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This lavishly illustrated guide to palpation techniques provides readers with a solid understanding of topographic anatomy using clear, step-by-step descriptions that teach how to first identify, and then distinguish between, the various body structures.Full-color photographs feature models with detailed drawings of muscles, bones, and tendons sketched directly onto their skin, indicating exactly where and how to palpate. Complementary color drawings show the functional significance of each anatomic region. Features




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This completely updated third edition of the award-winning Palpation Techniques is a beautifully illustrated guide with clear step-by-step descriptions that teach readers how to identify and distinguish between a multitude of underlying body structures, based mainly on palpation alone. A unique graphic technique using detailed drawings of muscles, bones, and tendons directly on the skin, which come alive in almost 900 full-color photographs along with complementary color illustrations, provides a solid understanding of the functional significance of each anatomic region. The previous edition introduced palpation techniques for the shoulder and included new photos and illustrations for the hand, hip, and foot. This third edition is upgraded with a chapter on the abdominal area and additional subchapters on further starting positions and palpation techniques of the shoulder, elbow, and hip/groin. Many new illustrations accompany these new sections.


The pulmonary examination consists of inspection, palpation, percussion, and auscultation. The inspection process initiates and continues throughout the patient encounter. Palpation, confirmed by percussion, assesses for tenderness and degree of chest expansion. Auscultation, a more sensitive process, confirms earlier findings and may help to identify specific pathologic processes not previously recognized.


Auscultation of the chest (Table 46.4) is part of every chest examination but it is the data collected during inspection, palpation, and percussion that alert the clinician what to listen for during auscultation in order to identify the correct diagnosis most effectively.


Palpation is used both as a screening technique and as a means to confirm a specific diagnosis. Light palpation over the entire thorax posteriorly, laterally, and anteriorly will aid in the identification of cutaneous and subcutaneous nodules and the site of previously unsuspected tenderness. Nodules that are firm and freely moveable suggest a focal benign inflammatory or clinically insignificant problem. Those that are hard, fixed, and multiple suggest metastatic malignancy. Fleshy nodules may be indicative of a systemic disease such as neurofibromatosis.


Tenderness may be elicited during this same maneuver. At times, it is unsuspected by both the patient and the examiner. Under other circumstances, it is used to aid in a diagnosis of the complaint of chest pain. Localizing a rib fracture, either traumatic or pathologic, or reproducing the chest pain of costochondritis by firm palpation of an inflamed costochondral junction may be most helpful in planning further management. Tenderness over an inflamed or infarcted area of lung may also aid in the localization of the disease process.


Palpation is used to assess further abnormalities; gynecomastia suspected because of observed breast enlargement is confirmed by the palpation of breast tissue. Similarly, spider hemangiomas are confirmed when the central arterial supply is seen to feed the spider's radicals following manual occlusion.


Measurement of first and second metatarsal and toe protrusion is frequently used to explain foot problems using x-rays, osteological measurements or palpation-based tests. Length differences could be related to the appearance of problems in the foot. A test-retest design was conducted in order to establish the intra-rater reliability of three palpation-based tests.


Several studies have utilised x-ray methodology [4],[7]-[11] in order to estimate relative metatarsal length. However, this method has many disadvantages due to cost, accessibility and ionising radiation exposure [12],[13]. Osteological methods are based on direct bone measurements [14]-[16] on cadaveric models, which could be influenced by the presence of necrosis [17]. Finally, clinical palpation is frequently used to identify metatarsal head position. However, many studies do not establish or describe the reliability and validity of this method. Spooner et al.[13] used clinical palpation in comparison to radiological measurements in order to establish metatarsal formula. Glasoe et al.[18] measured the relative length of the first and second metatarsals, using a caliper and reference bone marks such as the navicular tubercle and the dorsal crease of the first and second metatarsophalangeal joints, observing a poor inter-rater reliability. Based on this method, Davidson et al.[12] used a caliper in order to assess first and second toe and metatarsal length differences. They measured 36 feet of 18 participants, performing three different tests, one of which is described by Glasoe et al.[18]. The aim of this research is to use a larger sample to study the intra-rater reliability of these three methods used by Davidson et al.[12].


Reliability of measuring first and second metatarsal and toe protrusion using the three palpation-based tests showed a high degree of reliability for all the ICC values. Being simple, cheap and non-invasive, palpation-based methods can be used by clinicians to measure metatarsal and toe protrusion in clinical practice.


