Palpation Flashcards
ASIS & Iliac Crest
Patient in supine
Muscular Attachments onto ASIS: Sartorius & TFL
Muscular Attachments onto Iliac crest: QL, Abdominal Muscles
Inguinal Ligament
Patient Supine
Runs from the ASIS to the pubic Tubercle
Hip (Femero-acetabular) Joint
Patient in Supine
Located 1/3 of the way between the ASIS and the pubic tubercle (along the inguinal ligament) and inferior at the point of the flexor crease.
Sartorius
Origin: ASIS
Insertion: Pes anserinus (superior part of the medial tibia)
Action:
- Hip = Flexes, Abducts and laterally rotates
- Knee = Flexes and Medially rotates
Innervation: Femoral n.
Palpation: Patient in Supine. At the point of the ASIS, ask the patient to flex the hip and knee, and bring the foot up to the other knee.
Rectus Femoris
Origin: AIIS
Insertion: Quadriceps Tendon onto Patella
Action: Flexes the Hip and Extends the knee
Innervation: Femoral n.
Palpation: Patient in supine. Inferior to the sartorius arising at the ASIS. Have patient flex the hip in a straight line.
Greater Trochanter
Prominent Bony land mark on the lateral upper leg. Have patient in side-lying so that they are in relative adduction.
Muscular Attachments: Gluteus Medius & Minimus, Piriformis, Obturator Externus, Gemellus Superior & Inferior
Ischial Tuberosity
Bony landmark that we sit. Have patient side-lying, top leg bent (The further you flex the hip the more prominent the tuberosity will be), such that the knee rests on the table below.
Muscular Attachments: The hamstrings tendon
Gluteus Medius
Origin: External Surface of the ilium
Insertion: Lateral Surface of the greater trochanter
Action: Abducts, flexes and internally rotates the thigh
- Anterior Fibres - Internally Rotate
- Posterior Fibres - Externally rotates the thigh
Innervation: Superior Gluteal n.
Palpation: Patient side-lying, hip extended & uppermost knee flexed to 90. Asking the patient to abduct, identifying muscle origin just below the iliac crest & following it to the insertion at the greater trochanter.
Note - TFL is anterior and a stronger internal rotator & Glut max is posterior and a hip extensor
TFL
Origin: ASIS
Insertion: ITB (extending down to the lateral condyle of the tibia)
Action: Internally Rotates
Innervation: Superior gluteal n.
Palpation: Patient in side-lying and have them lift their heel off of the bed (internally rotate the hip).
ITB
Dense fascia emerging from the TFL to the lateral tibial condyle. Palpated in side-lying, hips and knees slightly flexed. Resist hip abduction to make it more prominent.
Iliac Crest & PSIS
PSIS located by the dimples on the lower back, and can follow the iliac crest around to the ASIS more medially.
The level of the two PSIS indicates S2. The top of the iliac crest indicates L5.
Sacroiliac Joint (SIJ)
Locate L5 from the iliac crest and then midway between L5 and PSIS you will be on the top of SIJ
Medial & Lateral Femoral Condyles of the Knee
Supine (Crook lying) w/ Towel under the knee. Palpable at the distal end of the femur.
Patella
Palpate the boarders and shape.
Lateral and Medial Facets of the Patella
Hands in a diamond shape over the patella, slide with your thumbs medially or laterally to palpate the facets underneath with your fingers.
Tibial Tubercle
Bony prominence at the top of the Tibia. Attachment for the quadriceps tendon.
Patella Tendon
From the Patella to the tibial tubercle
Infra-patella Fat Pad
Palpate on either side of the patella tendon
Tibiofemoral Joint Line
Move up from the tibial plateau and use your thumbs to dip into the joint space. Start at the boarders of the patella and move laterally and posteriorly on both sides.
Head of Fibula
Postero-Lateral below the joint line. Site of attachment of the LCL and the common peroneal nerve wrapping around. Can have the patient dorsi flex & plantar flex in order to get movement at the superior tib/fib joint
Collateral Ligaments of the Knee
Easier to palpate in sitting, but can also be done in supine.
