Palpation Exam Flashcards
Spinous process?
interspinous ligament
Transverse process?
Intertransverse ligament
Ribs 1-12
Ribs 1-7 = true ribs. Direct attachment to the sternum.
Ribs 8-10 = false ribs. Indirect attachment. Fused to costal cartilage of Rib 7.
Ribs 11 & 12 = Free floating ribs. No attachment to sternum.
Sacrum
- Posterior surface
- Median Crest
Posterior surface: Erector spinae originate
Median Crests: formed by fucion of 1st 3 SPs
Sternum
- Jugular notch (manubrium)
- Sternal angle
- Body
- Xiphoid process
Manubrium: Articulates with clavicle & costal cartilages of 1st rib
Sternal Angle: junction of Manubrium & sternal body via cartilaginous joint. Marks the level of the 2nd rib.
Body: Articulates with costal cartilages of Ribs 3-6.
Xiphoid Process: Attachment point for Rib 7 via xiphisternal joint.
External Occipital Protuberance
Ligamentum nuchae attaches here.
Mandible
- Angle
- Condyle
- Coronoid process
Angle: Medial pterygoid m. inserts on the medial surface of the angle.
Condyle: participates in the TMJ joint which is a combined hinge & synovial joint.
Coronoid Process: Temporalis m. inserts here.
Zygomatic Arch
Masseter m. originates here.
Scapula
- Spine
- Coracoid process
- Acromion
- Inferior Angle
- Medial Border
- Lateral Border
- Infraspinatus fossa
- Supraspinatus fossa
Spine: posterior deltoid fibers originate here
Coracoid process: Short head of biceps brachii m. originates here.
Acromion: Lateral deltoid fibers originate here.
Inferior Angle: At the level of ~ T7 SP.
Medial Border: Rhomboids insert here.
Lateral Border: Teres major & minor originate here.
Infraspinatus fossa: Infraspinatus m. originates here.
Supraspinatus fossa: Supraspinatus m. originates here.
Clavicle
- Sternal end
- Acromial end
- body
Sternal end: Sternoclavicular ligament attaches here.
Acromial end: Acromioclavicular ligament attaches here.
Body: Subclavius m. attaches to the subclavian groove inferior body.
Or pec . major
Humerus
- Greater Tubercle
- Lesser Tubercle
- Medial Epicondyle
- Lateral Epicondyle
Greater Tubercle: 3 rotator cuff muscles insert here (Supra & infraspinatus + Teres minor)
Lesser Tubercle: Subscapularis inserts here.
Medial epicondyle: Common origin of anterior flexor compartment m. of forearm via common flexor tendon.
Lateral epicondyle: Common origin of posterior flexor compartment m. of forearm via common extensor tendon.
Ulna
- Head
- Olecranon process
Head: Head of the ulna articulates with the ulnar notch of radius.
Olecranon process: Triceps brachii inserts here.
Radius
- Styloid process
Brachioradialis inserts just proximal to the styloid process.
Carpal Bones
- Scaphoid
- Pisiform
- Hook of Hamate
Scaphoid: Abductor Pollicis Brevis originates here.
-floor of anatomical snuffbox.
Pisiform: Flexor Carpi ulnaris inserts here.
-part of the carpal tunnel.
Hook of Hamate: Flexor Carpi Ulnaris inserts here.
Hip Bone
- Iliac Crest
- Iliac Fossa
- ASIS
- Ischial Tuberosity
Iliac Crest: Tensor fascia lata originates here.
Iliac Fossa: iliacus m. originates here.
ASIS: Sartorius m. originates here.
Ischial Tuberosity: Biceps femoris m long head originates here.
Femur
- Greater Trochanter
- Condyle
- Epicondyle
Greater Trochanter: piriformis inserts here.
Condyle: Gastrocnemius (medial & lateral head) originates on medial & lateral condyle.
Epicondyle:
Medial epicondyle: Medial (tibial) collateral ligament originates here.
Lateral epicondyle: Lateral fibular collateral ligament originates here.
Patella
- Base
- Apex
- Medial border
- Lateral Border
Base: Rectus femoris m. attaches here.
