Palpation
Palpation is a part of objective examination. The examiner keeps his hands on the part to be examined and feels the skin, subcutaneous tissue, muscle and bone through the touch.Palpation is a skill that develops by experience as and when the examiners hands become more sensitive to feel and understand the underlying structures. There are certain specific issues taken into particular consideration in palpating the stump of an amputee:
- Warmth
- Tenderness
- Bony prominence
- Bony spur
- Neuroma
- Muscle tone
- Scar condition
- Oedema
- Callus and skin
Warmth
Technique: the examiner keeps the dorsal part of the hand on the normal side and compares it with the part to be examined.
Interpretation: a warmer state can be because by any inflammation underlying. A colder state is doubted for any circulatory impairment, abscess or gangrene.
Tenderness, Bony prominence and Bony spur
Technique: gentle touch over the stump followed by a firmer touch makes the examiner feel the bony prominences under the skin and subcutaneous tissue. This may provoke pain in an area of tenderness.
Interpretation: the pressure sensitive areas help in suggesting the ‘relief’ areas in the socket.
Neuroma
Technique: keep the pad of the finger on the part to be examined and give a gentle tap on the dorsum. Also the index finger can be flicked on the stump especially in the inferior and peripheral parts to find for a Neuroma.
Interpretation: a tingling sensation or raw pain provoked by the tap could be because of a Neuroma which may also protrude like a bud over the surface of the skin.
Scar condition
Technique: pick the scar between the pad surfaces of the fingers and the thumb and attempt to move it against the underlying tissue.
Interpretation: the scar is not adhesive (mobile) if it moves freely and it is adhesive (immobile) if it does not move against the underlying tissue.
Muscle tone
Technique: feel the muscle by gripping it firmly between the fingers and the thumb. The feeling of the firmness or floppiness can be appreciated. It can also be compared with the other (unaffected) limb.
Interpretation: the firmness indicates ifthe muscle has normal tone. If floppier, it means that the muscle has reduced tone and had lost its contractile property. This might have been caused because of the damage to the nerve supplying the muscle, swelling or the muscle may not have been sutured properly.
Skin and callus
Technique: slide the palmar surface of the hand over the skin appreciating the texture of the skin.
Interpretation: callus is a thick roughened part of the skin which can be caused by friction or unusual weight bearing.