A palpation is one of the most important methods
during the examination because it can find a pathological structure. The most
valuable symptom for an exact determination of a pathological focus during the
palpation is an evoking of a pain which is intensive, and its quality
corresponds to patient's problems. The palpation is able masterfully localized
the pathological focus in the areas which are closely under the skin, and
simultaneously there is not a danger of a replacement with other structures5.
The palpation is suitable to be made systematically.
We also examine structures which the patient does not speak as about painful
ones. The patient is surprised very often with a discovery of the painful
structures in areas, in which he/she did not originally localized the pain, by
the palpation. A typical example is a pain at the affection of the
acromioclavicular articulation which
the patient is not able to localize exactly.
We have to ask the patient to show us the most painful structure in the area of
the shoulder girdle at the beginning of the examination. If the patient is able
to localize the pain well, it is the question of pathology of this structure6.
an acromioclavicular articulation
a sternoclavicular articulation
a tendon of the long head of the biceps
muscles and their trigger points – typical for myofascial pains
5but the glenohumeral
articulation is worse accessible for the palpation, and there is a danger of a
replacement with other structures (f. e. rotator cuff). It is almost impossible
to find out the filling of the glenohumeral articulation, and fluctuation rather
belongs to bursitis.
6In summary we can say that
if the patient localizes exactly the pains into a certain place himself/herself,
it deals with an affection of this place. But on the other hand, there exist
structures where the pain radiates more diffusively, so the patient localized
their affection wrongly, and therefore we cannot forget to palpate these places
during each examination.