Apex: Patella tendon/ligament originates here.
Lateral Border: Vastus lateralis m. attaches here.
Medial border: Vastus Medialis m. attaches here.
Tibia
- Lateral Condyle
- Medial Condyle
- Tibial Tuberosity
- Medial Malleolus
Lateral condyle: Biceps femoris inserts here.
Medial condyle: Semimembranosus inserts here.
Tibial tuberosity: All 4 quads insert here.
Medial Malleolus: Articulates with Talus.
Fibia
- Head
- Neck
- Lateral Malleolus
Head: Biceps femoris inserts here /articulates with lateral condyle
Neck: The neck is on the proximal fibia just distal to the head.
Lateral Malleolus: Articulates with talus.
Erector Spinae M.
O: Sacrum
I: Spine (SPs & TVPs of cervical & thoracic + cranium)
N: Posterior rami of spinal n.
Action: Extend vertebral column
SCM
O: Medial 1/3 Clavicle & Manubrium
I: Mastoid process (temporal bone) & Superior nuchal line (lateral 1/2)
N: CN XI: Accessory N.
Action:
1. Contralateral rotation of head & neck
2. Lateral flexion of head & neck
3. Flexion of lower neck
Scalenes
O: Cervical TVP
I: Rib 1 & 2 (Anterior & middle), Rib 1 (posterior)
N: Anterior rami of cervical spinal n.
Action:
1. Lateral flexion
2. Raise rib during forced inspiration
Temporalis m.
O: Temporal fosse
I: coronoid process & anterior border of ramus
N: Mandibular n.
Action:
1. Elevation
2. Retraction
**to activate: clench teeth
Masseter
O: Zygomatic arch
I: Lateral surface of ramus
N: Mandibular n.
Action:
1. Elevation
2. Protection
**to activate: clench
Rectus Abdominis
O: Pubic crest & symphysis pubis
I: Xiphoid process & ribs 5 - 7
N: Intercostal n.
Action:
1. Trunk flexion
2. posterior pelvic tilt
3. compress abdominal contents
External Abdominal Oblique
O: External surface of lower 8 ribs
I: Linea alba, Iliac crest & pubic tubercle
N: Intercostal n.
Action:
1. Contralateral rotation
2. Flexion of trunk
3. compress abdominal contents
Rhomboids Minor & Major.
Rhomboids MINOR:
O: SPs C7 & T1
I: medial border of scapula @ spine
Rhomboids MAJOR:
O: SPs T2 - T5
I: Medial border of scapula inferior to spine
BOTH:
N: Dorsal scapular n.
Action:
1. Retraction of spine ***
2. Elevation of spine
3. Downward rotation
Trapezius m.
O:
Upper: External occipital protuberance & medial superior nuchal line.
Middle: SPs T1-T5
Lower: SPs T6-T12
I: Clavicle (lateral 1/3), acromion, spine
N: Spinal accessory n.
Action:
Upper: Elevation & uoward rotation
Middle: Retraction
Lower: Depression & upward rotation
Latissimus Dorsi
O: Sps T7 to L5, Ilium & scaral crests, lower 4 ribs (thoracodorsal fascia)
I: Floor of Intertubercular groove
N: Thoracodrosal n.
Action:
1. Extension of arm
2. Adduction of arm
3. Medial rotation of arm
4. Anterior pelvic tilts
**To activate: adduct against resistance.
Serratus Anterior
O: Upper 9 Ribs
I: Anterior surface of medial boarder of scapula
N: Long thoracic n.
Action:
1. Protraction
2. Upward rotation
**to activate: boxer punch against resistance
Pectoralis major
O: Clavicle (medial 1/2) & sternum (1-7 costal cartilages)
I: Lateral lip Intertubercular groove
N: Medial & lateral pectoral n.
Action:
1. Flexion of arm
2. Horizontal adduction & adduction **
3. Medial rotation
Deltoid m.
O:
Anterior: Lateral clavicle
Lateral: Acromion
Posterior: Spine of scapula
I: Deltoid tuberosity (humerus)
N: Axillary n.
