Palpation Exam Flashcards
Erector spinae muscles (group)
Origin:
- Lower thoracic & lumbar vertebrae
- Sacrum
- Posterior aspect of iliac crest
- Sacroiliac & supraspinous ligaments
Insertion:
- Spinalis: SPs of C2, T1-T8
- Longissimus: Lower ribs, TVPs of C2-T12, mastoid process of skull
- Iliocostalis: Costal angle of ribs & cervical TVPs
Action:
- Unilateral: lateral flexion of vertebral column
- Bilateral: extension of vertebral column & head
Innervation: Posterior rami of spinal nerves
Sternocleidomastoid
Origin:
- Medial 1/3 of clavicle
- Manubrium of sternum
Insertion:
- Mastoid process of temporal bone
- Lateral ½ of superior nuchal line of occipital bone
Action:
- Unilateral: lateral flexion of head & neck, contralateral rotation of head & neck
- Bilateral: extension of head & upper neck, flexion of lower neck (MAJORITY), elevation of sternum & clavicle during FORCED inhalation
Innervation: CN XI (Accessory Nerve)
Scalene Group
Origin:
- Anterior: TVPs of C3-C6
- Middle & Posterior: TVPs of C5-C7
Insertion:
- Anterior: Scalene tubercule of 1st rib
- Middle: Superior surface of 1st rib, posterior groove for subclavian artery
- Posterior: External border of 2nd rib
Action:
- Anterior: elevation of 1st rib, ipsilateral flexion of neck
- Middle: flexion of neck laterally, elevation of 1st rib during FORCED inhalation
- Posterior: flexion of neck, elevation of 2nd rib during FORCED inspiration
Innervation: Anterior rami of C3-C8
Temporalis
Origin: Temporal fossa & fascia
Insertion:
- Coronoid process
- Anterior border of ramus of mandible
Action: Elevation & retraction of mandible
Innervation: Mandibular nerve (CN V3)
Masseter
Origin: Zygomatic arch
Insertion: Lateral surface of ramus of mandible
Action: Elevation & protraction of mandible
Innervation: Mandibular nerve (CN V3)
Rectus Abdominis
Origin:
- Pubic crest
- Symphysis pubis
Insertion:
- Xiphoid process
- Cartilages of ribs 5-7
Action:
- Flexion of trunk @ spinal joints
- Posterior tilt of pelvis (tilt in, pelvis is flat)
- Compress abdominal contents
Innervation: Intercostal nerves (T6-T12)
External Abdominal Oblique Muscle
Origin: External surface of ribs 5-12 (fibers go inferior & anterior)
Insertion:
- Linea alba
- Pubic tubercle
- Anterior half of iliac crest
Action:
- Contralateral rotation of trunk
- Flexion of trunk
- Compress abdominal contents
Innervation: intercostal nerve
Rhomboid Major & Minor
Origin:
- Minor: SPs of C7-T1
- Major: SPs of T2-T5
Insertion:
- Minor: medial (vertebral) border of scapula @ root of spine
- Major: medial (vertebral) border of scapular inferior to spine
Action:
- Retraction (adduction) of scapula
- Elevation of scapula
- Downward rotation of scapula (bringing arm back down)
Innervation: Dorsal scapular
Trapezius
Origin:
- Skull
- Ligamentum nuchea
- SPs of C7-T12
Insertion:
- Clavicle
- Acromion
- Scapula spine
Action:
- Elevate scapula
- Rotate scapula (during arm abduction)
- Retract scapula
- Pull scapula inferiorly
Innervation: CN XI (Accessory nerve)
Latissimus Dorsi
Origin:
- SPs of T6-T12 (T7-L5?)
