The term “PALP” in medical notes is a common abbreviation for palpation, a fundamental technique of physical examination. This action involves the healthcare provider using their hands and fingertips to feel the patient’s body to gather diagnostic information. Palpation is one of the oldest and most direct methods for assessing a patient, providing an immediate sense of what is happening beneath the skin’s surface. It remains standard practice because touch can often detect subtle physical changes that visual inspection alone would miss.
The Definition and Role of Palpation
Palpation is a method where a clinician uses their hands to assess the size, location, texture, temperature, consistency, and tenderness of a body part or organ. It is one of the four main components of a comprehensive physical assessment, performed alongside inspection (looking), percussion (tapping), and auscultation (listening with a stethoscope). Through touch, the examiner can sense physical properties like skin moisture, tissue elasticity, and any vibrations within the body.
The information gathered during this tactile assessment provides a real-time understanding of the patient’s physical state. The back of the hand is sensitive to temperature, allowing the clinician to evaluate localized inflammation or fever. Palpation establishes a baseline assessment, allowing the healthcare professional to compare findings with known normal anatomical landmarks.
Developing skill in this technique requires extensive practice and a detailed knowledge of human anatomy to accurately interpret subtle tactile signs. Clinicians learn to distinguish between a healthy organ’s normal contour and the irregular shape or density of an abnormal mass or swollen tissue. Detecting these subsurface changes is a valuable diagnostic tool that complements and guides the use of modern medical imaging.
Understanding Palpation Techniques
The effectiveness of palpation relies on using different degrees of pressure, categorized into light and deep techniques. Light palpation is the initial touch, involving gentle pressure to depress the skin surface approximately one to two centimeters. This superficial technique checks for surface characteristics, such as skin texture, temperature variations, moisture levels, and localized tenderness.
Deep palpation involves applying firm, steady pressure to depress the tissue about four to five centimeters to reach deeper internal structures. This method is necessary for examining larger internal organs, such as the liver, spleen, and kidneys, or for defining the boundaries of an underlying mass. Because deep palpation can sometimes cause discomfort, the clinician typically begins away from any reported pain and proceeds systematically.
A specialized approach called bimanual palpation involves using both hands to examine an area, often when assessing the abdomen, kidneys, or pelvis. One hand is placed on the body to apply pressure, while the other hand is used to feel and isolate the organ or structure between the two hands. For example, when checking the kidneys, the lower hand can push the organ forward while the upper hand palpates its size and shape.
Key Diagnostic Uses of Palpation
Palpation is employed across nearly every system of the body to gain objective data that points toward a diagnosis. One frequent application is identifying and characterizing masses, such as tumors or enlarged lymph nodes. When a mass is detected, the clinician uses palpation to determine its approximate size, consistency (soft, firm, or hard), and mobility (whether it is fixed or moves freely under the skin).
Another primary use is assessing tenderness, which is a patient’s pain response upon being touched, indicating inflammation or injury beneath the surface. The clinician also checks for organ enlargement, known as organomegaly, such as an enlarged liver (hepatomegaly) or spleen (splenomegaly), by palpating below the rib cage. Detecting an enlarged spleen is a significant finding that can suggest conditions ranging from infection to blood disorders.
The technique is also used for evaluating the cardiovascular system through the examination of peripheral pulses. By placing fingertips over an artery, the provider feels the pulse’s rate, rhythm, and quality, which offers immediate insight into the heart’s function and circulation. Palpation also helps assess musculoskeletal health by checking muscle tone, joint stability, and the presence of crepitus, a grinding or crunching sensation that can signify joint dysfunction.