Mehta Priyesh, Rand Ethan B, Visco Christopher J, Wyss James
Department of Physiatry, Hospital for Special Surgery, New York, New York, USA.
Department of Rehabilitation Medicine, Weill Cornell Medical Center, New York, New York, USA.
J Ultrasound Med. 2018 Jul;37(7):1719-1724. doi: 10.1002/jum.14523. Epub 2017 Dec 27.
The purpose of this observational study was to determine the accuracy of musculoskeletal palpation of the medial joint line of the knee, medial patellar tendon, and posterior tibialis tendon verified by ultrasound imaging among physical medicine and rehabilitation residents.
Eighteen physical medicine and rehabilitation resident physicians at a single specialized institution were asked to identify the medial joint line of the knee, medial patellar tendon, and posterior tibialis tendon on 2 separate standardized patient models during a single data collection. They were asked to place a paper clip flat on the surface of the skin parallel to the specified anatomic structure. A high-frequency linear array transducer was used to identify whether the paper clip was correctly placed over the structures and to measure the distance from the intended structure.
The accuracy rates for palpation of the medial joint line, medial patellar tendon, and posterior tibialis tendon in both models were 14%, 36%, and 28%, respectively, for all levels of residents. Accuracy rates for all of the structures by level of education were 19%, 29%, and 31% for postgraduate years 2, 3, and 4. Median confidence scores were 3.75, 3.5, and 2 for the medial joint line, medial patellar tendon, and posterior tibialis tendon.
This study highlights the level of inaccuracy of musculoskeletal palpation skills and draws further attention to an area of much-needed improvement in our musculoskeletal residency training programs. Ultrasound imaging is an effective noninvasive method for providing swift feedback to medical students and residents and thereby reduce the instances of inaccurate musculoskeletal palpation.
本观察性研究旨在确定在物理医学与康复住院医师中，通过超声成像验证的膝关节内侧关节线、髌内侧肌腱和胫后肌腱的肌肉骨骼触诊准确性。
在一次数据收集过程中，一所专科医院的18名物理医学与康复住院医师被要求在2个单独的标准化患者模型上识别膝关节内侧关节线、髌内侧肌腱和胫后肌腱。他们被要求将一个回形针平放在与指定解剖结构平行的皮肤表面。使用高频线性阵列换能器来确定回形针是否正确放置在这些结构上，并测量与预期结构的距离。
在两个模型中，所有级别的住院医师对膝关节内侧关节线、髌内侧肌腱和胫后肌腱的触诊准确率分别为14%、36%和28%。按教育水平划分，研究生二年级、三年级和四年级对所有结构的准确率分别为19%、29%和31%。膝关节内侧关节线、髌内侧肌腱和胫后肌腱的中位置信度得分分别为3.75、3.5和2。
本研究突出了肌肉骨骼触诊技能的不准确程度，并进一步引起人们对我们肌肉骨骼住院医师培训项目中急需改进领域的关注。超声成像是一种有效的非侵入性方法，可为医学生和住院医师提供快速反馈，从而减少肌肉骨骼触诊不准确的情况。
