Percussion, also known as palpation, is an important examination method in orthopedics. In the Qing Dynasty's "Yi Zong Jin Jian: Zheng Gu Xin Fa Yao Zhi: Shou Fa Zong Lun," it is said, "Use your hands to feel it, and you will understand its condition." When palpating superficial lesions, do not apply too much force. Moderate or greater force is required to identify tender points in deep muscles. Bone injuries often require more force to be detected.
1. Tender Points
Tender points and areas of tenderness. When a patient complains of pain in a certain area, it is difficult to determine the specific location of the lesion without palpation. Palpation must be performed repeatedly to understand the situation clearly. During palpation, it is important to distinguish between primary and secondary tender points. Throughout the treatment process, primary and secondary tender points may transform and change. By repeatedly palpating, one can identify the key points and guide clinical treatment accurately.
The range, location, and degree of tenderness can be used to differentiate between tendon and bone injuries. Sharp and pronounced tenderness often indicates a fracture, while mild tenderness over a wide area suggests a tendon injury.
2. Palpating Swelling
If the swelling is firm and the skin color is bluish-purple, it indicates a fresh injury. If the injury has been present for a long time and blood stasis has not resolved, the swelling can also be firm. If the swelling is soft and bluish-purple with a yellowish tinge, it indicates an old injury. Fresh injuries can cause extravasation of blood outside the blood vessels, leading to subcutaneous hematoma formation or internal bleeding that manifests as swelling. Diagnosis should be based on the patient's medical history in combination with the depth and evolution of the injury.
3. Palpating Deformities
By palpating the protrusions or depressions that appear in the affected area, one can determine the nature, location, and displacement of fractures and dislocations, as well as whether the fracture reduction is satisfactory.
4. Palpating Abnormal Movements
Injuries to long tubular bones in the limbs that prevent certain movements indicate the presence of a fracture. If a fracture has been confirmed and there is still abnormal movement at the fracture site, it suggests that the fracture has not healed. Abnormal movements in joints often indicate complete rupture of the corresponding ligaments.
5. Palpating Elastic Fixation
In cases of chronic dislocation where the protruding bone can be elastically moved during traction, it is generally possible to achieve reduction. After joint injuries, if there is an elastic sensation during traction, it indicates the presence of adhesions. Manual techniques can be used to release the adhesions.
6. Percussing the Distal End
Percussing the body surface with a fist can determine the depth and degree of pain in the affected area. Longitudinal percussion on the distal end of a limb can assess whether there is a fracture and the degree of healing.
