Lee Se Won, Le Phuong Uyen, Van Dien Craig, Lai Stepfanie, Aguila Eric
Department of Physical Medicine and Rehabilitation, Sunrise Health GME Consortium, MountainView Hospital, Las Vegas, NV.
Division of Physical Medicine and Rehabilitation, Department of Internal Medicine, Lehigh Valley Health Network, Allentown, PA.
HCA Healthc J Med. 2021 Apr 28;2(2):115-121. doi: 10.36518/2689-0216.1189. eCollection 2021.
The objective of this cross-sectional study is to evaluate the accuracy of physical medicine and rehabilitation (PM&R) resident palpation skills of hand and wrist joint and soft tissue structures using ultrasonography (US) verification.
PM&R residents palpated hand and wrist anatomic structures in an outpatient musculoskeletal (MSK) clinic. Once the presumed structures were localized, residents marked a one centimeter size circle on the overlying skin with an ink marker. The accuracy of the circle over the joint line and soft tissue structures was verified using US.
Overall palpation accuracy for 16 joint line and soft tissue structures was 40.6%. There was no significant difference in palpation accuracy with advanced educational level (37.5% in PGY-2, 33.8% in PGY-3, 50% in PGY-4, p = 0.12). The percentage of combined accurate palpation and less than one centimeter error in accurate palpation revealed a significant improvement along the advancement of PGY training (50%, 61.3%, 69.8% in PGY-2, 3, 4 respectively, p = 0.01).
This study demonstrated an overall suboptimal accuracy of hand and wrist palpation skills by PM&R residents and a need to improve palpation skills among PM&R residents.
本横断面研究的目的是通过超声（US）验证来评估物理医学与康复（PM&R）住院医师对手腕关节和软组织结构的触诊技能的准确性。
PM&R住院医师在门诊肌肉骨骼（MSK）诊所对手腕的解剖结构进行触诊。一旦确定了推测的结构，住院医师用墨水笔在覆盖的皮肤上标记一个一厘米大小的圆圈。使用超声验证圆圈在关节线和软组织结构上的准确性。
16个关节线和软组织结构的总体触诊准确率为40.6%。不同教育水平的触诊准确率无显著差异（PGY-2为37.5%，PGY-3为33.8%，PGY-4为50%，p = 0.12）。随着PGY培训的推进，准确触诊与准确触诊误差小于一厘米的综合百分比有显著提高（PGY-2、3、4分别为50%、61.3%、69.8%，p = 0.01）。
本研究表明PM&R住院医师对手腕的触诊技能总体准确性欠佳，需要提高PM&R住院医师的触诊技能。
