Palpation tenderness

Palpation of the abdomen may reveal left lower quadrant tenderness, which may indicate a tender sigmoid colon. 

VS Blood pressure 125/75 mm Hg, pulse 84 beats per minute, temperature 37.3°C (99.1 °F), respiratory rate 18/minutes, oxygen saturation 98% on room air CV RRR, no murmurs, rubs, or gallops Chest CTA bilaterally, no crackles or wheezes Abd Tense, distended abdomen that is tender to palpation, decreased bowel sounds, (+) hepatosplenomegaly Exts 2 + pedal pulses, 2+ pitting edema... 

Abd Mildly distended, tender to deep palpation, decreased bowel sounds, (+) hepatosplenomegaly and fecal occult blood test... 

Gyn Normal external appearance of labia minora and majora, vaginal walls within normal limits, cervix well visualized and without lesions, midposition uterus, no cervical motion tenderness, no adnexal masses palpated... 

Clinical signs of improvement include reduction in joint swelling, decreased warmth over actively involved joints, and decreased tenderness to joint palpation. 

Workers exposed to 10-2 00 ppm complained of lacrimation, dizziness, insomnia, vomiting, constipation, and anorexia liver tenderness on palpation, epigastric pain, and elevated urobilinogen were observed. Impairment of the central nervous system and increased morbidity, especially diseases of the liver and bile ducts, were found in workers chronically exposed to ethylene dichloride at concentrations below 40 ppm and averaging 10-15 ppm. ... 

Chest Obtain respiratory rate reassess breath sounds in anterior lobes for equality. Palpate chest wall and sternum for pain, tenderness, and crepitus. Observe inspiration and expiration for symmetry or paradoxic movement note use of accessory muscles. Reassess apical heart rate for rate, rhythm, and clarity. 

Back Logroll as a unit to inspect back maintain spinal alignment during examination observe for bruising and open wounds palpate each vertebral body for fenderness, pain, deformity, and stability assess flank area for bruising and tenderness. 

Nodular scleritis consists of one or more focal nonmovable nodules of inflamed scleral tissue (Figure 28-5), usually in the interpalpebral region. These nodules are frequently tender to palpation, and nodular scleritis is more likely to cause severe or radiating pain than diffuse scleritis. 

Sliding palpation Liver size, consistency and surface as well as tenderness on pressure can be determined by sliding palpation. The lower edge of the liver is perceptible by touch at the costal arch in the mid-clavicular line. It crosses the epigastrium and ends at the left costal arch on the level of the parasternal line. Under palpation, the liver edge was felt to be deeper than shown by the scan, and only in 60% of all cases did palpation of the liver edge correlate with the scan. (32)... 

Clinical features With regard to the main findings of chronic heart insufficiency, the liver is symptom-free, apart from tenderness upon pressure in the right upper abdomen corresponding to hepatomegaly. On palpation, the liver is hard and has a smooth surface. Splenomegaly is detected in about 20% of patients. 

Musculoskeletal Variable Superficial Movement, palpation Time, analgesia Mu Itiple Tenderness... 

Premonitory symptoms and aura are absent with tension-type headache. The pain usually is mild to moderate in intensity and often is described as a duU, nonpulsatile tightness or pressure. Bilateral pain is most common, but the location can vary (frontal and temporal pain are most common occipital and parietal regions also may be affected). The pain is classically described as having a hatband pattern. Associated symptoms generally are absent, but mild photophobia or phonophobia may be reported. The disability associated with tension-type headache typically is minor in comparison with migraine headache, and routine physical activity does not affect headache severity. Palpation of the pericranial or cervical muscles may reveal tender spots or localized nodules in some patients. Tension-type headache is classified as either episodic (infrequent or frequent) or chronic based on the frequency and dmation of the attacks. ... 

Intraabdominal abscess may pose a difficult diagnostic challenge because the symptoms are neither specific nor dramatic. The patient may complain of abdominal pain or discomfort, but these symptoms are not reliable. Fever usually is present often it is low grade, but it may be high, with a spiking pattern. The patient may have a paralytic ileus and abdominal distension. The abdominal examination is unreliable tenderness and pain may be present, and a mass may be palpated. 