Action:
1. Abduction of arm (all)
2. Medial rotation & flexion (anterior)
3. Lateral rotation & extensions (posterior)
Subscapularis m.
O: Subscapularis fossa
I: Lesser tubercle (humerus)
N: Upper & lower subscapularis n.
Action:
1. Medial rotation of arm @ shoulder joint
Supraspinatus m.
O: Supraspinatus fossa
I: Greater tubercle (humerus)
N: Suprascapular n.
Action:
1. Abduction of arm @ shoulder joint
Infraspinatus m
O: Infraspinatus fossa
I: Greater tubercle (humerus)
N: Suprascapular n.
Action:
1. Lateral rotation
2. horizontal abduction
**To activate external rotation against resistance
Teres Minor
O: Lateral border of scapula
I: Greater tubercle (humerus)
N: Axillary n.
Action:
1. Lateral rotation
Teres Major
O: Lateral border of scapula
I: Medial lip of inter tubercular groove (Humerus)
N: Upper & lower sub scapular n.
Action:
1. Extension
2. Adduction
3. Medial rotation
**To activate: adduct against resistance
Biceps brachii
O:
Long head: Supraglenoid tubercle (scapula)
Short head: Coracoid process (scapula)
I: Radial tuberosity & forearm fascia via biceps aponeurosis
N: Musculocutaneous n.
Action:
1. Flex forarm @ elbow joint
2. Supination of forearm @ elbow joint
3. Flex arm @ shoulder joint (long head)
Triceps Brachii
O:
Long: Infraglenoid tubercle (scapula)
Lateral: Lateral, posterior humerus (Superior to radial groove)
Medial: Medial, posterior humerus (inferior to radial groove)
I: Olecranon process (ulna)
N: Radial n.
Action:
1. Extension of forearm @ elbow joint
2. Extension of arm @ shoulder joint (long head)
Pronator teres
O:
Humeral head: Medial epicondyle (CFT)
Ulnar head: Coronoid process (ulna)
I: Radius
N: Median n.
Action:
1. Pronate forearm
2. Weak forearm flexion
Flexor Carpi Radialis
O: Medial epicondyle (CFT)
I: Base of 2nd & 3rd metacarpal
N: Median n.
Action:
1. Flex hand @ wrist joint
2. Radial deviate
3. Weak forearm flexion
Flexor Carpi Ulnaris
O:
Humeral: Medial Epicondyle (CFT)
Ulnar: olecranon + posterior border
I: Base of 5th metacarpal, hook of hamate, pisiform
N: Ulnar n.
Action:
1. Flex hand @ wrist joint
2. Ulnar deviate
3. Weak forearm flexion
Flexor Digitorum Superficialis
O:
Humero-ulnar head: Medial epicondyle (CFT) + coronoid process
Radial head: Radius
I: Base of middle phalanges (2 - 5)
N: Median n.
Action:
1. Flex hand @ wrist
2. Flex digits 2 - 5 @ MCP & PIP points
3. Weak forearm flexion
Brachioradialis
O: Supracondylar ridge (humerus)
I: Proximal to styloid process of radius
N: Radial n.
Action:
1. Flex forearm
**To activate: Flex against resistance in mid-pronation
Extensor Carpi Radialis Longus
O: Supracondylar rideg (humerus)
I: Base of 2nd metacarpal
N: Radial n.
Action:
1. Extend hand @ wrist joint
2. Radial deviate
3. Weak elbow flexion
Extensor digitorum?
O: Lateral epicondyle (CET)
I: Dorsal digital expansion
N: Radial n.
Action:
1. Extend hand @ wrist joint
2. Extend digits 2-5 @ MCP, PIP, & DIP joint.
3. Weal elbow extension
**to activate extend fingers against resistance or flutter fingers
Abductor Pollicis Longus
O: Radius, ulna & interosseous membrane
I: Base of 1st metacarpal
N: Radial n.
Action:
1. Abduction of thumb @ CMC joint
2. Extension of thumb @ CMC joint
3. Radial deviation
**To activate: Abduct thumb. Very outside of snuff box.
Abductor Pollicis Brevis
O: Flexor retinaculum, scaphoid & trapezium
I: Base of proximal phalanx
N: Medial n.
