referred pain, and commonly involves the pelvic floor muscles...
BACKGROUND
Myofascial pain is characterized by the presence of trigger points, tenderness to palpation, and local or referred pain, and commonly involves the pelvic floor muscles in men and women. Pelvic floor myofascial pain in the absence of local or referred pain has also been observed in patients with lower urinary tract symptoms, and we have found that many patients report an improvement in these symptoms after receiving myofascial-targeted pelvic floor physical therapy.
OBJECTIVE
We sought to systematically review the literature for examination techniques used to assess pelvic floor myofascial pain in women.
STUDY DESIGN
We performed a systematic literature search using strategies for the concepts of pelvic floor disorders, myofascial pain, and diagnosis in Ovid MEDLINE 1946-, Embase 1947-, Scopus 1960-, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Cochrane Database of Systematic Reviews. Articles were screened by 3 authors and included if they contained a description of a pelvic myofascial physical examination.
RESULTS
In all, 55 studies met our inclusion criteria. Overall, examination components varied significantly among the included studies and were frequently undefined. A consensus examination guideline was developed based on the available data and includes use of a single digit (62%, 34/55) to perform transvaginal palpation (75%, 41/55) of the levator ani (87%, 48/55) and obturator internus (45%, 25/55) muscles with a patient-reported scale to assess the level of pain to palpation (51%, 28/55).
CONCLUSION
Physical examination methods to evaluate pelvic musculature for presence of myofascial pain varied significantly and were often undefined. Given the known role of pelvic floor myofascial pain in chronic pelvic pain and link between pelvic floor myofascial pain and lower urinary tract symptoms, physicians should be trained to evaluate for pelvic floor myofascial pain as part of their physical examination in patients presenting with these symptoms. Therefore, the development and standardization of a reliable and reproducible examination is needed.
Topics: Female; Humans; MEDLINE; Myofascial Pain Syndromes; Pain Measurement; Palpation; Pelvic Floor; Physical Examination; Urologic Diseases
PubMed: 29959930
DOI: 10.1016/j.ajog.2018.06.014 -
British Journal of Anaesthesia Aug 2018Peripheral vein cannulation is a routine and straightforward invasive procedure, although i.v. access can be difficult to obtain. To increase the success rate of... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Peripheral vein cannulation is a routine and straightforward invasive procedure, although i.v. access can be difficult to obtain. To increase the success rate of inserting an i.v. catheter, many devices have been proposed, including ultrasonography. The objective of this study was to compare ultrasound guidance with the traditional approach of palpation and direct visualisation for peripehral vein cannulation. The primary outcome was successful peripheral i.v. cannulation.
METHODS
Database search was performed on PubMed, Clinical Key, CINAHL, Cochrane Library of Clinical Trials, and Trip Database (from January 2000 to December 2017). Random-effect meta-analysis was performed to determine the pooled odds ratio for success in peripheral i.v. cannulation.
RESULTS
After database review and eligibility screening, eight studies were included in the final analysis, with a total of 1660 patients. The success rate in the ultrasound group was 81% (n=855), and was 70% (n=805) in the control group, resulting in a pooled odds ratio for success upon ultrasound-guided peripheral i.v. cannulation of 2.49 (95% confidence interval 1.37-4.52, P=0.003). Furthermore, the ultrasound-guided technique reduced the number of punctures and time needed to achieve i.v. access, and increased the level of patient satisfaction, although it did not result in a decreased number of complications.
CONCLUSIONS
Ultrasound guidance increases the success rate of peripheral i.v. cannulation, especially in patients with known or predicted difficult i.v. access.
Topics: Adult; Catheterization, Peripheral; Humans; Palpation; Ultrasonography, Interventional; Vascular Access Devices; Veins
PubMed: 30032874
DOI: 10.1016/j.bja.2018.04.047 -
Chiropractic & Manual Therapies Aug 2021Static or motion manual palpation of the low back is commonly used to assess pain location and reproduction in low back pain (LBP) patients. The purpose of this study is... (Review)
Review
BACKGROUND
Static or motion manual palpation of the low back is commonly used to assess pain location and reproduction in low back pain (LBP) patients. The purpose of this study is to review the reliability and validity of manual palpation used for the assessment of LBP in adults.
