This is a shortcut to describe a swelling.
In general, it is divided into inspection and palpation
INSPECTION
- SITE of the swelling
- SHAPE of the swelling
- SIZE of the swelling
- DEFINITION of the swelling: Well-defined or Ill-defined
- SURFACE of the swelling: Smooth, Nodular or Lubulated
- PULSATION: Is the swelling pulsatile?
- SKIN CHANGES on and around the swelling: colour changes, scars, sinuses
PALPATION
- TENDERNESS: Is the swelling tender?
- TEMPERATURE: Is there any local rise in temperature?
- Confirm all inspectory findings
- CONSISTENCY: Hard, Firm(feel something like the consistency of your nose), Soft
- Plane/Mobility: Where is the swelling lie on in relation of underlying structures such as bone, muscle, skin?
- TRANSILLUMINATION
If the swelling is at the neck, you just have to add on some of the followings:
In INSPECTION, add on:
- SWALLOWING: Does the swelling moves with swallowing?
- PROTRUDE TONGUE: Does the swelling move with protruding the tongue?
- PEMBERTEN SIGN: Ask the patient to put both his/her hands on his/her head, wait for 10 seconds and look for any pressure signs/cyanosis on his/her face. Its significant is that, if it is positive, it suggest that there is something (such as retrosternal extension of goitre) compressing the iminent vein.
- TRACHEA POSITION: Is the trachea centrally placed?
In PALPATION, add on:
- CAROTID: Feel for the carotid pulse
- LYMPH NODES
In case the swelling is at the groin:
In INSPECTION, add on:
- COUGH IMPULSE: Does the swelling become more prominent on coughing?
- REDUCIBILITY: Is the swelling reducible (on its own or on manual reduction)?
- Check for the OPPOSITE SIDE
- Check the EXTERNAL GENITALIA
In PALPATION, Add on:
- RING OCCLUSION TEST
You may add other special tests on your examination if it is relevant. But the above are the important points that you must not miss.
Source: Class taken by Dr. Sivabalan, HOD of Surgery HPSF, Muar
