The Role of Palpation in Medicine

Palpation is the process of using one's hand or fingers to physically examine part of the body by feeling. It can be used to feel something near the surface of the skin (superficial) or farther inside the body (deep).

Uses

Medical practitioners use palpation to determine the following about an organ or body part: 

• Location (site on the body)
• Size (length and width)
• Shape (oval, round, elongated, irregular)
• Consistency (soft, firm, hard)
• Tenderness (degree of tenderness or pain to palpation) 
• Position of a fetus during pregnancy
• Abnormal or irregular findings (inflammation, tumor, hernia, fracture, joint dislocation, or slipped disk)

Commonly used to examine the abdomen and chest, palpitation can also be applied to any part of the body, including the mouth, vagina, and anus. By its strictest definition, taking a person's pulse may be considered a form of palpation.

This article discusses several kinds of palpation assessments and describes the process of palpating during medical examinations.

Types of Palpation

The sense of touch is just as important as the sense of sight in a physical examination. As part of their training, medical practitioners learn how to recognize problems on or below the surface of the skin by touch alone. They do so by applying general pressure with the hand or fingers to detect subtle changes that might otherwise go unnoticed by a layperson.

The techniques used for palpation can vary by the body part being examined, as well as the aims of the exam (i.e., screening vs. diagnosis). A few possible examples are listed below, but there are many other kinds of palpation your provider may use.

Thoracic Palpation

Thoracic palpation is typically used to diagnose problems of the chest or spine. It involves the touching of superficial and deep tissues to assess the position of the vertebra, the presence of edema (swelling) or lymphadenopathy (swollen lymph nodes), or any protrusion in the ribs, sternum, or spinal column.

The palpation may be performed in a seated position or when lying in a supine (face-up) or prone (face-down) position.

Palpation is also helpful in evaluating the function of the heart. The location, size, and force of the cardiac impulse on the chest wall can help determine whether the heart is working normally, and abnormal vibrations can indicate the presence of a heart murmur.

Abdominal Palpation

Deep palpation of the abdomen (stomach area) is performed by placing the flat of the hand on the abdominal wall and applying firm, steady pressure. Two-handed palpation—when the upper hand is used to exert pressure, while the lower hand is used to feel—is often useful in evaluating an abdominal mass.

Palpation may even help diagnose an abdominal aortic aneurysm. This is done by placing both hands on the abdomen with index fingers on each side of the aorta (located just above and to the right of the navel). If an abdominal aortic aneurysm is present, the fingers would separate with each heartbeat. This finding should be followed up with imaging like an ultrasound or CT scan.

With abdominal palpation, medical practitioners check not only for tenderness or masses, but other important characteristics that can be felt with the fingers. Some of these include:

• Rigidity: Rigidity is an involuntary contraction of the abdominal muscles that results in the muscles feeling hard or rigid. It often indicates a serious problem such as peritonitis.
• Guarding: In contrast to rigidity, guarding is the voluntary contraction of abdominal muscles by a patient who fears palpation will be painful.
• Rebound tenderness: In testing for rebound tenderness, a practitioner palpates deeply on the abdomen and then releases the pressure abruptly. A significant increase in pain for the patient often indicates an acute abdominal process such as appendicitis (positive Blumberg's sign).

Uterine Palpation

Another two-handed palpation procedure is the bimanual pelvic exam, also known as manual uterine palpation. It involves the compression of the lower abdomen with one hand and the palpation of tissues inside the vagina with the fingers of the other hand.

Breast Palpation

Palpation of the breasts is performed with the flats of the hand and fingers. The procedure is systematic and involves the clockwise assessment of the breast and nipples to check for consistencies and lumps. The nipples themselves would be palpated for elasticity and gently squeezed to check for discharge.

Hernial Palpation

Palpation is part of the process involved in the diagnosis and characterization of an inguinal hernia (the type situated in the lower abdomen or groin). The size of the hernia can be assessed by asking the subject to cough as the flats of fingers are placed against the bulging tissue. The back of the hand would be used to assess the temperature of the skin in comparison to the surrounding tissue.

Hand and Wrist Palpation

Hand or wrist injuries are typically diagnosed with palpation. The palpation might involve the gentle rotation of a joint as the fingers detect subtle signs such as crepitus (cracking sounds and sensations), diminished range of motion, or increased warmth and swelling indicative of inflammation.

Similar techniques may be applied to other joints, such as the knee, ankle, elbow, or shoulder.

Dental Palpation

Palpation can be used in dentistry to check for inflammatory conditions like periodontitis, the causes of a bite discrepancy (dental occlusion), or the development of a tooth abscess or oral lesion.

Typically the tip of the finger is used to check for changes in:

• Texture
• Color
• Temperature
• Gum consistency

In addition to an intraoral (inside the mouth) examination, palpation may be used on the jaw muscles to feel for clicks or bite irregularities. This is typically performed by pressing the fingers of both hands on jaw muscles as the person bites down.

The same technique can be used to help diagnose temporomandibular joint (TMJ) disorders.

Palpation in Physical Exams

A physical examination, along with the review of your medical history, is usually the first step a doctor will take when diagnosing a medical condition or performing a routine physical.

There are four core components of a physical exam. They are not necessarily used on every body part but generally include:

• Inspection: Visual examination of the body
• Palpation: Touching of the body
• Percussion: Tapping of the body to evaluate the size and consistency of an organ or check for the presence of fluid
• Auscultation: Listening to heart, lung, and bowel sounds with a stethoscope

Summary

Palpation is an assessment skill used by various healthcare providers to feel structures below the skin. Sometimes palpation is used to confirm normal findings. Palpation can also be used to test for an injury or abnormal process.

Palpation is part of your clinical examination, and your provider may recommend additional testing depending on what is found during your visit.

A Word From Verywell

Palpation involves being touched by your healthcare provider. Most providers will let you know what they are planning to examine and what you can expect (how much pressure, how long it will take). If you have any questions or are sensitive to touch from others, it is helpful to inform your provider before the exam starts. You also have the right to ask to have another person in the room for the exam if that makes you more comfortable.