Cho John Chinsuk, Reckelhoff Kenneth
Department of Clinical Sciences, Parker University, 2540 Walnut Hill Lane, Dallas, TX 75229 USA.
Chiropr Man Therap. 2019 Oct 23;27:47. doi: 10.1186/s12998-019-0269-4. eCollection 2019.
To determine whether a discrepancy exists in identifying three musculoskeletal landmarks (medial meniscus, lateral malleolus and lateral epicondyle of the humerus) and whether ultrasound-guided (US-guided) palpation intervention can reduce that discrepancy and improve localization for chiropractic interns.
Sixteen chiropractic interns were asked to identify three subcutaneous anatomical landmarks before/ after the intervention and at a 3-day follow-up. The intervention was a three-minute US-guided demonstration of the landmarks after the intern's initial localization. The primary outcome measure was the change in distance between the intern's landmark identification. Non-normal data were analyzed with the Friedman's and Wilcoxon signed rank tests. Discrepancy between examiner-determined landmarks and intern-identified landmarks at the initial time point was assessed with a 1-sample Wilcoxon signed rank test.
All locations demonstrated an initial discrepancy between examiner-determined landmarks and intern-identified landmarks at the initial time point. Overall, a statistically significant difference was noted in the identification of the medial meniscus ( = 0.012) and lateral malleolus ( = 0.001), but not at the lateral epicondyle ( = 0.086). For the before and immediately after comparison, a significant improvement was found with the medial meniscus ( = 0.005) and lateral malleolus ( = 0.002). The 3-day post-intervention comparison found an improvement only for the lateral malleolus ( = 0.008).
This pilot study demonstrated palpatory discrepancy at identifying all three landmarks. Our data suggests that US-guided palpation intervention seems to improve an intern's ability to palpate two landmarks (medial meniscus and lateral malleolus) post-intervention.
确定在识别三个肌肉骨骼标志（内侧半月板、外踝和肱骨外上髁）时是否存在差异，以及超声引导（US引导）触诊干预是否可以减少这种差异并改善整脊实习生的定位。
16名整脊实习生被要求在干预前/后以及3天随访时识别三个皮下解剖标志。干预是在实习生初步定位后对标志进行三分钟的US引导演示。主要结局指标是实习生标志识别之间距离的变化。对非正态数据进行Friedman检验和Wilcoxon符号秩检验。在初始时间点，用单样本Wilcoxon符号秩检验评估检查者确定的标志与实习生识别的标志之间的差异。
在初始时间点，所有部位在检查者确定的标志与实习生识别的标志之间均显示出初始差异。总体而言，在内侧半月板（P = 0.012）和外踝（P = 0.001）的识别上存在统计学显著差异，但在肱骨外上髁处没有（P = 0.086）。对于干预前和干预后立即进行的比较，在内侧半月板（P = 0.005）和外踝（P = 0.002）方面发现有显著改善。干预后3天的比较发现仅在外踝方面有改善（P = 0.008）。
这项初步研究表明在识别所有三个标志时存在触诊差异。我们的数据表明，US引导的触诊干预似乎可以提高实习生在干预后触诊两个标志（内侧半月板和外踝）的能力。
