graduate medical education; palpation; physical examination; ultrasonography; diagnostic imaging; musculoskeletal system; hand; wrist joint; wrist joint/anatomy and histology; internship and residency


Musculoskeletal System | Rheumatology | Sports Medicine



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.