Action:
1. Abduction of thumb
Flexor Pollicis Brevis
O: Flexor retinaculum & Trapezium
I: Base of proximal phalanx
N: Median n.
Action:
1. Flexion of thumb
Dorsal Interossei
O: Adjacent sides of metacarpals
I: Dorsal Digital expansion & base of proximal phalangers 2-4
N: Ulnar n.
Action:
1. Abduction of fingers 2, 3, 4
2. TATA = Flexion of MCP joint and extension of PIP & DIP joint (2,3,4)
Tensor Fascia Lata
O: Lateral ASIS & anterior iliac crest
I: Gerdy’s tubercle (tibia) via ITB band
N: Superior gluteal n.
Action:
1. Flex of thigh @ hip joint
2. Abduction of thigh @ hip joint
3. Medial rotation of thigh @ hip joint
4. Tenses ITB to support femur on tibia standing
** to activate: abduct against resistance
Sartorius
O: ASIS
I: proximal medial tibial shaft
N: Femoral n.
Action:
1. Flexion of leg @ knee joint
2. Flexion of thigh @ hip joint
3. External rotation @ hip joint
**To activate: Flex hip & knee
Biceps femoris?
O:
Long: ischial tuberosity
Short: Linea aspera
I: Fibula head & lateral condyle of tibia
N: Tibular (long) & fibular/peroneal (short)
Action:
1. Flex leg @ hip joint
2.Extend thigh @ hip joint
3. Lateral rotation of leg @ knee joint (when knee flexed)
Semitendinosus
O: Ischial tuberosity
I: Proximal medial tibial shaft
N: Tibial n.
Action:
1. Hip extension
2. Knee flexion
3. Medial rotation @ knee joint (when knee flexed)
**To activate: To activate: Hip extension & knee flex against resistance. Palpate medial at above knee.
Rectus Femoris
O:
Straight/anterior head: AIIS
Reflected/Posterior head: Groove above acetabulum brim
I: Base of petalla via quad tendon & tibial tuberosity via patellar ligament
N:Femoral n.
Action:
1. Extension of the leg @ knee joint
2. Flexion of thigh @ hip joint
Vastus Medialis
O: Intertrochanteric line, linea aspera (medial lip) & Medial supracondylar line.
I: Medial border of patella via quad tendon & tibial tuberosity via patellar tendon
N: Femoral n.
Action:
1. Extension of leg @ knee joint
Adductor Muscles (as a group)
1. Pectineus
2. Adductor longus
3. Adductor brevis
4. Adductor Magnus
5.Gracilis
O: Pubic ramus, pubis & Ischium
I: linea aspera of femur
N: obturator n.
EXCEPT
Magnus post head = tibial n Pectineus = femoral n.
Action:
1. Adduction
Gastrocnemius
O: Medial & lateral condyles of femur
I: Calcaneous via achilles tendon
N: Tibial n.
Action:
1. Plantar Flexion of foot @ ankle joint
2. Flexion of leg @ knee joint
Shoulder joint?
Synovial ball & Socket
flexion/extension
abduction/adduction
lateral & medial rotation
& circumduction
Elbow joint
Synovial hinge joint
flexion/extension
Radiocarpal (wrist) joint
Synovial Condyloid/ellipsoid joint
Flexion/extension
abduction/adduction
First carpometacarpal joint
Modified Saddle joint (synovial)
Flexion & extension
Abudction & adduction
Rotation (opposition)
Metacarpophalangeal joint?
Condyloid/ellipsoid joint
Flexion/extension
abduction/adduction
PIP & DIP Joints
Synovial Hinge joints
Flexion & extension
Hip joint
Synovial ball & socket
Flexion & extension
abduction & adduction
lateral & medial rotation
Knee joint?
3 joints:
Medial & lateral tibio-femoral = modified hinge joint
- flexion & extension
- lateral & medial rotation
Patellar-femoral joint = synovial planar joint
-slide & glide