- Crests of ilium & sacrum
- Ribs 9-12
- thoracolumbar fascia
Insertion: Intertubercular sulcus of humerus
Action:
- Extensionof upper limb
- Adduction of upper limb
- Medial rotation of upper limb
Innervation: thoracodorsal nerve
Serratus Anterior
Origin: Lateral aspects of ribs 1-8
Insertion: Costal surface of medial border of scapula
Action: protraction, rotation of scapula allowing arm to be raised over 90 degrees
Innervation: Long thoracic nerve
Pectoralis Major
Origin:
- Clavicular head: anterior surface of medial clavicle
- Sternocostal head: anterior surface of sternum, costal cartilages of ribs 1-7, aponeurosis of external oblique
Insertion: Lateral lip of intertubercular (bicipital) groove of humerus
Action:
- Flexion of arm (clavicular head)
- Adduction of arm
- Medial rotation of arm
- Horizontal adduction of arm
- Draws scapula anterior inferiorly
Innervation: Medial & lateral pectoral nerves
Deltoid
Origin:
- Lateral clavicle (anterior fibers)
- Acromion (lateral fibers)
- Spine of scapula (posterior fibers)
Insertion: Deltoid tuberosity of humerus
Action:
- Flexion of shoulder (anterior fibers)
- Medial rotation of shoulder joint (anterior fibers)
- Extension of shoulder joint (posterior fibers)
- Lateral rotation of shoulder joint (posterior fibers)
- Abduction of shoulder joint (entire muscle)
Innervation: Axillary nerve (C5, C6)
Subscapularis
Origin: Subscapular fossa
Insertion: Lesser tubercle of humerus
Action: Medial rotation of shoulder
Innervation: Upper & lower subscapularis
Supraspinatus
Origin: Supraspinous fossa
Insertion: Greater tubercle of humerus
Action: Abduction of shoulder joint
Innervation: Suprascapular (C5, C6)
Infraspinatus
Origin: Infraspinous fossa
Insertion: Greater tubercle of humerus
Action:
- Lateral rotation of shoulder joint
- Horizontal abduction of shoulder joint
Innervation: Suprascapular (C5, C6)
Teres minor
Origin: Superior lateral border of scapula
Insertion: Greater tubercle of humerus
Action: Lateral rotation of shoulder joint
Innervation: Axillary (C5, C6)
Teres major
Origin: Inferior lateral border of scapula
Insertion: Medial lip of intertubercular groove of humerus
Action:
- Extension of shoulder joint
- Adduction of shoulder joint
- Medial rotation of shoulder joint
Innervation: Upper & lower subscapular
Biceps brachii
Origin:
- Short head: coracoid process of scapula
- Long head: supraglenoid tubercle of scapula
Insertion: Radial tuberosity & fascia of forearm via bicipital aponeurosis
Action:
- Flexion of arm @ shoulder
- Flexion of forearm @ elbow
- Supination of forearm
Action: Musculocutaneous nerve
Triceps brachii
Origin:
- Long head: infraglenoid tubercle
- Lateral head: lateral, posterior humerus (lateral superior to radial groove)
- Medial head: posterior surface of humerus (medial inferior to radial groove
Insertion: Olecranon process
Action:
- Extension of arm @ shoulder (long head only)
- Extension of forearm @ elbow
Innervation: Radial nerve
Pronator teres
Origin:
- Humeral head: medial epicondyle of humerus (via common flexor tendon)
- Ulnar head: coronoid process of ulna
Insertion: Middle of lateral surface of radius
Action:
- Pronation of forearm
- Flexion of forearm
Innervation: Median nerve
Flexor carpi radialis
Origin: Medial epicondyle of humerus
Insertion: Base of 2nd & 3rd metacarpal
Action:
- Flexion of forearm
- Flexion of hand
- Abduction (radial deviation) of wrist
Innervation: Median nerve
Flexor carpi ulnaris
Origin:
- Humeral head: medial epicondyle of humerus
- Ulnar head: olecranon process of ulna & posterior border of ulna
Insertion:
- Base of 5th metacarpal
- Hook of hamate
- Pisiform
Action:
- Flexion of forearm
- Flexion of hand
- Adduction (ulnar deviation) of hand
Innervation: Ulnar nerve
Flexor digitorum superficialis
Origin:
- Humeroulnar head: medial epicondyle of humerus & coronoid process of ulna
- Radial head: proximal of anterior border or radius
Insertion: Base of middle phalanges of fingers #2-5
Action:
- Flexion of fingers 2-5 @ MCP, PIP
- Flexion of hand
- Flexion of forearm
Innervation: median nerve
Extensor carpi radialis longus
Origin: Distal 1/3 of lateral supracondylar ridge of humerus
Insertion: Base of 2nd metacarpal bone
Action:
- Extension of forearm
- Extension of and
- Radial deviation of wrist
Innervation: radial nerve
Brachioradialis
Origin: Proximal 2/3 of lateral supracondylar ridge of humerus