METHOD
We systematically searched five databases from 2000 to 2019. We critically appraised internal validity of studies using QAREL and QUADAS-2 instruments. We stratified results using best-evidence synthesis. Validity studies were classified according to Sackett and Haynes.
RESULTS
We identified 2023 eligible articles, of which 14 were low risk of bias. Evidence suggests that reliability of soft tissue structures palpation is inconsistent, and reliability of bony structures and joint mobility palpation is poor. We found preliminary evidence that gluteal muscle palpation for tenderness may be valid in differentiating LBP patients with and without radiculopathy.
CONCLUSION
Reliability of manual palpation tests in the assessment of LBP patients varies greatly. This is problematic because these tests are commonly used by manual therapists and clinicians. Little is known about the validity of these tests; therefore, their clinical utility is uncertain. High quality validity studies are needed to inform the clinical use of manual palpation tests.
Topics: Adult; Humans; Low Back Pain; Palpation; Radiculopathy; Range of Motion, Articular; Reproducibility of Results
PubMed: 34446040
DOI: 10.1186/s12998-021-00384-3 -
Journal of Osteopathic Medicine May 2023In this article, the authors will discuss a modified anatomy-based neck and thyroid examination that allows for a more comprehensive evaluation. It is the opinion of the...
In this article, the authors will discuss a modified anatomy-based neck and thyroid examination that allows for a more comprehensive evaluation. It is the opinion of the authors that an organ and its function are best evaluated utilizing the following steps: anatomy-based inspection and palpation, imaging, and blood tests. Approximately half of the lateral part of the thyroid is deep to the sternocleidomastoid (SCM) and sternothyroid muscles, which makes it rather difficult to palpate the entire gland utilizing prior physical examination techniques. The goal of this modified anatomy-based thyroid examination is to minimize the number of structures between the physician's fingers and the patient's thyroid by utilizing neck flexion, side bending, and rotation. If one approaches the thyroid from behind the patient, nodules can be missed due to the muscles and transverse processes overlaying them. The incidence of thyroid cancer in the United States is drastically increasing, which demonstrates the importance of a more thorough thyroid palpation. Our anatomy-based approach may allow for earlier detection and therefore earlier treatment.
Topics: Humans; Thyroid Neoplasms; Physical Examination; Palpation
PubMed: 36940275
DOI: 10.1515/jom-2023-0005 -
Ultrasound in Obstetrics & Gynecology :... Aug 2007
Review
Topics: Delivery, Obstetric; Female; Fetal Monitoring; Humans; Labor Onset; Labor Presentation; Palpation; Pregnancy; Pregnancy Complications; Ultrasonography, Prenatal
PubMed: 17659656
DOI: 10.1002/uog.4096 -
The British Journal of Radiology Oct 2022Although infantile hypertrophic pyloric stenosis (IHPS) is a well-known disease, there is no systematic review regarding the optimal diagnostic strategy. We conducted a... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Although infantile hypertrophic pyloric stenosis (IHPS) is a well-known disease, there is no systematic review regarding the optimal diagnostic strategy. We conducted a systematic review and meta-analysis to obtain diagnostic accuracy of all methods to diagnose IHPS.
METHODS
According to the Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines, we searched MEDLINE and Embase to identify studies reporting sensitivity and specificity of all methods used to diagnose IHPS. Inclusion criteria were infants with suspicion of/or diagnosed with IHPS who underwent pyloromyotomy or had clinical follow-up. A random-effects model was used to obtain pooled estimates of sensitivity, specificity and area under the receiver operating characteristic curve.