High fever, significant leukocytosis with left shift, elevated alkaline phosphatase, and liver tenderness on palpation" " " " ... 

Fibromyalgia is defined by the American College of Rheumatology as chronic, widespread pain in all 4 quadrants of the body and pain in at least 11 of 18 tender point sites on digital palpation. ... 

Palpation Solitary nodule Multiple nodules Enlarged thyroid Tender thyroid Thrill... 

The cardinal clinical sign of fracture is bony tenderness and careful palpation of the injured ankle will often differentiate between a fracture and a soft tissue injury. Clinical prediction rules have been shown to be useful in determining which children with ankle injuries require X-ray investigation (Dayan et al. 2004 Myers et al. 2005). Adherence to such rules may miss the diagnosis of a small proportion of fractures but these will generally be those of little clinical significance. 

The abdominal examination should include auscultation for bowel sounds and abdominal bruits and palpation for organomegaly, masses, and diffuse abdominal tenderness. 

T denotes tenderness. Although not an objec five finding, tenderness is produced during palpation of the tissues where it should not occur if there was no somatic dysfunction. 

A second mnemonic has been proposed for the diagnostic criteria, S-T-A-R, by Dennis Dow-ling, DO. In this mnemonic, the S represents sensitivily. Tenderness is a response by the patient to palpation by the physiciam This occurs in tissue that should normally not be tender to palpatioa However, the sensitivity change may be experienced by the patient as numbness, paresthesia, or anesthesia, or other subjective sensatioa The T still represents tissue texture changes, the A, asymmetry, the R, restriction of motion, as in TART. This may be used if the student or physician finds it more helpfiil. 

Tenderness is the subjective sensation of pain or soreness that is reported by the patient in response to palpation of tissues by the physician. Tenderness is the most likely subjective finding. This sensation is almost always present in tissues surrounding a somatic dysfunction when the physician exerts no more than normal pressure. Pressing too firmly on soft tissues will almost always cause pain or tenderness. Pressure that should not normally cause pain will do so in tissues around a dysfunctional joint. 

Tenderness is a subjective rather than an objective finding. Palpation of certain areas may cause the sensation of pain to the patient. This is... 

The next step is important. The joint is returned slowly to its neutral position. The slow motion prevents re-initiation of the inappropriate proprioceptive firing. The point should be monitored at all times because it is possible to palpate the changes occurring in the muscle, and therefore perhaps less than 90 seconds may be needed for treatment. The degree of tenderness remaining in the tissues should be re-assessed. 

Counterstrain is a myofascial release technique originally described as "spontaneous release by positioning." A tender point is noted on palpation and the region or entire bo is positioned into freedoms for the pittpose of shortening mnscles. The positions ate typicahy held for 90 to 120 seconds or imtil a mobile point reaction is noted. Snbseqnent tissne softening and/or reduced tenderness ate noted. 

Her physical examination was unremarkable for any problems other than findings related to the neck injury. The posterior neck musculature was tense and tender to palpation. Motion was grossly restricted in flexion, side-bending, and rotation bilaterally. There was some muscle tension and tenderness in the upper back to about the level of T4. A neurologic examination was normal. The cranial rhythm was sluggish and there was a tendency toward a right side-bending dysfunction of the basi-occiput. 

The soft tissues of the thoracic area should be palpated for texture changes skin, fascia, subcutaneous tissues, and muscle. Large muscle hypertonicity or small localized areas of muscle tension should be noted. Areas of tenderness or specific Jones tender points or trigger points should be noted. 

This tender point is palpated by pushing the monitoring finger medially on the lateral edge of the sacrum at the midpoint between the posterior superior iliac spine (PSIS) and the sacral apex. This is at the site of the piriformis attachment to the sacrum and probably represents a second piriformis tender point, it is often found in association with the tender point in the belly of the muscle. 

---