Localization of Hand and Wrist Anatomic Structures Among Physical Medicine and Rehabilitation Residents: Implication of Ultrasonography in Palpation Skill Verification.

Objective: 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. Methods: 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. Results: 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). Conclusions: 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.