When you palpate,
I usually palpate layer by layer
starting with the skin
making sure there’s glide, making
sure I know if the tissue texture
You observe above the skin,
you check out the skin,
you look at the subcutaneous tissue
by going a little bit deeper maybe
half a pound to a pound,
you feel whether or not where you
can tell where the vessels are
or if there’s any pulsations,
and then you get a little bit deeper
down to 1 to 2 pounds
where you start feeling the deep fascia,
and you start to feel the muscle
with about 5 pounds of pressure.
Then once you get to 9 pounds,
you can typically feel
a ligament or a bone.
And that’s the general way that
you’re going to get to feel
what’s going on underneath the skin.
The viscera are also palpated through
different layers of skin
and different levels of sensitivity
just to be aware of.
I usually do a skin drag test to make
sure that’s there’s no restrictions
and that the patient isn’t dehydrated,
which will affect skin drag,
or have other issues that would limit their
skin’s ability to function as an organ
because the skin is the largest
organ in the body.
You want to check for friction.
You want to make sure that there’s moisture.
You may want to check skin turgor
and make sure that you have proper response
and look for any acute changes in color,
any lesions, or anything else that may
lead you to need to investigate further.
When testing skin drag,
it’s basically pulling the skin
and making sure that it moves comfortably
and moves accurately.
You may note asymmetry, you may note atrophy,
or you may note chronic changes,
or flaking of the skin.
Once you get to the fascia,
you want to observe if there’s any swelling,
any warmth that comes out,
any redness, tenderness, temperature changes,
and what the skin drag is like,
what the texture is like,
and what the turgor is like,
what the rebound is.
When you get to the subcutaneous
tissue that’s underneath the skin,
contact it with light pressure,
look at what fat tissue there is
and how confluent
or maybe how lumpy bumpy,
or segmented it is, where does it go
and can you feel pulses or
other things in the area.
Allow for general movement both
of the skin and the muscles,
and I usually check the feet to see
if there’s any tenderness, swelling,
and any other abnormalities of the feet.
When you get to the deep fascia,
you want to contact with medium pressure.
You may want to get up to 5 pounds of
pressure and check for smoothness,
continuousness, firmness, toughness
and just see how the functioning
of the tissue goes.
When you get to the muscle layer,
you want to make contact with medium
pressure, generally about 9 pounds.
Palpate through the deep fascia.
Make sure you feel the muscle.
Make sure you feel the shape of the muscle,
how it feels, and what it feels like,
how substantial is it versus how
atrophied might it be,
and you may want to follow the fibers
of some muscles just to see
what the muscles feel like. Does it feel
different in different places?
You may feel tendons and ligaments
which can give you information. Often times
they get injured and we do know
that meniscal tears,
ligament tears, and tendon tears
all contribute to edema
and other changes in the body.
Once you feel deeper, you’ll get to the bone
nd you can feel whether or not
the bones feel lighter, heavier
because different bones will have
a different feel to them.
Make sure you contact with pressure
enough to feel the bone
but not enough pressure to cause
pain or discomfort.
When you do feel the bone, you
don’t want to do it too long
because people are going to
and it’s going to be an unpleasant
but you can follow the contour
of the bone a little bit
just to make sure that you get
a sense of what it feels like.
Pay attention to joint capsules
and joint spaces
and compare the density
of different tissues.
Make sure there’s some consistency
and the palpation of the body
makes sense to you, or if not,
that you explore further.
Remember that you’re dealing
with living tissue.
It feels different for the person
than it does for you.
Be respectful but use palpation
to its maximal benefit.