Using discretion in safeguarding the person’s privacy, the injured area should be fully exposed. This may require the removal of protective equipment and clothing. This should be done a skilled clinician or any trained personnel with a first aid certification.
The localized injury site should be inspected for any deformity, swelling (i.e., edema or joint effusion), discoloration (e.g., redness, pallor, or ecchymosis), signs of infection (i.e., redness, swelling, pus, red streaks, or swollen lymph nodes), scars that might indicate previous surgery, and general skin condition (e.g., oily, dry, blotchy with red spots, sores, or hives). The injured area should be compared to the opposite side if possible. This bilateral comparison helps to establish normal parameters for the individual.
For palpation, informed consent must be granted before making physical contact with a patient. If the patient is younger than 18 years, permission must be granted by the parent or guardian. In some cultures and religions, the act of physically touching an exposed body part may present certain moral and ethical issues. Likewise, some patients may feel uncomfortable being touched by a health care provider of the opposite gender. If a same-gender clinician is not available, the evaluation should be observed by a third party (e.g., another clinician, parent, or guardian).
Bilateral palpation of paired anatomic structures can detect eight physical findings: temperature, deformity, swelling, muscle spasm, point tenderness, cutaneous sensation, crepitus, and pulse.
The examiner should have clean, warm hands. Latex examination gloves should be worn as a precaution against disease and infection. Palpation should begin with gentle, circular pressure, followed by gradual, deeper pressure, and it should be initiated on structures away from the site of injury and progress toward the injured area. Palpating the most painful area last avoids any carryover of pain into noninjured areas.
Skin temperature should be noted when the fingers first touch the skin. Increased temperature at the injury site could indicate inflammation or infection, whereas decreased temperature could indicate a reduction in circulation.
The presence of localized or diffuse swelling can be determined through palpation of the injured area. In addition, palpation should assess differences in the density or “feel” of soft tissues that may indicate muscle spasm, hemorrhage, scarring, myositis ossificans, or other conditions.
Point tenderness and crepitus may indicate inflammation when felt over a tendon, bursa, or joint capsule. It is important to note any trigger points that may be found in muscle and, when palpated, refer pain to another site.
Palpation of the bones and bony landmarks can determine the possibility of fractures, crepitus, or loose bony or cartilaginous fragments. Possible fractures can be assessed with percussion, vibrations through use of a tuning fork, compression, and distraction. The region should be immobilized if test results indicate a possible fracture.
Cutaneous sensation can be tested by running the fingers along both sides of the body part and asking the patient if it feels the same on both sides. This technique can determine possible nerve involvement, particularly if the individual has numbness or tingling in the limb. Peripheral pulses should be taken distal to an injury to rule out damage to a major artery. Common sites are the radial pulse at the wrist and the dorsalis pedis pulse on the dorsum of the foot.