Episode 1663 - Using palpation for differential diagnosis

Dr. Cody Gingerich // #ClinicalTuesday // www.ptonice.com

In today's episode of the PT on ICE Daily Show, Extremity lead faculty Cody Gingerich discusses the importance of thorough palpation to rule in or out differential diagnosis during an objective exam.

Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

CODY GINGERICH All right, good morning everybody and welcome to the PT on Ice daily show. My name is Cody Gingrich. I'm one of the lead faculty in the extremity division coming to you on a clinical Tuesday. So getting into it, what I want to talk about today is talking about palpation and using a good palpation exam in your objective exam for doing some differential diagnosis. We're going to talk about the upper extremity and the lower extremity and why doing a really solid palpation job in those areas, specifically when you're dealing with extremity management. is going to be super, super important when you're trying to differentiate, is this something that might be more of an extremity issue or is this potentially something that's coming more from the spine, okay? We're going to talk about different things that you might see from a subjective standpoint that might lead you to figuring out, not having a super clear picture on which of those two things it might be. UPPER EXTREMITY PALPATION So we're going to start in the upper extremity, okay? So things that you might see or hear, I guess, from your patient when you're doing your subjective exam. right? Numbness and tingling that comes down the arm that comes down lower than the, um, than the clavicle elbow, potentially even all the way into the hand. Okay. Anything noticing tingling. A lot of times when we hear numbness, tingling, we're immediately clued into, Oh, that might be a nervous system problem. That can be a cervical radiculopathy, all of those types of things. but then some of their other aggravating factors are going to be, right? Potentially sitting at a desk, if it's a more of a fitness athlete, pressing overhead, all of those type of things might bring out their symptoms. So if they're sitting, if they're driving, where they could be stressing the actual cervical spine, but they could also be very much stressing that posterior shoulder, okay? Another thing that I see all the time is anterior shoulder pain. Okay, anterior shoulder pain with a lot of pressing type of movements and a lot of times if you know someone's sleeping on that shoulder or whatever else, we need to figure out is that coming from that anterior shoulder, but also we get a lot of referral from the posterior shoulder that pings right to that anterior shoulder. Okay, so I want to talk about how then your palpation job is going to be most efficient in bringing out some of those symptoms. The number one thing is you have to have a system. You have to have a system to know when you're going, where you're going to be and how you get back to that spot every time and how you touch each and every muscle area on what you're trying to palpate. In the extremities, specifically posterior shoulder and posterior hip when we get to it, posterior lateral hip, you can actually hit all of those structures and feel good about where you are palpating is touching what you want to touch. In the spine and areas like that, there are so many layers of tissue, you can't really always say, like, I know what I'm on, but specifically in the back of the shoulder, you can say, I'm on infraspinatus, I'm on supraspinatus, I'm touching teres. All of those things can be very confident that you're hitting that. So where do you want to start? Inferior angle of the scapula. Then you work laterally. You know then when you work laterally and you come back to that inferior angle, you go thumb, thumb, and then you start here and then you work away again. Come back, thumb, thumb, thumb. Now you're three thumb widths up. Each time you're touching your thumb, like working and doing your palpation eve...