Sensitive Parts of the Hand

Tactile sense. The tips of the fingers are

most sensitive for fine tactile
discrimination

Vibratory sense. Palpate with the

palmar aspects of the
metacarpophalangeal
joints or the ulnar side of the hand (fifth
metacarpal and fifth phalanges) rather
thanwith the fingertips to perceive
vibrations such as thrills. Prove the
superiority

Temperature sense. Use the dorsa of the

hands or fingers; the skin is much

thinner than elsewhere on the hand.

Deep palpation. Firm pressure is applied

to displace the superficial tissues

allowing
palpation for deeper lesions. This is especially
useful in the abdomen, but
is also useful in the neck, breasts, and large
muscle masses. Avoid firm palpation
over nerves or other tender structures
whenever possible

Bimanual palpation. In this technique,

the tissue is examined between the

fingers
of the two hands. It is useful for soft tissue
such as the breasts, intraoral,
abdominal and pelvic examinations, and
examination of the muscles and joints

Gastrointestinal Examination:
positioning the patient

Hyperpigmentation in CronkhiteCanada syndrome

Carcinoid syndrome involving

the chest and abdomen

Glucagonoma: migratory rash

involving the groin

Dermatitis herpetiformis

Peutz-Jeghers syndrome, with

discrete brown-black lesions of
the lips

Acanthosis nigricans: (a) axilla; (b)

chest wall

AXILLA

CHEST WALL

Hereditary haemorrhagic
telangiectasia involving the lips

Porphyria cutanea tarda-scarring

from photosensitivity

Leuconychia-Terry's nails

A large crop of spider naevi

Scleral icterus

Kayser-Fleischer rings

Amyloidosis causing
macroglossia

Parotid gland examination

Aphthous ulceration

Abdominal scars

Detecting the direction of flow of

a vein

Prominent veins on the

abdominal wall

(a) Regions of the abdomen (b)

Quadrants of the abdomen

Abdominal examination: the liver

Percussing the liver span: (a)

upper border; (b) lower border

UPPER BORDER

LOWER BORDER

Massive splenomegaly: note the

splenic notch

Palpation of the spleen

(a) Palpation begins in the lower mid-abdomen and finishes up

under the left costal margin.

(b) The examiner's hand supports the patient's

side

(c) and then rests over the lower costal margin

to reduce skin resistance.

(d) If the spleen is not palpable when the

patient is flat, he or she should be rolled
towards the examiner.

Detecting an expansile impulse

Percussion of the spleen

Shifting dullness

(a) Percuss out to the left flank until the percussion note
becomes dull. Mark this spot with your finger.

(b) Roll the patient towards you, wait 30 seconds.

Shifting dullness is present if the left lateral dull
area is now resonant.