Triple-handed approach eases palpation of ticklish patients

(HealthDay)—A novel triple-handed approach allows for examination of lymph-node basins without eliciting a ticklish response, according to a letter to the editor published in the March 10 issue of the New England Journal of Medicine.

Christopher M. Dobson, M.B.B.S., from the Royal Preston Hospital in the United Kingdom, and colleagues developed an approach to performing palpation of lymph-node basins in ticklish patients with skin cancer. The examiner places the fingertips of one hand on the skin overlying the lymph-node basin. The patient then places the fingertips of one hand on top of the examiner's fingertips. The examiner places their second hand on top of the patient's hand. The patient is advised that the examiner will initiate movement with their top hand, which the patient should actively match. The patient's movements are transmitted through the examiner's underlying fingers. Patients perceive that they are initiating the palpation and consequently anticipate the sensation and do not tickle themselves.

The researchers found that the technique worked in all ticklish adults examined in the past year, for palpation of lymph nodes and hepatosplenomegaly examination. In two patients, the technique was used to perform an examination of tender flexures without eliciting a ticklish response.

"We have found that the triple-hand technique is very helpful in the cancer clinic setting but suggest that it has potential usefulness in other areas of clinical and radiologic examination involving ticklish patients," the authors write.