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242 - Using Ultrasound to Improve Wrist Palpation Skills of Physical Medicine and Rehabilitation Residents: A Pilot Educational Study

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

NM

Nirmal Maxwell, DO

PM&R Resident
Metrohealth
Cleveland, Ohio, United States

Co-Author(s)

DM

Daniela Mehech, MD

Physician
Virginia Mason Franciscan Health
Seattle, Washington, United States
CR

Connor Richmond, DO

PM&R Resident
MetroHealth/CaseWestern Reserve
Cleveland, Ohio, United States

Objectives: Since a wide range of pathologies can affect the wrist in a small area, accurate palpation is an essential skill for physicians. As more medical training programs incorporate ultrasound didactics, it is worthwhile to examine whether ultrasound enhances clinical skills. The purpose of this pilot study is to make an initial estimate of the effect of an ultrasound-based training session on the accuracy of wrist palpation skills in PM&R residents.

Design: Fifteen PM&R residents placed 1-cm wires on five landmarks (Carpometacarpal joint, Triangular Fibrocartilage Complex, Scaphoid, Scapholunate ligament, 1st dorsal extensor compartment) on two models. A Sports Medicine (SM) physiatrist saved an ultrasound image of each landmark, with the pin visible if within range of the US probe. Residents then attended a 45-minute ultrasound workshop where two SM physiatrists taught wrist anatomy and residents practiced scanning each other. Residents repeated the test immediately after the workshop and 6 weeks later. After finishing testing, the SM physiatrist, blinded to resident and date, reviewed the images, measuring the distance in centimeters from the pin to the landmark. 2-cm was the score assigned if the pin was not within range of the probe and target. The primary outcome was the change in distance of pins from the landmark before and after the workshop.

Results: Four PGY-2, five PGY-3, and six PGY-4 residents participated in pre-training and post-training testing. Median score for pre-training testing was 2 cm. Median score for post-training testing was 0.36 cm. Using an N-way ANOVA, there was a statistically significant difference between pre and post-training test scores (p< 0.001), landmark (p< 0.001), and number of MSK rotation (p < 0.05), but not PGY-level (p = 0.12).

Conclusions: Based on our results, our ultrasound-based training session led to a significant improvement in resident’s palpation accuracy for key wrist landmarks.