The challenge for cow-calf producers is to use management techniques that stimulate production without drastically increasing operating costs. You can improve weaning weight through a number of methods, including:


Thorough knowledge of the structures of the female reproductive system is essential for successful palpation. Only the reproductive tract and associated organs will be discussed here, but you should be aware that endocrine glands located in other parts of the body, particularly the brain, are also involved in the sexual cycle. Figure 2 is a general diagram of the reproductive tract.


Figure 2 (right to left) shows the next portion of the tract: the vagina. It serves as a receptacle for semen during natural mating, is a thin-walled structure and is not easily felt during palpation.


Usually, the longer the examination, the more rectal straining you will encounter. Do not be upset by a small amount of bleeding, as this occurs occasionally and is not necessarily a sign of damage to the rectum. An indication of rectal damage is a sandpaper or gritty feeling, which means that the mucosa lining of the rectum has been rubbed off during palpation. If this occurs, it is best to stop palpating immediately.


Brahman and Charolais breeds appear to have more tissue inside than smaller breeds. More folds of the omentum seem to cover the intestines, making it slightly more difficult to pick up the uterus. Charolais cattle seem to have less flexibility in the rectum. It is commonly harder to feel deep in the body cavity in these cattle, and lateral movement is somewhat restricted. In Holstein cows, the anal sphincter may be tight. This limits the deep entry into the body cavity necessary to determine the stage of pregnancy. In these cases, proficiency at mid-uterine artery palpation may be necessary (Figure 13).


Even after following a systematic approach to palpation, some beginners will be unable to confirm pregnancy status on some cows. If this happens to you, simply wait 30 days and check these few again. If they are pregnant, their uteri will have grown which makes it easier to confirm their status. Never speculate on their status, as incorrect guesses can be costly.


Practice! Experience is the key to palpation. In many instances, the ranch manager should not be the one to palpate but should supervise the operation and critically observe the cows. Unhealthy, unsound and undesirable types should be eliminated, as should open cows.


Shorten the calving interval by reducing the time during the breeding season when the bulls are with the cows. Cows that settle first are most adapted to reproduction. Wait about 90 days after the bulls are removed before you palpate. Most cows should conceive at the beginning of the season, and only a few will be short-term pregnancies. Cull as critically as is feasible for your operation. If every open, unsound cow can be removed, cull immediately. Remember, palpation is an art and a skill. It pays dividends to the person who uses it wisely.


When comparing BioPRYN to rectal palpation or ultrasound, note that the results of the BioPRYN test are not immediately available, so any keep or cull decisions would be postponed until receipt of the lab report. In addition, cattle must be individually identified to allow for culling or other management once the results of the BioPRYN test are known. With the other two methods, neither individual ID nor the need to re-work cattle is required. Also, a skilled person can determine the stage of pregnancy (e.g., I, II or III) with either rectal palpation or ultrasound. This type of information may be useful for culling and marketing decisions, or in determining if conception may have occurred (unintentionally) after the end of a breeding season.


Palpatory accuracy can be confirmed by imaging techniques such as x-ray, MRI or Ultrasound and may have enhanced the validity of our results. We dismissed x-ray imaging on ethical grounds, MRI as it does not image bone tissue and ultrasound as it does not allow the entire spine to be imaged accurately. We also dismissed retrospective evaluation of x-ray images taken of patients in a standing position, as we considered the inherent inaccuracies in this approach to be too great.


Although our approach has been shown to be very accurate, its validity remains to be demonstrated. In order to demonstrate its validity we would have had to perform x-ray imaging, which given that all our participants were healthy, was considered unethical. In order to improve the validity of our palpation procedure, we always used two testers, used functional criteria and anatomical features to identify a particular vertebra[15, 17, 19, 20, 22, 23]. By using a functional approach, the accuracy of correctly identifying C7 increased from 37.5% to 77.1% in a study by anaesthesiologists[22]. Using x-ray images, Kim et al. validated the position of PSIS level to S1 or S1-S2 interspace level in 73% of examined cases[19]. It has to be considered though, that the authors had their subjects lay in a prone position with a pillow under the abdomen. This may have caused the sacrum to rotate posteriorly in relation to the innominate, altering the relative position of defined landmarks. 041b061a72


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