MCL
- Broad Ligament
- Attaches from the Medial femoral condyle and inserts into medial meniscus and the tibial plateau
LCL
- Cord Like ligament
- Runs from the lateral femoral condyle attaches to the head to the fibula.
- Easier to palpate with the leg cross onto the other leg.
Vastus Medialis
Origin: Intertrochanteric line, Linear Aspera
Insertion: Quadriceps Tendon onto Patella, and tibial tuberosity
Action: Locks and extends the knee
Innervation: Femoral n.
Palpation: Patient in supine w/ towel under the knee. can differentiate from adductors by having the patient resist adduction.
Vastus Lateralis
Origin: Intertrochanteric Line, inferior boarder of greater trochanter, gluteal tuberosity, lateral lip of linear aspera
Insertion: Quadriceps Tendon onto Patella, and then tibial tuberosity
Action: Locks and Extends the knee
Innervation: Femoral n.
Palpation: Patient in supine towel under knee. Start distally and travel upwards and make sure to go posterior to the ITB as the muscle travels underneath it.
Semimembranosus
Origin: ischial tuberosity
Insertion: Medial tibial Condyle
Action: Flexes the knee and extends the hip
Innervation: Sciatic n (Tibial Portion)
Palpation: Patient in prone, resist knee flexion. Distally the muscle is flatter and underneath the semitendinosus tendon.
Semitendinosus
Origin: Ischial tuberosity
Insertion: Pes Anserinus
Action: Flexes the knee and extends the hip
Innervation: Sciatic n (Tibial Portion)
Palpation: Patient in prone, resist knee flexion. Distally the muscle is a long tendon and is more prominent with the knee flexed to 90.
Biceps Femoris
Origin: Long Head (ischial tuberosity), Short Head (Lateral Supracondylar ridge & lateral inter-muscular septum)
Insertion: Head of fibula
Action: Flexes the knee and extends the hip
Innervation: Sciatic n
- tibial Part = Long Head
- common peroneal part = short head
Palpation: Patient in prone, resist knee flexion. Easier to feel with knee at 90.
Pes Anserinus
Located on the proximal medial side of the Tibia.
Semitendinosus (Most posterior)
Gracilis (Middle)
Sartorius (Most anterior)
Lateral and Medial Malleoli
Medial Malleolus - Distal end of tibia
Lateral Malleolus - Distal end of fibula
Anterior Talocrural Joint Line
Palpate along the joint line once you have identified the two malleoli.
Anterior Talofibular Ligament (ATFL)
Travels from Fibula to Talus on the anterior side. Most easily palpated in the sinus Tarsi, which is the hole produced in plantar flexion and inversion.
Calcaneofibular Ligament
Origin: Tubercle on calcaneus
Insertion: Lateral tubercle on posterior aspect of the Fibula
Invert to palpate a cord-like structure. Easiest to palpate than the other two ligaments.
Posterior Talofibular Ligament
Origin: Posterior edge of the lateral malleolus
Insertion: Lateral tubercle of the Talus
Prevents forward slipping of the Fibula onto the Talus. Strongest Ligament.
Cuboid
Articulates with the distal edge of the calcaneus on the LATERAL SIDE OF THE FOOT, and then goes onto articulate directly with the 4-5th MTs.
Palpate by locating the sinus tarsi and then following calcaneus down to the joint line. You could also come from the other way by surpassing the prominent tubercle of the 5th MT.
Tuberosity of the 5th MT
Prominent bony landmark located on the lateral side of the foot. Point of attachment for the peroneus brevis tendon.
Sustentaculum Tali
The bony shelf of the calcaneus bone located inferior to the medial malleolus. Attachment point of the spring ligament (Palmar calcaneonavicular ligament).
Head of the Talus
Invert the foot and you will feel the lateral aspect of the head of talus become more prominent in line with the 3rd toe. Then with one finger follow it around to the medial side.
Navicular
There is a prominent tubercle that can be identified on the medial side of the foot. Draw line between the head of first MT and the medial malleolus and should lie in the middle of this line.
navicular extends as far as the 3rd toe and articulates with the cuneiform bones.
