Landmarks Lab

Question 1

zygomatic arch (of temportal bone)

Answer 1

Posterior lateral portion of the cheekbone. Palpate the cheekbone just inferior to the orbit and follow this structure posteriorly and laterally toward the ear. Bilateral structure.

Question 2

Temporomandibular joint (TMJ)

Answer 2

The junction of the condylar portion of the mandible with the indentation (articular tubercle) of the temporal bone. Place one finger in the ear and another just in front of the ear. Have the patient fully open and close their jaw slowly. You may feel popping, clicking, or uneven motion in comparison to the other side.

Question 3

Angle of the Mandible

Answer 3

Find the TMJ, then palpate the mandible inferiorly until it makes an angle anteriorly. Bilateral structure.

Question 4

Mastoid process

on temporal bone

Answer 4

Bony prominence posterior to the ear lobule. Bilateral structure.

Question 5

Transverse process of atlas (C1)

Answer 5

Midway between the angle of the mandible and the tip of the mastoid process of the temporal bone. With the tip of the index finger, gently palpate this area. The small, firm structure is the transverse process of C1. Bilateral structure.

Question 6

Inion (external occipital protuberance)

Answer 6

Small bump/protuberance located in the midline on the posterior inferior aspect of the occiput.

Question 7

Superior nuchal ridge (line)

Answer 7

Ridge of bone on the occiput that runs laterally from the inion to the mastoid process of the temporal bone. Dynamically palpate this ridge by gently sliding the skin medially to laterally and inferiorly to superiorly.

Question 8

First Rib

Answer 8

Just below the clavicle or with patient supine follow ear down to neck area and slowly feel deep tissues

Question 9

Clavicle

Answer 9

Stand behind the seated patient and lightly place your hands on the top of the shoulders, allowing your fingers to drape anteriorly toward the chest. Palpate the long, s-shaped bone that attaches medially at the manubrium and laterally at the acromium of the scapula. Stand in front of the seated patient and place your palms on the anterior, superior portion of the chest and palpate as above. Bilateral structure.

Question 10

jugular notch

Answer 10

In the midline, lightly palpate the anterior aspect of the base of the neck. Continue inferiorly until you feel a notch or groove intermediate to the two medial clavicular heads.

Question 11

sternoclavicular joint (SC joint)

Answer 11

Just lateral to the jugular notch where the medial head of the clavicle meets the sternum. With both hands trace each clavicle towards the midline until you reach the sternum.

Question 12

synchondrosis

Answer 12

Palpate inferior to the medial clavicular heads on the anterior aspect of the chest wall. Bilateral structure.

Question 13

sternal angle (anlge of louis)

Answer 13

Palpating inferiorly from the jugular notch in the midline you will feel a subtle shelf of bone (sometimes more prominent in men). Easier to find if you dynamically palpate the manubrium with the skin slide.

Question 14

second costal cartialge

Answer 14

Palpate just lateral to the sternal angle and feel the cartilage of the second rib. Bilateral structure.

Question 15

costochondral junction

Answer 15

Junction of the cartilage of the first seven ribs with the sternum anteriorly and bilaterally. Often difficult to palpate unless a dysfunction is present in which you may feel a bump. Palpate by sliding (gently) over the skin medially and laterally (dynamic palpation with skin slide).

Question 16

costoclavicular space

Answer 16

The space inferior to the medial third of the clavicle, bilaterally.

Question 17

infraclavicular fossa

Answer 17

The deep space inferior to the lateral two-thirds of the clavicle, bilaterally.

Question 18

illiac crest

Answer 18

check standing then supine. Superior aspect of the innominate bone or “hip bone.” With patient supine or prone, place your hands on the lower portion of the rib cage and gently palpate inferiorly until you hit a bony structure. Keep your hands flat on top of the crests. Stand on your dominant eye side to assess asymmetry of the iliac crest heights. Iliac crests are usually more cephalad in men due differences in the overall shape of the innominates when compared to females. Bilateral structure.

Question 19

anterior superior iliac spine

Answer 19

Patient is supine. With your hands on top of the crests of the ilium, drop your palms onto the anterior bony structures bilaterally. You may hook your thumbs underneath and assess height differences. Stand on your dominant eye side. Bilateral structure.