RESULTS
After screening 5364 studies, we included 43 studies with in total 6085 infants ( = 4241 IHPS; = 1844 controls). The diagnostic sensitivity of palpation ranged from 10.0 to 93.4% and decreased over time. Different parameters for ultrasonography were found. Most used parameters were pyloric muscle thickness (PMT) ≥ 3 mm (pooled sensitivity 97.6% and specificity 98.8%), PMT ≥ 4 mm (pooled sensitivity 94.0% and specificity 98.0%) or a combination of PMT ≥ 4 mm and/or pyloric canal length ≥16 mm (pooled sensitivity 94.0% and specificity 91.7%). The AUC showed high diagnostic accuracy (0.997, 0.966 and 0.981 respectively), but large heterogeneity exists. Due to the large differences in cut-off values no meta-analysis could be conducted for pyloric canal length and pyloric diameter.
CONCLUSION
Palpation has limited sensitivity in diagnosing IHPS. We showed that ultrasonography has highest diagnostic accuracy to diagnose IHPS and we advise to use PMT ≥ 3 mm as cut-off.
ADVANCES IN KNOWLEDGE
This is the first systematic review and meta-analysis on diagnosing IHPS, which summarizes the available literature and may be used as a guideline.
Topics: Humans; Infant; Pyloric Stenosis, Hypertrophic; Ultrasonography; Palpation; Sensitivity and Specificity
PubMed: 36043474
DOI: 10.1259/bjr.20211251 -
The Western Journal of Medicine Jul 1991Assessing for the presence of splenomegaly is an important component of the physical examination. Although several methods of palpation and percussion of the spleen have... (Comparative Study)
Comparative Study Review
Assessing for the presence of splenomegaly is an important component of the physical examination. Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. We review the literature comparing various physical examination techniques with noninvasive imaging modalities and conclude that palpation and percussion of the spleen are complementary but frequently insensitive and that further studies are needed to evaluate the efficacy of specific diagnostic methods.
Topics: Evaluation Studies as Topic; Humans; Magnetic Resonance Imaging; Palpation; Percussion; Radionuclide Imaging; Spleen; Splenomegaly; Tomography, X-Ray Computed; Ultrasonography
PubMed: 1877230
DOI: No ID Found -
The Journal of the American Osteopathic... Jun 2020There is no consensus on the correlation between clinical experience and accuracy in diagnosing somatic dysfunctions, which makes it difficult to justify the use of more...
CONTEXT
There is no consensus on the correlation between clinical experience and accuracy in diagnosing somatic dysfunctions, which makes it difficult to justify the use of more subjective measures to evaluate this important association. To better understand this relationship, palpatory forces can be observed while diagnosing a somatic dysfunction.
OBJECTIVE
To quantify the pressure applied in diagnosing lumbar somatic dysfunction, find a correlation between accuracy of diagnosis and palpation pressure, set the standards for palpation, and develop precise palpatory skills for osteopathic medical students.
METHODS
The palpatory forces were evaluated between participants with varying experience levels (osteopathic medical students and attending physicians from the New York Institute of Technology College of Osteopathic Medicine). Two osteopathic physicians confirmed an L5 somatic dysfunction diagnosis in a volunteer standardized patient (SP), who served as the control. Participants then palpated the lumbar segment of the SP in a prone position with F-Scan System (TekScan) sensors, which recorded the amount of pressure and time used to reach a full diagnosis.
RESULTS
Participants (11 osteopathic medical students and 10 attending physicians) who diagnosed an L5 somatic dysfunction consistent with the SP's diagnosis had less of a difference in peak force (mean [SD] difference, 62.50 [325.7] g/cm2) between the contact points (right hand vs left hand). In contrast, participants with a dissimilar L5 diagnosis from the SP's had a mean (SD) difference in peak force of 319.38 (703.1) g/cm2. Similarly, the difference in the mean (SD) force of palpation between the contact points was lower in participants who made the correct diagnosis (16.81 [117.4] g/cm2) vs those who made an incorrect diagnosis (123.92 [210.3] g/cm2). No statistical significance was found between the diagnostic accuracy of the students and physicians (P=.387) or the time taken to reach a diagnosis (P=.199).
CONCLUSION
We observed that using equal pressures in both hands while palpating a lumbar segment correlates to more accurate somatic dysfunction diagnoses.
