Lump : Examination

                                                Lump/Swelling: Examination

[A] Inspection „

1.       Number

2.       Site

3.       Shape

4.       Size

5.       Surface

6.       Extent

7.       Margin

8.       Skin over the swelling

•Scar/Pigmentation/Ulcer /Peau d’orange /Satellite nodule

9.       Impulse on cough (for hernias and meningocele)

10.   Pressure effect

•Swelling of limbs

•Muscle wasting

11.  Movement with respiration

12.  Movement with deglutition

13.  Movement with protrusion of tongue

(Mnemonic -Man’s PENIS or Male SPINE- Margin-Movement, Pressure effect, Extent, Number, Impulse, Size-shape-surface-site-skin)

[B]Palpation

1.       Temperature /tenderness

2.       Site/Shape/Size/Surface

3.       Extent/Margin

4.       Consistency

·         Soft (feel of a relaxed muscle)

·         Firm (feel of a contracted muscle)

·         Hard (feel of bone)

·         Variegated- variable feel soft, firm or hard at different parts of the swelling

5.       Fluctuation (cystic or solid)

·         Transmitted impulse in two planes at right angles to each other

·         Displacing finger- finger which presses the swelling

·         Watching finger- static fingers that appreciate the displacement

·         Paget’s test- for small swelling

6.       „Transillumination

·         Demonstrated by placing a torch over the swelling under the shade of a screen using cylindrical roll

·         Brilliantly transilluminant swelling

§  „ Vaginal hydrocele

§  „ Cystic hygroma

§  „ Encysted hydrocele of the cord

§  „ Hydrocele in the canal of nuck

7.       „Reducibility

8.       „Compressibility

·         Swelling compressed with the fingers àdiminishes in size (may disappear)àpressure releasedà reappears slowly

·         Hemangiomas, lymphangiomas and meningocele or meningomyelocele

9.       „ Palpable impulse on cough

10.   „ Fixity of the swelling to skin

·         Pick up the skin from the underlying swelling

11.   „ Fixity of the swelling to deeper structure

•                      Muscle/Tendon : test mobility with muscle/tendon relaxed and contracted

•                      Bones: Swelling is fixed, Not movable in any direction

•                      Vessel compression effect: Absence of pulse distal to the swelling

•                      Nerve compression effect: Reduced muscle power and sensation

12.   Pulsation: if present, transmitted or expansile pulsation

·         Index and middle finger kept over the swelling

·         Transmitted pulsation – fingers move up parallel to each other(a swelling in front of an artery)

·         Expansile - fingers are lifted up and also move apart (aneurysm)

13.   Fluid thrill

[C] Percussion

·         Hydatid thrill

§  Seen in hydatid cyst

§  Due to displacement of daughter cysts in the fluid of the mother cystàstrike back the wall of mother cyst

[D] Auscultation

·         Machinery murmur in aneurysmal varix

[E] Movement of adjacent joint

[F] Examination of regional lymph nodes