Palpation is starting to get a bad name in our field as it is not reliable between clinicians and validity of it’s use is undetermined. However, just as I teach my interns, you have to put your hands on the patient. You have to with a purpose and not just to poke around. I am glad to finally see a research study conclude what I’ve determined for years, palpation does have diagnostic value, especially ruling out conditions. Here is a good example:
Shoulder impingement is very common in any outpatient clinic and honestly can be ‘diagnosed’ quite easily. There is or there isn’t shoulder impingement with other common choices of frozen shoulder, labral tears and/or instability. All of these can really be determined through the history but as the purpose of clinical tests, it is best to finalize your hypothesis through the objective examination.
I have written in the past on how to rule out adhesive capsulosis (shown here ) but let’s get back to shoulder impingement diagnosis.
We know to rule out conditions we need to choose the clinical tests with the highest sensitivity. For shoulder impingement, these have been around for a long time and are Hawkins-Kennedy (here ) and Neer Test (here). We all know how to do this, however, in some instances; patients will walk into our office who do not have the range of motion (due to pain, guarding, etc.) to perform these measures. This is where palpation can be very important.
Toprak and colleagues (article here) just came out with a research article comparing Neer’s and Hawkins-Kennedy Test to palpation for shoulder impingement using sonography. What they found was that palpation to the supraspinatus and biceps tendon have a slightly higher accuracy compared to impingement tests. Pretty good results considering these two impingement tests are our go to guys for ruling – out subacromial impingement due to the high sensitivity values.
The authors recommend (and myself) that you use palpation as a strong tool in your physical examination for subacromial impingement. A positive finding does not tell you much, but if negative, it has significant clinical utility.