Topics: Humans; New York; Osteopathic Medicine; Palpation; Pressure
PubMed: 32451546
DOI: 10.7556/jaoa.2020.066 -
Simulating dynamic facial expressions of pain from visuo-haptic interactions with a robotic patient.Scientific Reports Mar 2022Medical training simulators can provide a safe and controlled environment for medical students to practice their physical examination skills. An important source of...
Medical training simulators can provide a safe and controlled environment for medical students to practice their physical examination skills. An important source of information for physicians is the visual feedback of involuntary pain facial expressions in response to physical palpation on an affected area of a patient. However, most existing robotic medical training simulators that can capture physical examination behaviours in real-time cannot display facial expressions and comprise a limited range of patient identities in terms of ethnicity and gender. Together, these limitations restrict the utility of medical training simulators because they do not provide medical students with a representative sample of pain facial expressions and face identities, which could result in biased practices. Further, these limitations restrict the utility of such medical simulators to detect and correct early signs of bias in medical training. Here, for the first time, we present a robotic system that can simulate facial expressions of pain in response to palpations, displayed on a range of patient face identities. We use the unique approach of modelling dynamic pain facial expressions using a data-driven perception-based psychophysical method combined with the visuo-haptic inputs of users performing palpations on a robot medical simulator. Specifically, participants performed palpation actions on the abdomen phantom of a simulated patient, which triggered the real-time display of six pain-related facial Action Units (AUs) on a robotic face (MorphFace), each controlled by two pseudo randomly generated transient parameters: rate of change [Formula: see text] and activation delay [Formula: see text]. Participants then rated the appropriateness of the facial expression displayed in response to their palpations on a 4-point scale from "strongly disagree" to "strongly agree". Each participant ([Formula: see text], 4 Asian females, 4 Asian males, 4 White females and 4 White males) performed 200 palpation trials on 4 patient identities (Black female, Black male, White female and White male) simulated using MorphFace. Results showed facial expressions rated as most appropriate by all participants comprise a higher rate of change and shorter delay from upper face AUs (around the eyes) to those in the lower face (around the mouth). In contrast, we found that transient parameter values of most appropriate-rated pain facial expressions, palpation forces, and delays between palpation actions varied across participant-simulated patient pairs according to gender and ethnicity. These findings suggest that gender and ethnicity biases affect palpation strategies and the perception of pain facial expressions displayed on MorphFace. We anticipate that our approach will be used to generate physical examination models with diverse patient demographics to reduce erroneous judgments in medical students, and provide focused training to address these errors.
Topics: Facial Expression; Female; Humans; Male; Pain; Palpation; Robotic Surgical Procedures; Robotics
PubMed: 35273296
DOI: 10.1038/s41598-022-08115-1 -
Journal of Thoracic Oncology : Official... Jun 2010There are four matters of uncertainty considered in this working group report, which are distilled into four clinical questions: (1) What is the evidence for the need... (Review)
Review
There are four matters of uncertainty considered in this working group report, which are distilled into four clinical questions: (1) What is the evidence for the need for palpation of the lung in modern era of imaging? (2) Is there evidence of a difference in outcome for an open versus a closed approach? (3) Is there evidence of a difference in outcome for an initial policy of bilateral versus unilateral exploration? (4) In patients with known bilateral disease, is there a difference in outcome with a simultaneous versus a staged approach?We searched the literature formally and supplemented this with knowledge from all other sources. We provide evidence tables on the first two questions by relying on a group consensus and frame recommendations for the other two.There are no randomized trials to guide us but there are comparative studies addressing the need for palpation and the need to and open operation in all cases. The evidence is equivocal, and opinions are divided in the literature.Palpation of the lung is still seen as necessary in a therapeutic metastasectomy as opposed to a diagnostic procedure when videothoracoscopy is adequate. However, the importance of palpation becomes less clear with advances in imaging. Routine bilateral exploration for unilateral disease was not favored. For bilateral disease, an initial median sternotomy has a place for some cases but sequenced thoracotomy was preferred.
Topics: Humans; Lung Neoplasms; Palpation; Pneumonectomy; Thoracic Surgery, Video-Assisted; Tomography, Spiral Computed
PubMed: 20502249
DOI: 10.1097/JTO.0b013e3181dcf62c