Question 20

Anterior inferior iiiac spine

Answer 20

With your hands on the ASIS (as above) palpate caudally and slightly medially until you find the next bony prominence. This will be smaller, deeper, and less prominent than the ASIS. You may have the patient try to raise their leg towards the ceiling to contract the rectus femoris muscle which attaches to this landmark. Stand on your dominant eye side. Bilateral structure.

Question 21

pubic sumphysis

Answer 21

With patient supine place the heel of the hand at the umbilicus. Slowly walk the heel of the hand towards the feet. The bony structure is the pubic bone. Once found with the heel of your hand, place index or middle finger pads of both hands on the SUPERIOR aspect of the pubic bone. Bilateral structure. In men the pubic bone is more cephalad than in females. Politely ask the man to arrange himself before palpating this landmark. Stand on your dominant eye side.

Question 22

inguinal ligament

Answer 22

The ligament runs from the ASIS to the pubic tubercle and feels like a tight band. With the patient supine, start at the ASIS and palpate inferiorly and medially following the tight band towards its insertion on the pubic tubercle. This can be very tender/ticklish on people. Stand on your dominant eye side. Bilateral structure.

Question 23

vertebral prominens/spinous process of T1

Answer 23

With the patient seated, have them flex their head. Stand behind the patient and look for the most prominent midline structure at the base of the neck. To differentiate the spinous processes of C7 and T1, place the middle finger on the most superior bony midline structure and the index finger on the inferior one. Passively extend the patient’s head. The spinous process of C7 will move forward and ‘disappear’ as the spinous process of T1 remains. Re-test with flexion of the neck.

Question 24

spine of scapula

Answer 24

With the patient seated, place both palms on the superior-lateral aspect of the shoulders. Palpate the bony shelf or ‘spine’ that traverses medially from the acromion process. Spine is located at the level of the body of T3. Bilateral structure.

Question 25

vertebral (medial border) of scapula

Answer 25

Palpate medially along the spine of the scapula until it begins to angle inferiorly. Palpate the medial border just lateral to the spinous processes bilaterally. May have the patient place their hand behind their back which may ‘wing’ the scapula, helping to accentuate this medial border.

Question 26

inferior angle of scapula

Answer 26

Palpate the medial border of the scapula inferiorly until you feel a tip or angle. The inferior angle of the scapula is located at the level of the spinous process of the 7th vertebra and points to the 8th rib. Bilateral structure.

Question 27

rib angles

Answer 27

bumps medial to the spine?

Question 28

posterior superior iliac spines

Answer 28

Palpate with patient standing or prone. Wrap your palms around the iliac crests bilaterally. Thumbs should ‘fall’ onto the posterior bony protuberances of the PSIS; then hook your fingers underneath the structure. Or, if difficult to find, may press gently using finger pads or whole hand (whole hand principle) on the superior area of the buttocks. Stand directly behind the patient with your eyes at the level of the PSIS when diagnosing from a standing position. Stand on your dominant eye side when evaluating prone. Assess height differences. Bilateral structure.

Question 29

sacral sulcus

Answer 29

With your thumbs on the PSIS (see above), move them medially and slightly inferior. Stand on your dominant eye side. Assess depth of sulci bilaterally. Bilateral structure

Question 30

inferior lateral angle of sacrum (ILA)

Answer 30

With your thumbs in the sacral sulcus, palpate the spine of the sacrum until you reach the coccyx. Then place both thumbs just superior and lateral to the coccyx. Assess which thumb is more superior or inferior. Stand on your dominant eye side. Bilateral structure.

Question 31

ischial tuberosity

Answer 31

The inferior portion of the innominate bone, more specifically located on the ischium. Bones upon which we sit. Place your thumbs on the posterior aspect of the thighs and palpate superiorly until you feel the bony prominences deep to the gluteal folds bilaterally. Let your patient know what you are doing before palpating. Stand on your dominant eye side. Assess which tuberosity is more caudad (towards the feet) or cephalad (towards the head). Bilateral structure.

Question 32

tip of acromion process

Answer 32

As you palpate the joint space above, the acromion process is the most lateral structure palpated on top of the shoulder. Bilateral structure.

Question 33

acromioclavicular (AC) joint

Answer 33

Place hand on clavicle and palpate laterally until it meets the acromion. Have the patient perform rowing or shrugging motions to palpate motion at this joint. Bilateral structure.