Deltoid Ligament of the Ankle
Origin: Medial malleolus
Insertion: Medial Aspect of the Talus
Resists eversion. To palpate evert the ankle and feel between the sustentaculum tali and the medial malleolus
1st TarsoMetatarsal Joint
Palpate the 1st MT following from head to base.
1st Metatarsophalangeal joint
Palpate along the 1st ray to reach the phalanx. Confirm joint by translating the distal phalanx over the distal head.
Midtarsal joint Line
Made by 4 bones:
Proximally: Talus & Calcaneus
Distally: Navicular and Cuboid
Plantar Fascia
Origin: Tuberosity of the calcaneus
Insertion: Heads of metatarsal bones
Palpate by having patient dorsi flex the toes and ankle (can be against a finger resistance on top of the toes).
Gastrocnemius
Origin:
- Lateral Head: Lateral Femoral condyle
- Medial Head: Medial femoral Condyle
Insertion: Calcaneal tendon
Action: Plantar Flexion & Knee Flexion
Innervation: Sciatic n (Tibial Part)
Palpation: Resist plantar flexion to palpate boarders. Differentiate from peroneal by resisting eversion.
Soleus
Origin: Posterior aspect of fibula and soleal line of the Tibia
Insertion: Posterior surface of Calcaneus via Calcaneal/Achilles tendon
Action: Plantar Flexion
Innervation: Tibial n.
Palpation: Patient in prone w knee flexed to 90, muscle emerges laterally under the gastrocnemius.
Tibialis Anterior
Origin: Lateral condyle and superior lateral surface of the Tibia
Insertion: Medial Cuneiform and bask of 1st MT
Action: Dorsi flexion and inversion
Innervation: Deep Peroneal n.
Palpation: Patient in supine, get them to dorsi flex and invert the foot. Medial boarder with the Tibia and lateral boarder with the Peroneals differentiate with by eversion.
Peroneus Longus
Origin: Head of Fibula
Insertion: Base of 1st MT & Medial Cuneiform
Action: Eversion and assist in plantar flexion
Innervation: Superficial Peroneal N
Palpation: Patient in supine, Evert the foot and feel from the fibula head down to where it becomes more tendinous at the dimple area on the lateral side of the leg.
Peroneus Brevis
Origin: Inferior 2/3 of Fibula lateral surface
Insertion: Tubercle of the 5th MT
Action: Eversion and assist in plantar flexion
Innervation: Superficial Peroneal N
Palpation: Patient in supine, Evert the foot and feel from the dimple of fibula deep to the tendinous peroneus longus.
Tibialis Posterior
Origin: Interosseous membrane + Posterior surface of the Tibia (below soleal line) & posterior surface of Fibula
Insertion: Tuberosity of navicular, cuneiform, cuboid and bases of 2,3,4.
Action: Inversion
Innervation: Tibial n.
Palpation: Patient in supine. Can only feel close to the medial malleolus with foot in plantar flexion and inversion.
T12 Spinous Process
Count up from L4 when identifying it from the iliac crest. Notably smaller spinous process than those seen in the lumbar spine.
Piriformis
Origin: Anterior surface of the sacrum
Insertion: Greater Trochanter
Action: Abducts the flexed thigh
Innervation: Muscular Branches of L5, S1, S2
Palpation: Patient in 3/4 prone or prone. Locate the upper border of the greater trochanter and ask patient to externally rotate the leg.
Spinous Processes of Thoracic Spine T1-12
Remember that C7 tends to be the most prominent and tends to disappear during neck extension. Then once identified T1 count down from here to T12.
Sternoclavicular Joint
Palpate bilaterally to detect asymmetry. Have the patient elevate and depress their scapula in order to identify the joint position.
Clavicle
Palpate length of anterior surface (largely free of muscular attachment with the exception of Platysma).
Feel convexity of medial 2/3rds and then the concave shape of the lateral 1/3.
Muscles that attach to the clavicle: sternocleidomastoid, deltoid, trapezius, pectoralis major (clavicular head) & Subclavius.
Coracoid Process
Find the midpoint of the lateral 1/3rd of the clavicle and drop inferiorly into the concave part. Press obliquely posteriorly and laterally to find the coracoid process.
