title: Resident accuracy of joint line palpation using ultrasound verification.
abstract: OBJECTIVE
  To determine the accuracy of knee and acromioclavicular (AC) joint line palpation in Physical Medicine and Rehabilitation (PM&R) residents using ultrasound (US) verification.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  PM&R residency program at an academic institution.
  
  
  METHODS
  Twenty-four PM&R residents participating in a musculoskeletal US course (7 PGY-2, 8 PGY-3, and 9 PGY4 residents).
  
  
  METHODS
  Twenty-four PM&R residents participating in an US course were asked to palpate the AC joint and lateral joint line of the knee in a female and male model before the start of the course. Once the presumed joint line was localized, the residents were asked to tape an 18-gauge, 1.5-inch, blunt-tip needle parallel to the joint line on the overlying skin. The accuracy of needle placement over the joint line was verified using US.
  
  
  METHODS
  US verification of correct needle placement over the joint line.
  
  
  RESULTS
  Overall AC joint palpation accuracy was 16.7%, and knee lateral joint line palpation accuracy was 58.3%. Based on the resident level of education, using a value of P < .05, there were no statistically significant differences in the accuracy of joint line palpation.
  
  
  CONCLUSIONS
  Residents in this study demonstrate poor accuracy of AC joint and lateral knee joint line identification by palpation, using US as the criterion standard for verification. There were no statistically significant differences in the accuracy rates of joint line palpation based on resident level of education. US may be a useful tool to use to advance the current methods of teaching the physical examination in medical education.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago/McGaw Medical Center of Northwestern University, 1030 North Clark Street, Suite 500, Chicago, IL 60610(∗). Electronic address: mrho@ric.org.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Rho
authors.affiliation: Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago/McGaw Medical Center of Northwestern University, Chicago, IL(†).
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Chu
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, CO(‡).
authors.forename: Aaron
authors.initials: A
authors.lastname: Yang
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY(§).
authors.forename: Farah
authors.initials: F
authors.lastname: Hameed
authors.affiliation: Changi Sports Medicine Centre, Changi General Hospital, Singapore(‖).
authors.forename: Cindy Yuchin
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA(¶).
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hurh
mesh_terms: D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging*; D059925:Anatomic Landmarks; D002983:Clinical Competence; D003937:Diagnosis, Differential; D004521:Educational Measurement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency; D007592:Joint Diseases / Q000175:diagnosis; D008297:Male; D010173:Palpation / Q000592:standards*; D010810:Physical and Rehabilitation Medicine / Q000193:education*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*; D014481:United States