Palpation Flashcards
FLEXOR HALLUCIS BREVIS
This muscle belongs to the third layer of the sole of the foot. When attempting to palpate the muscle, firm palpation should be applied long the shaft of the 1st metatarsal during big toe flexion.
QUADRATUS PLANTAE
This muscle belongs to the second layer of muscles of the sole of the foot and therefore, is not directly palpable. When attempting to detect trigger points in this muscle one must palpate deeply and anterior to the calcaneus. Location of this muscle by isolated contraction is not possible because it contracts together with flexor digitorum brevis which overlies it. However, if contracture is suspected then dry needling or electro-dry needling can be used to eliminate the possibility as part of the diagnostic process.
Quadratus Lumborum
The muscle lies deep to the erector spinae, internal oblique and external oblique muscles but are superficial to the deep stabilising muscles such as the rotatores and multifidi.
The muscle can be differentiated through fibre direction and action (hip hike) while palpating the muscle.
The muscle lies between the 12th rib which is situated superiorly, the TPs T12-L4 which are positioned medially and posterior iliac crest which is inferiorly located.
The structure can be palpated in both a standing, prone and side lying position with a flat palpation.
Flexor Hallucis Longus
The muscle lies between the posterior shaft of the tibia and calcaneal tendon. The muscle is virtually inaccessible to direct palpation, except at a small region on the medial side of the leg and ankle.
Sidelying. Palpate posterior to the medial malleoli. Resist big toe flexion & feel for a contraction between behind tibialis posterior and FDL. Follow the tendon proximally.
Lumbar Paraspinals – Iliocostalis Lumborum and Lx and Sx Multifidus
With your patient lying prone, locate the spinous processes and then run your fingers laterally over a band of muscle tissue which lies parallel to the spine on either side. To confirm, you can ask your patient to either lift their feet or head off the table and you should feel the erector spinae group contract. Use a flat palpation.
Multifidus – Patient prone, locate the spinous processes and push the erector spinae group laterally out of the way, or let your fingers sink through this muscle bulk to feel underneath it. Run your fingers in a cross-fibre direction between the spinous and transverse processes to feel for the oblique fibres of multifidis.
EXTENSOR DIGITORUM BREVIS
This is easily palpated over the anterolateral aspect of foot. It is often visibly seen as a large lump during toe extension.
ABDUCTOR HALLICIS
Found on medial side of foot just distal and medial to calcaneus
Flexor Digitorum Longus
This muscle lies deep to the gastrocnemius and soleus and therefore requires special positioning to access its trigger points. When searching for this muscle and its trigger points have the patient side-lying with the uninvolved leg uppermost. The knee of the leg being palpated should be flexed at 90degrees and the foot plantar flexed, allowing the gastrocnemius and soleus to be pushed out of the way. Using flat palpation, press between the tibia and gastrocnemius and soleus muscles.
Gluteus Maximus
Patient prone. Locate the bony landmarks – coccyx, lateral sacral border, PSIS, the posterior 5cm of the iliac crest and the gluteal tuberosity. Outline the muscle and trace its borders using contract relax - ask your patient to extend the thigh – resistance can be placed on the posterior thigh.
Differentiation:
Hamstrings – by resisted knee flexion
Glute med – by resisted hip abduction and location
Gluteus Medius
Patient sidelying. Trace the attachment from the PSIS almost to the ASIS and outline the muscle down to the lower attachment on the greater trochanter. Palpate in this area just below the iliac crest down to the greater trochanter for the dense fibres of the gluteus medius.
With the partner’s knee flexed, resist abduction of the hip with resistance at the knee. Fibres are felt more closely to illiac crest on the lateral surface (Note: the gluteus medius will be the only muscle felt in this region).
Differentiation:
Gluteus Minimis – by medial rotation. Gluteus medius attachment to greater trochanter is more posterior than that of gluteus minimis. The gluteus medius is more superficial & larger
Gluteus maximus – by hip extension and location
Gluteus Minimus
Partner side-lying. Trace the attachment along the ilium and outline the muscle down to the lower attachment on the greater trochanter. Palpate in between these areas & sink deeper through the gluteus medius to feel for the mass of gluteus minimis. The muscle may be covered by gluteus medius and is found inferior to gluteus medius, being more palpable on the lateral surface. To palpate a contraction, resist medial rotation of the hip with the knee flexed.
Piriformis
Partner prone, locate the coccyx, the PSIS and the greater trochanter. These form a T-shape. The piriformis is located along the base of the ‘T’ in the area known as the ‘piriformis line’. To feel for a contraction, resist lateral rotation of the thigh (the foot will move medially) with a flexed knee. The piriformis muscle may be easier to palpate closer to the greater trochanter.
To palpate TrPs the patient is side-lying with the uppermost knee and hip flexed to 90 degrees.
The lateral TrP is usually only accessed by direct palpation.
The medial TrP region is located by applying pressure medially towards the region of the greater sciatic foramen.
Iliopsoas
Palpation can be performed in either the side lying or supine position.
Psoas
Patient is positioned with the hip flexed and laterally rotated. Locate the ASIS and umbilicus. Place your finger pads hand on hand midway between these points and use slow progressive pressure to compress the abdomen aiming posteriorly and medially towards the lumbar vertebra. Perform resisted hip flexion to palpate a strong contraction close to the lumbar vertebral bodies. If no contraction is palpated, repeat the procedure moving more inferior to the umbilicus.
Iliacus
Patient is positioned with the hip flexed and laterally rotated. Locate the anterior portion of the iliac crest and place your finger pads, hand on hand onto the superior portion of the iliac fossa. Slowly curl your fingers further into the iliac fossa as the patient breathes deeply. Your fingers will only sink a small distance into the tissues. Ask your patient to flex the hip slightly and feel for the contraction on the anterior surface of the ilium.
Tensor Fascia Latae
To locate this muscle place the patient in the supine position. Place one hand just inferior to the ASIS and the iliac crest and have the patient internally and externally rotate the thigh at the hip. On internal rotation the muscle can be felt to contract.
Using flat digital palpation follow the attachment at the ASIS to the connection with the iliotibial band on the lateral aspect of the thigh where the fibres become tendinous
Sartorius
Although it is superficial in its entirety, the sartorius can be difficult to isolate and palpate.
Patient supine, ask them to place their foot on their opposite knee so that the hip is flexed and laterally rotated. The muscle is predominately felt just below the ASIS, lateral to the femoral artery. Instruct the patient to raise the knee towards the ceiling against resistance and feel a superficial contraction. Palpate the medial border from the origin to the insertion, the muscle belly is approx. 2 fingers wide.