You can only feel the medial surface. Can confirm location by either contracting biceps (resisting elbow flexion) or pectoralis minor, hand off the back.
Muscular Attachments: P. Minor, Coracobrachialis, Short head of biceps
Acromioclavicular Joint (ACJ)
Palpate laterally along the clavicle until the AC articulation feels like a slight depression. Can be confirmed by asking the patient to flex and extend the shoulder.
Acromion
Can be palpated at the point of the shoulder. Immediately laterally to the AC joint. Can palpate the anterior, lateral and posterior surface
Greater Tuberosity of Humeral Head
Palpate inferiorly from the acromions lateral border.
Muscular Attachments: Supraspinatus, Infraspinatus & Teres Minor
Lesser Tuberosity of Humeral head
Need to externally rotate the shoulder as it is located to far medially to palpate in the resting position. Find the coracoid process, place one finger more laterally and passively internally and externally rotate the humerus to feel it pop in and out.
Muscular Attachments: Subscapularis
Bicipital Groove
Located in between the greater and lesser tuberosity. Can be felt when passively rotating the humerus.
Anterior Shoulder Joint Line
Located in between the coracoid process and the lesser tuberosity.
Posterior Shoulder Joint Line
Drop down vertically from the tip of the posterior aspect of the acromion.
Pectoralis Major
Origin:
- Clavicular Head - Anterior surface of the medial half of the clavicle
- Sternal Head - Anterior surface of the sternum
Insertion: Lateral Lip of the bicipital groove
Action: Internal Rotation, Adduction, Lateral Flexion. Can also extend the humerus in the overhead position.
Innervation: Lateral and medial pectoral nerves
Palpation: Patient in supine, arm abducted to 90 and elbow at 90. Have patient push to laterally flex through resistance. At 90 abduction feels clavicular head and at 110 abduction feels sternal head.
Pectoralis Minor
Origin: Ribs 3-5 & costal cartilages
Insertion: Medial lip of the bicipital groove
Action: Protracts scapula, depresses scapula, downwardly rotates scapula
Innervation: Lateral and medial pectoral nerves
Palpation: Patient in sitting, with hand behind back and moving it off of the back.
Rhomboid Major and Minor Muscles
Origin:
- Minor: Ligamentum Nuchae + Spinous Processes of C7, T1
- Major: Spinous Processes of T2-5
Insertion: Medial border of scapula from level of the spine to the inferior angle
Action: Downward Rotation & Retracts Scapula + fixes scapula to the thoracic wall
Innervation: Dorsal scapular nerve
Palpation: Patient in prone, palpate medial border of the scapula. Ask the patient to move their arm away from the back of the waist.
Teres Major
Origin: Dorsal surface of the inferior angle of the scapula
Insertion: Medial lip of the bicipital groove
Action: internally Rotation
Innervation: Lower subscapular nerve
Palpation: Patient in prone, arm handing to the side w/elbow bent. Patient pushes the palm of their hand into the therapist leg.
Infraspinatus
Origin: Infraspinous Fossa
Insertion: Greater Tubeosity
Action: External Rotation
Innervation: Subscapular n.
Palpation: Patient in prone, arm handing to the side w/elbow bent. Patient pushes the back of their hand into the therapist leg.
Teres Minor
Origin: Superior Lateral border of the scapula
Insertion: Greater Tuberosity
Action: External Rotation
Innervation: Subscapular n.
Palpation: Patient in prone, arm handing to the side w/elbow bent. Patient pushes the back of their hand into the therapist leg.
Trapezius
Origin: Medial Third of superior nuchal line, external occipital protuberance, ligamentum nuchae, spinous processes of C7-T12.
Insertion: Superior border of lateral clavicle, acromion process and superior lip of spine of scapula
Action:
- Upper: Elevates Scapula + Upwardly rotates Scapula
- Middle: Retracts the scapula
Lower: Lowers the scapula * Upwardly rotates the scapula.
Innervation: Accessory Spinal n.
Palpation:
Superior Trap: Patient in sitting. Have them hold their arms in abduction against gravity and easily palpate
Middle Trap: Best felt between the spinal column and the medial border to the scapula.