Question 34

coracoid process

Answer 34

Facing the patient, place your palm on anterolateral aspect of the shoulder with thumb pointing medially (make an ‘L’). Gently press thumb into the soft tissue just inferior to the clavicle. Can be tender. Bilateral structure

Question 35

greater tubercle (humerus)

Answer 35

With arm in anatomic position, palpate the tip of the acromion and then just inferiorly to reach the greater tubercle of the humerus. Press gently into the humerus with finger pads to appreciate the bony protuberance. Bilateral structure.

Question 36

lesser tubercle (humerus)

Answer 36

With the arm in external rotation and with hand placement in the position for finding the intertubercular groove (see above), continue to externally rotate the arm until a small bony protuberance is palpated. May be tender. Bilateral structure.

Question 37

intertubular groove

Answer 37

With the patient’s arm in the anatomically neutral position and your finger pads on the greater tubercle, flex the arm at the elbow and externally rotate (rotate anterior portion of arm outward) until finger pads drop into small cleft. May be tender. Bilateral structure.

Question 38

medial epicondyle (distal humerus)

Answer 38

Flex arm up (bend elbow). Place fingertips on either side of the elbow and palpate towards the shoulder. Bony protuberance on the upper arm closest to the body (medial). Bilateral structure.

Question 39

lateral epicondyle (distal humerus)

Answer 39

Flex arm up (bend elbow). Place fingertips on either side of the elbow and palpate towards the shoulder. Bony protuberance on the upper arm farthest from the body (lateral). Bilateral structure.

Question 40

olecranon process (proximal ulna)

Answer 40

Flex the elbow. Palpate the bony protuberance in the midline on the posterior aspect of elbow joint. Bilateral structure.

Question 41

radial head (proximal)

Answer 41

Flex arm at the elbow. Place thumb on the anterior lateral aspect of the elbow with the index finger wrapped around the elbow laterally, on the posterior aspect. Supinate and pronate to feel motion. May also find the lateral epicondyle of the humerus and palpate distally to the humero-radial joint space; then palpate just inferiorly to find the radial head. Bilateral structure.

Question 42

styloid process of the radius (distal and lateral)

Answer 42

On the distal aspect of the forearm, on the thumb side (first finger), directly proximal to the wrist. Flex and extend the wrist to differentiate from the bones of the wrist. Small bony protuberance. Bilateral structure.

Question 43

styloid process of ulna

Answer 43

On the distal end of the forearm, on the side of the fifth finger (pinky), directly proximal to the wrist. Palpate the dorsum of the hand proximally and feel the small bony protuberance. Flex and extend the wrist to differentiate from the bones of the wrist. Bilateral structure.

Question 44

greater trochanter

Answer 44

Place open hands on sides of hips near crests and push medially. ‘Walk down’ the lateral aspect of the hips until a firm, bony protuberance is palpated. Bilateral structure.

Question 45

patella

Answer 45

With the patient supine, palpate the anterior aspect of the knee and appreciate a firm, oval structure. To enhance palpation, have patient tighten their thigh muscles to feel its motion. May also gently push/pull the bone laterally/medially with thigh relaxed. Bilateral structure.

Question 46

tibial tuberosity

Answer 46

Directly below the patella in the midline. Bony protuberance on the proximal, anterior aspect of the tibia. May be enlarged on some patients. Bilateral structure.

Question 47

medical malleolus (tibula)

Answer 47

Bony protuberance on medial aspect of the ankle. Bilateral structure.

Question 48

fibular head

Answer 48

With patient supine, flex knee to 90 degrees. Using the whole hand principal palpate the lateral aspect of the knee. You will feel a bone sticking out laterally; this is the fibular head. Place thumb and index fingers around the fibular head. Dynamically palpate by moving fibular head slightly in posterior/medial and anterior/lateral positions. Bilateral structure.

Question 49

lateral malleolus (fibula)

Answer 49

Bony protuberance on lateral aspect of the ankle. It is more distal than the medial malleolus. Bilateral structure.

Question 50

calcaneal tendon

Answer 50

(achilles tendon) - With patient supine, palpate the heel of the foot (calcaneus). Palpate the midline, round tendon superiorly towards the calf musculature. Bilateral structure.