Enhancement of tactile perception in palpation

We studied tactile perception in palpation of the precordium to determine the frequency response of the hand and to improve, if possible, the sensitivity of the hand as a transducer for precordial movement. The threshold of tactile sensation was determined for 10 subjects by manipulating the amplitude of movement of an impulse generator at each of a series of frequency settings in the subaudible range (1-40 Hz). Relatively gross movements were necessary to achieve threshold in the lowest frequencies. A more than fourfold increase in sensitivity was obtained by restraining the fingers with the application of a light but unyielding disc to their dorsal surface. Clinical application of this device permitted the easy perception of a systolic thrust as well as a rapid filling wave in normal adult subjects over the right ventricle at the left sternal edge, an area generally considered to be motionless by conventional palpation.