Insertion: Lateral surface of distal end of radius proximal to styloid process
Action: Flexion of elbow in mid-pronation
Innervation: radial nerve
Extensor digitorum
Origin: Lateral epicondyle of humerus (via common extensor tendon)
Insertion: Distal and middle phalanges of fingers #2 – 5 (via its dorsal digital expansion)
Action:
- Extension of fingers 2-5 at MCP, PIP, DIP joints
- Extension of hand at wrist
- Extension of elbow (weak)
Innervation: radial nerve
Abductor pollicis longus
Origin: The middle of posterior surface of radius, ulna, and interosseous membrane
Insertion: Base of the 1st metacarpal
Action:
- Abduction of thumb at carpometacarpal joint
- Extension of thumb of carpometacarpal joint
- Radial deviation of hand at wrist (weak)
Innervation: radial nerve
Abductor pollicis brevis
Origin:
- Flexor retinaculum
- Tubercle of scaphoid
- Tubercle of trapezium
Insertion: Lateral side of the base of proximal phalanx of thumb
Action: abduction of thumb
Innervation: median nerve
Flexor pollicis brevis
Origin:
- Flexor retinaculum
- Trapezium
Insertion: Lateral side of the base of proximal phalanx of thumb
Action: flexion of thumb
Innervation: median nerve
Dorsal interossei
Origin: Adjacent sides of metacarpals
Insertion:
- Base of proximal phalanges & dorsal digital expansion of fingers (2, 3, 4)
- Dorsal interosseous 1 to lateral side of index finger
- Dorsal interosseous 2 to lateral side of middle finger
- Dorsal interosseous 3 to medial side of middle finger
- Dorsal interosseous 4 to medial side of ring finger
Action:
- Abduction of fingers 2-4 @ MCP joints
- Flexion of fingers 2-4 @ MCP joints
- Extension of fingers 2-4 @ PIP & DIP joints
Innervation: ulnar nerve
Tensor fascia lata
Origin: Lateral side of ASIS & anterior part of iliac crest
Insertion: Tibia (Gerdy’s tubercle) via ITB (ITT) (1/3 of the way down the thigh)
Action:
- Flexion of thigh (hip joint)
- Abduction of thigh (hip joint)
- Medial rotation of thigh (hip joint)
- Anterior pelvic tilt
- Tenses ITB to support femur on tibia during standing
Innervation: superior gluteal nerve
Sartorius
Origin: Anterior superior iliac spine
Insertion: Proximal part of medial surface of shaft of tibia (forms pes anserine tendon)
Action:
- Flexion of thigh (hip joint)
- Abduction of thigh (hip joint)
- Lateral rotation of thigh (hip joint)
- Flexion of leg @ knee joint
- Medial rotation of leg @ knee joint
Innervation: femoral nerve
Biceps femoris
Origin:
- Long head: ischial tuberosity
- Short head: linea aspera
Insertion:
- Head of fibula
- Lateral condyle of tibia
Action:
- Flexion of leg (knee joint) – entire muscle
- Extension of thigh (hip joint) – long head
- Lateral rotation of leg @ knee joint (when knee is flexed)
Innervation: Tibial (long head) & common fibular (peroneal) (short head) branches of sciatic nerve
Semitendinosus
Origin: Ischial tuberosity
Insertion: Proximal part of medial surface of shaft of tibia (forms Pes anserine tendon)
Action:
- Flexion of leg (knee joint)
- Extension of thigh (hip joint)
- Medial rotation of leg @ knee joint – when knee is flexed
Innervation: Tibial branch of sciatic nerve
Rectus femoris
Origin:
- Straight (ant) head: AIIS
- Reflected (post.) head: groove above brim of acetabulum
Insertion: Base of patella via quadriceps tendon & then to tibial tuberosity via the patellar ligament
Action:
- Extension of leg (knee joint)
- Flexion of thigh (hip joint)
Innervation: Femoral Nerve
Vastus medialis
Origin:
- Intertrochanteric line
- Medial lip of linea aspera
- Medial supracondylar line
Insertion: Medial border of patella via the quadriceps tendon & then to tibial tuberosity via the patellar ligament (tendon)
Action: Extension of leg (knee joint)
Innervation: femoral nerve
Adductor muscles (group)
Origin: pubic ramus & ischium
Insertion:
- linea aspera or femur
- pectineal line
- medial upper surface of tibia
Action: Adduction of hip joint
Innervation: Obturator nerve (EXCEPT for pectineus – femoral nerve)
Gastrocnemius
Origin:
- Medial head: medial condyle of femur
- Lateral head: lateral condyle of femur
Insertion: Calcaneus via calcaneal (Achilles) tendon
Action:
- Plantar flexion of foot (ankle joint)
- Flexion of leg (knee joint)
Innervation: Tibial Nerve
Shoulder joint
Classification: Ball and socket synovial (3 DOF)
Movements:
- Flexion/extension
- Adduction/Abduction
- Internal/External Rotation
- Circumduction
Elbow joint