Lower Trap: Felt moving up from T12 in a lateral direction towards the insertional area at the base of the spine of the scapula.
Latissimus Dorsi
Origin: Spinous Processes of inferior Thoracic Vertebrae & ThoracoLumbar Fascia
Insertion: Floor of bicipital groove
Action: Adduction, Internal rotation, extension
Innervation: Thoracodorsal n.
Palpation: Patient in prone, arm handing to the side arm straight. Patient pushes the arm via adduction into the therapist leg.
Medial Epicondyle of humerus
Common flexor attachment point
Lateral Epicondyle of Humerus
Common Extensor Attachment Point
Elbow Joint Line
An arbitrary line between the medial and lateral epicondyles.
Head of Radius
With elbow in flexion 90, palpate the lateral epicondyle then move approx 2cm distally.
Radio-ulnar joint
At the head of the radius. Confirm by pronation and supination.
Olecranon & Ulnar n
Elbow flexion moves the olecranon out of the fossa making it easy to palpate on the posterior elbow. ulnar nerve lies between the olecranon and the medial epicondyle.
Brachioradialis
Origin: Lateral supracondylar ridge of humerus
Insertion: Base of radial styloid process
Action: Flexes forearm + supports radius whenever biceps is acting.
Innervation: Radial n.
Palpation: Patient sitting. Shoulder flexed 30, elbow flexed 90. Make a fist and flex the wrist. Palpate down the medial and lateral sides of the muscle.
Extensor Carpi Radialis Longus
Origin: Lateral Supracondylar Ridge
Insertion:
Posterior surface of base of 2nd Metacarpal
Action: Extends and radially hand at the wrist joint
Innervation: Radial n.
Palpation: Patient in sitting, wrist extends and radially deviates. The 2nd finger flicks to make it more prominent.
Extensor Carpi Radialis Brevis
Origin: Common Extensor Origin
Insertion: Posterior surface of the base of 3rd metacarpal
Action: Extends and radially deviates hand at wrist joints
Innervation: Radial n.
Palpation: Patient in sitting, wrist extends and radially deviates. The 3rd finger flicks to make it more prominent.
Extensor Digitorum
Origin: Lateral epicondyle of humerus
Insertion: Dorsum of middle and distal phalanges of the four fingers
Action: Extends the wrist and digits
Innervation: Radial n.
Palpation: Patient in sitting, wrist extends and radially deviates. Piano Fingers.
Extensor Carpi Ulnaris
Origin: Lateral Epicondyle of humerus
Insertion: Medial side of the base of the 5th MT
Action: Extends and adducts the hand
Innervation: Radial n.
Palpation: Patient in sitting, wrist extends and ulnar deviates. Medial boarder is the ulnar and lateral border is the extensor digitorum.
Pronator Teres
Origin: Common Flexor Origin (Medial Epicondyle) & a smaller portion from the coronoid process of the ulnar.
Insertion: Lateral side of radius about halfway down the forearm.
Action: Flexes Elbow & Pronates the wrist
Innervation: Median n.
Palpation: Patient in sitting, muscle forms the medial border of the cubital fossa. Begin palpation at the proximal attachment and work down.
Flexor Carpi Radialis
Origin: Common Flexor Origin
Insertion: Base of second metacarpal
Action: Flexes and radially deviates the hand
Innervation: Median n.
Palpation: Patient in sitting, forearm supinated. Make a tight fist and then radially deviate the wrist. The tendon lies radial to the palmaris longus tendon.
Biceps
Origin:
- Short Head - Coracoid Process
- Long Head - Supraglenoid tubercle of the scapula
Insertion: Tuberosity of radius and fascia of forearm via bicipital aponeurosis
Action: Elbow flexion and forearm supination
Innervation: Musculocutaneous n.
Palpation: Tendons felt in bicipital groove (long head) & coracoid process (short head). Palpate the medial and lateral borders by resisting elbow flexion.
Triceps
Origin:
- Long Head: Infraglenoid Tubercle of the scapula
- Lateral Head: Posterior surface of humerus (superior to radial groove)
- Medial Head: Posterior surface of humerus inferior to radial groove
Insertion: Proximal end of the olecranon
Action: Extends the elbow
Innervation: Radial n.
