Rho Monica E, Chu Samuel K, Yang Aaron, Hameed Farah, Lin Cindy Yuchin, Hurh Peter J
Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago/McGaw Medical Center of Northwestern University, 1030 North Clark Street, Suite 500, Chicago, IL 60610(∗).
Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago/McGaw Medical Center of Northwestern University, Chicago, IL(†).
PM R. 2014 Oct;6(10):920-5. doi: 10.1016/j.pmrj.2014.02.006. Epub 2014 Feb 14.
To determine the accuracy of knee and acromioclavicular (AC) joint line palpation in Physical Medicine and Rehabilitation (PM&R) residents using ultrasound (US) verification.
Cohort study.
PM&R residency program at an academic institution.
Twenty-four PM&R residents participating in a musculoskeletal US course (7 PGY-2, 8 PGY-3, and 9 PGY4 residents).
Twenty-four PM&R residents participating in an US course were asked to palpate the AC joint and lateral joint line of the knee in a female and male model before the start of the course. Once the presumed joint line was localized, the residents were asked to tape an 18-gauge, 1.5-inch, blunt-tip needle parallel to the joint line on the overlying skin. The accuracy of needle placement over the joint line was verified using US.
US verification of correct needle placement over the joint line.
Overall AC joint palpation accuracy was 16.7%, and knee lateral joint line palpation accuracy was 58.3%. Based on the resident level of education, using a value of P < .05, there were no statistically significant differences in the accuracy of joint line palpation.
Residents in this study demonstrate poor accuracy of AC joint and lateral knee joint line identification by palpation, using US as the criterion standard for verification. There were no statistically significant differences in the accuracy rates of joint line palpation based on resident level of education. US may be a useful tool to use to advance the current methods of teaching the physical examination in medical education.
通过超声（US）验证，确定物理医学与康复（PM&R）住院医师对膝关节和肩锁（AC）关节线触诊的准确性。
队列研究。
一所学术机构的PM&R住院医师培训项目。
24名参加肌肉骨骼超声课程的PM&R住院医师（7名PGY-2级、8名PGY-3级和9名PGY-4级住院医师）。
24名参加超声课程的PM&R住院医师在课程开始前，被要求在一名女性和一名男性模型上触诊AC关节和膝关节的外侧关节线。一旦确定了假定的关节线，住院医师们被要求在覆盖皮肤上与关节线平行粘贴一根18号、1.5英寸的钝头针。使用超声验证针在关节线上放置的准确性。
超声验证针在关节线上的正确放置情况。
AC关节触诊的总体准确率为16.7%，膝关节外侧关节线触诊的准确率为58.3%。根据住院医师的教育水平，P值<0.05时，关节线触诊准确性无统计学显著差异。
本研究中的住院医师通过触诊识别AC关节和膝关节外侧关节线的准确性较差，以超声作为验证的标准。根据住院医师的教育水平，关节线触诊准确率无统计学显著差异。超声可能是推进医学教育中当前体格检查教学方法的有用工具。
