Palpation of the swelling 1 Warmth Temp increase

Palpation of the swelling 1. Warmth. Temp increase in inflammatory swellings and vascular swellings (by dorsum of the hand) Because temperature receptors are more in the dorsum of the hand.

2. tenderness lnflammatory swellings are mostly tender Neoplastic swellings are not tender. 3. Surface Smoth , granular , nodular or lobulated

4. Edge: Ill -defined (finding no border , mostly malignant ), Well-defined (finding a border all around mostly benign), Pedunculated. Slippery edge (moves in front of my advancing finger ) as Lipoma

tests for cystic swellings: 5. Consistency may be : Cystic or solid. 1 -Fluctuation test: lt should be done in 2 perpendicular planes 1. Keep pressing by receiving fingers against one pole 2. Exert sharp pressure at opposite pole by displacing fingers. pseudo-fluctuation can be elicited in lipoma why?

2 - Cross fluctuation test: (to detect weather two adjacent cystic swellings are communicating or not): Percuss the swelling by a finger & recive the impulse by a finger of the other hand placed on the 2 nd swelling e. g. psoas abscess.

3 - Paget's test: - It is used in small or tense swellings (< 2 cm). - lt compares the consistency at centre with that at periphery. - Solid swelling (harder at center) due to greater concentration of solid tissue). - Cystic swelling softer at center

4 - Bipolar test: - For pedunculated swellings - Fix by the upper hand receive by it - Press by the lower hand 5 - Fluid thrill: ln big swelling: tapping on a side of the swelling so percussion wave is felt on the other side.

6 - Trans-illumination. Test: lf the swelling is cystic: differentiates opaque from translucent - Translucent cysts ( clear fluid ) as cystic hygroma, menigocele, ranula, epidydmal cyst. - Opaque cysts as blood, pus.

6 - mobility Skin: - Not related to overlying skin ) skin can be pinched Attached to overlying skin ) can not pinch up Skin. . . Muscle by (Ms contraction ): - Less prominent = deep to the muscle. - More prominent = superficial to the muscle.

- Swellinq of the muscle : * lf moves across muscle when it is relaxed & become fixed on contraction ) attatch to the muscle. * lf mobile when the muscle is relaxed then becomes limited on contraction ) attached to fascia.

. Nerves: - Can be moved across but not along the axis of the nerve. There may be distal signs of motor or sensory affection. Vessels: . - Can be moved across but not along the axis of the vessel. - May be pulsating. - There may be distal signs: ischemia

. Tendons : moves across the tendon & becomes fixed when muscle is contracted. . Bones: fixed and immobile from the start.

How to differentiate? • Expansile pulsation : it arises from the wall of an artery • Transmitted pulsation : it lies very close to an artery. 2 fingers, one from each hand are placed on the swelling : 1) When the 2 fingers are raised and separated with each beat of the artery ( Expansile Pulsation) 2) When the 2 fingers are only raised ( transmitted pulsation)

How to differentiate? - Reducibilitv: Swelling reduces or disappears as soon as it is pressed upon in a certain direction and reappears again on coughing or straining (e. g. hernia). - Compressibilitv: Flattening under pressure and regains its original size on release of the compression AS Hemangioma, saphena varix.

Special Signs - Thrill: felt over aneurysm and A-V fistula - lmpulse on cough: ( increase in all direction ) in swellings which are ln continuity with abdominal cavity (hernias) ln continuity with pleural cavity (empyema necessitates) qln continuity with spinal cord (meningocele).

Draining Lymph Nodes No examination of a swelling is complete without the examination of the draining lymph nodes.

Percussion 1. Over the swelling: Resonant -+ over gaseous swelling (hernia, laryngeocele) Dull -+ over cystic & solid swellings 2. Around the swelling (to determine its relation to surrounding organs): The dullness of liver swelling is continuous with the normal hepatic dullness

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