Classification: Synovial hinge (1 DOF)
Movement: Flexion/extension
Radiocarpal joint
Classification: Condyloid (ellipsoid) joint (2 DOF)
Movement:
- Flexion/extension
- Adduction/abduction
First carpometacarpal joint
Classification: Synovial saddle (2 DOF)
Movement:
- Flexion/extension
- Adduction/abduction
- Opposition
Metacarpophalangeal joint
Classification: Synovial condyloid (2 DOF)
Movement:
- Flexion/extension
- Adduction/abduction
Proximal interphalangeal joint
Classification: Synovial Hinge (1 DOF)
Movement: Flexion/extension
Distal interphalangeal joint
Classification: Synovial Hinge (1 DOF)
Movement: Flexion/extension
Hip joint
Classification: Synovial ball & socket (3 DOF)
Movement:
- Flexion/extension
- Adduction/abduction
- Lateral/medial rotation
Knee joint
Classification: Synovial modified hinge joint
Movement:
- Flexion/extension
- *When knee is flexed: medial & lateral rotation
Spinous processes of Vertebral Column
Cervical vertebrae 1 has no spinous process
Transverse processes of Vertebral Column
They have a transverse foramen in the cervical region
Ribs 1-12, Body of Ribs
Rib 11 and 12 are floating and do not attach to the sternum
Posterior superior surface of sacrum
Sacrum is 5 fused vertebrae
Median crest of sacrum
fusion of sacral spinous processes
Sternum Manubrium (Jugular notch)
Most superior part of the sternum
Sternal Angle
Level with the 2nd rib
Sternal Body
Largest part of the sternum
Xiphoid process
Most inferior part of the sternum (in line w/ rib 7)
External Occipital Protuberance
Attachment for trapezius
Mandible Angle
Overlays tonsillar lymph node
Mandible Condyle
Articulates w/ condylar fossa makes TMJ joint
Mandible Coronoid Process
Where temporalis inserts
Zygomatic Arch
origin for masseter muscle (1/2 temporal bone, 1/2 zygomatic bone)
Scapula – Spine
Separates the supraspinatous and infraspinatous fossa’s
Scapula – Coracoid process
Attachment for short head of biceps
Scapula – acromion
Forms acromioclavicular joint with lateral end of clavicle
Scapula – inferior angle
Where the medial and lateral borders of the scapula intersect
Scapula – medial border
insertion for rhomboid major & minor
Scapula – lateral border
origin for teres minor & major
Scapula – infraspinatus fossa
origin for infraspinatus muscle
Scapula – supraspinatus fossa
origin for supraspinatus muscle
Clavicle – sternal end
Articulates w/ sternum to form sternoclavicular joint
Clavicle – acromial end
Articulates w/ acromion to form acromioclavicular joint
Clavicle - body
Origin for sternocleidomastoid muscle
Humerus – greater tubercle
Insertion for supraspinatous, infraspinatous, teres minor muscle
Humerus – lesser tubercle
Insertion for subscapularis muscle
Humerus – medial condyle
Common flexor tendon
Humerus – lateral epicondyle
Origin of most extensor muscles of the forearm
Ulna – head
Has a styloid process that projects distally
Ulna – olecranon process
Origin for flexor carpi ulnaris/ insertion for triceps
Radius – styloid process
Brachioradialis inserts just before this landmark
Carpal bones – scaphoid
Content of the snuff box / abductor pollicis brevis originates here
Carpal bones - pisiform
Insertion for flexor carpi ulnaris
Carpal bones – hook of hamate
Insertion for flexor carpi ulnaris
Hip bone – iliac crest
in line w/ L4 / origin for tensor fascia lata
Hip bone – iliac fossa
Pain in the right iliac fossa can be a sign of appendicitis
Hip bone - ASIS
Origin of sartorius muscle
Hip bone – ischial tuberosity
Absorbs weight when you sit down/ origin for biceps femoris & semitendinosus
Femur – greater trochanter
Gluteus medius inserts on lateral surface
Femur – condyle
gastrocnemius originates from both lateral & medial condyles of femur
Femur – epicondyle
Medial Cruciate Ligament runs from medial epicondyle to tibia
Patella – base
Insertion for quadriceps tendon
Patella – apex
Attachment for patellar ligament
Patella – medial border
Insertion for vastus medialis
Patella – lateral border
Insertion for vastus lateralis
Tibia – lateral condyle
Insertion for biceps femoris
Tibia – medial condyle
insertion for semimembranosus muscle
Tibia – tibial tuberosity
Gives attachment to patellar ligament
Tibia – medial malleolus
tibial artery travels behind it
Fibula – head
insertion for biceps femoris muscle
Fibula – neck
Common fibular nerve travels posteriolaterally to this
Fibula – lateral malleolus
Is larger than the medial malleolus