Palpation: Patient in prone, shoulder abducted to 90, elbow level with the edge of the bed. Patient lift elbow to ceiling to indicate posterior fibres of the deltoid. Place on finger in the dip and resist elbow extension to feel the tendon of the long head
Radial/Ulnar Styloid Process
Bony prominence on either side of the wrist
Inferior Radio-ulnar Joint
Palpated between the radial and ulnar styloid processes
Radiocarpal Joint Line
Made by the radius, articular disc, scaphoid, lunate & Triquetrium
Scaphoid
Palpated through the anatomical snuff box. Have the patient ulnar deviate to make more prominent.
Lunate
Just distal to the radial styloid on the dorsal side, and becomes more prominent during wrist flexion (will disappear in wrist extension)
Triquetrium
Distal to the ulnar Styloid process, have the patient in radial deviation and it is an easy bone to palpate
Pisiform
On the anterolateral side of the Triquetrium, essentially a sesamoid bone sitting inside the tendon of FCU
Trapezium
At the BASE OF THE THUMB, distal to the scaphoid.
Trapezoid
Laterally to the dip articulating with the 2nd MT
Capitate
medially to the dip articulating with the 3rd MT
Hamate
Hook - Located on the palmar side in line with the 4th MT in the hypothenar eminence
Body - Found on the dorsal surface at the bottom of the 4th & 5th MT
Abductor Pollicis Longus
Origin: Posterior Surface of the radius
Insertion: Baes of 1st MT
Action: Abducts and extends 1st CMC
Innervation: Radial n.
Palpation: Lateral tendon of the snuff box
Extensor Pollicis Brevis
Origin: Posterior surface of the distal radius
Insertion: Base of distal phalanx of the thumb
Action: Extends the 1st MCP
Innervation: Radial n.
Palpation: Lateral tendon of the snuff box
Extensor Pollicis Longus
Origin: Posterior Surface of the radius
Insertion: Base of distal phalanx of the thumb
Action: Extends IP and MCP joints. Extension and adduction of CMC joint.
Innervation: Radial n.
Palpation: Middle of snuff box
Abductor Pollicis Brevis
Origin: Tubercle of scaphoid and Trapezium
Insertion: Base of proximal phalanx
Action: Abducts the CMC and MCP Joint
Innervation: Median n.
Palpation: 1st layer muscle, most lateral. Felt with the thumb in abduction
Flexor Pollicis Brevis
Origin: Trapezium & 1st Metacarpal
Insertion: base of proximal phalanx
Action: Flex the CMC and MCP joint
Innervation: Median N.
Palpation: 1st layer muscle, sits just medial to AbdPB. Flex the thumb to feel.
Opponens Pollicis
Origin: Tubercle of trapezium
Insertion: Lateral border of 1st MC
Action: Flexes, abducts and medially rotates the CMC
Innervation: Ulnar n.
Palpation: Abduct a little and then oppose. Thin muscle strip
Adductor Pollicis
Origin:
- Oblique Head: Anterior surface 2nd and 3rd MC, capitate and trapezoid
- Transverse Head: Anterior surface of 3rd
Insertion: Medial side of the proximal phalanx
Action: Adducts the CMC joint. Flexes and adducts the MCP
Innervation: Median n.
Palpation: Adduct the thumb against resistance. Put finger in the webspace.
Flexor Pollicis Longus
Origin: Anterior surface of the radius
Insertion: Palmar aspect of distal phalanx
Action: Flexes the IP and MCP
Innervation: Median n.
Palpation: Tendon palpated on proximal phalanx during IP flexion.
First dorsal interosseous
Origin: Adjacent sides of 1st and 2nd MCs
Insertion: Radial side of proximal phalanx of the index finger
Action: Abduct the index finger
Innervation: Ulnar n.
Palpation: Palpate on posterior aspect of the web space close to the second MC, abduct the index finger
Spinous Processes of the Cervical Vertebrae
C1 - No spinous process
C2 - First one you can feel after the dip from the Occiput
C3-5 are deep due to lordosis and very close together. Can place the neck in slight flexion but hard to feel.
C7-T1 -
