PALPATION REVIEW FOR FINAL EXAM

Muscles from Weeks One, Two, And Three

Supraspinatus

P: Supraspinous Fossa of the scapula

D: Greater tubercle of the humerus

1. Abducts the arm at the shoulder joint

Part of the rotator cuff muscle group

Palpation of Supraspinatus

Client seated with arm medially rotated and hanging at the side

Place palpating hand just superior to the spine of the scapula

Ask the client to perform a short, quick range of motion of active abduction of the arm at the shoulder joint

DeltoidP: Lateral clavicle, acromion process, and the spine of the scapula

D: Deltoid tuberosity of the humerus

1. Abducts the arm at the shoulder joint (entire muscle)

2. Flexes the arm at the shoulder joint (anterior deltoid)

3. Extends the arm at the shoulder joint (posterior deltoid)

4. Medially rotates the arm at the shoulder joint (anterior deltoid)

5. Laterally rotates the arm at the shoulder joint (posterior deltoid)

Palpation of the Deltoid

Have client seated Middle deltoid: Place palpating hand just

proximal to the deltoid tuberosity. Have client actively abduct the arm

Anterior deltoid: Place hand on anterior shoulder. Have client actively horizontally flex the arm at the shoulder joint

Posterior deltoid: Place palpating hand just inferior to the spine of the scapula. Have client actively horizontally extend the arm at the shoulder joint

Biceps Brachii

P: Long head: Supraglenoid tubercle of the scapula

Short head: Coracoid process of the scapula

D: Radial tuberosity

1. Flexes the forearm at the elbow joint (entire muscle)

2. Supinates the forearm at the radioulnar joints (entire muscle)

3. Flexes the arm at the shoulder joint (entire muscle)

Palpation of Biceps Brachii Have client seated with the forearm

supinated Place palpating hand on the anterior

arm and feel for the biceps brachii Have the client actively flex the

forearm at the elbow joint against resistance with the forearm fully supinated

Triceps BrachiiP: Long head: Infraglenoid tubercle of the scapula

Lateral head: Posterior shaft of the humerus

Medial head: Posterior shaft of the humerus

D: Olecranon process of the ulna

1. Extends the forearm at the elbow joint

Palpation of Triceps Brachii Have client prone with arm perpendicular to

the body and the forearm hanging off the table

Long head: Have client extend elbow. Palpate in the proximal medial 2/3 of the arm

Medial head: Most of the medial head is deep to the other two heads. Palpate just proximal to the medial and lateral epicondyles

Lateral head: Palpate the proximal lateral 2/3 of the arm

Flexor Carpi Radialis

P: Medial epicondyle of the humerus

D: Radial hand on the anterior side

1. Flexes the hand at the wrist joint

2. Radially deviates (abducts) the hand at the wrist joint

Plapation of Flexor Carpi Radialis

Client seated Place palpating hand across anterior wrist Have client actively flex and radially deviate

the hand at the wrist joint and feel for the distal tendon on the radial side just lateral to the palmaris longus

Palpate proximally toward the medial epicondyle

It is difficult to palpate the proximal tendon because it blends with the common flexor tendon of the elbow

Palmaris Longus

P: Medial epicondyle of the humerus

D: Palm of hand

1. Flexes the hand at the wrist joint

Palpation of Palmaris Longus

Have client seated Place palpating hand on anterior wrist Ask the client to cup the hand (bring

thenar and hypothenar eminence together) Ask client to flex the hand at the wrist

joint against resistance with the fingers fully extended; feel for the distal tendon of the palmaris longus in the center of the wrist.

Palpate distally to the common flexor tendon of the elbow

Flexor Carpi Ulnaris

P: Medial epicondyle of the humerus

D: Ulnar hand on the anterior side

1. Flexes the hand at the wrist joint

2. Ulnar deviates (adducts) the hand at the wrist joint

Palpation of Flexor Carpi Ulnaris

Have client seated Place palpating hand across anterior

wrist Have client actively flex and ulnar

deviate the hand at the wrist joint and feel for the distal tendon on the medial side of the anterior wrist.

Palpate proximally toward the medial epicondyle and the common flexor tendon of the elbow.

Brachioradialis

P: Lateral supracondylar ridge of the humerus

D: Styloid process of the radius

1. Flexes the forearm at the elbow joint

Palpation of the Brachioradialis

Have client seated with forearm flexed at the elbow 90 degrees, and in a position halfway between pronation and supination.

Place palpating hand on lateral forearm. Resist client from further flexing the

forearm and feel for contraction of the brachioradialis.

Palpate distally to the styloid process of the radius and proximally to the lateral supracondylar ridge of the humerus.

Extensor Carpi Radialis Longus

P: Lateral supracondylar ridge of the humerus

D: Radial hand on the posterior side

1. Extends the hand at the wrist joint

2. Radially deviates (abducts) the hand at the wrist joint

Palpation of Extensor Carpi Radialis Longus

Have client seated Place palpating hand posterior to

brachioradialis Ask client to make a fist in a slightly

extended position and feel for contraction of the muscle.

Continue palpating proximally toward the lateral supracondylar ridge of the humerus.

Continue palpating distally to the 2nd metacarpal

Extensor Carpi Radialis Brevis

P: Lateral epicondyle of the humerus

D: Radial hand on the posterior side

1. Extends the hand at the wrist joint

2. Radially deviates (abducts) the hand at the wrist joint

Palpation of the Extensor Carpi Radialis Brevis

Client seated Pinch the radial group of forearm muscles with

your thumb on one side and your fingers on the other and slightly pull them away from forearm.

The fingers on the posterior aspect of the radial group are on the extensor carpi radialis brevis

Have client actively extend and/or radially deviate the hand at the wrist to feel for contraction of the muscle.

The distal tendon can be palpated by having the client make a fist with the wrist slightly extended. Attaches to 3rd metacarpal.

Extensor Carpi Ulnaris

P: Lateral epicondyle of the humerus and the ulna

D: Ulnar hand on the posterior side

1. Extends the hand at the wrist joint

2. Ulnar deviates (adducts) the hand at the wrist joint

Palpation of Extensor Carpi Ulnaris

Have client seated Place palpating hand directly posterior

to the shaft of the ulna and feel for the belly of the extensor carpi ulnaris.

Continue palpating proximally toward the lateral epicondyle of the humerus and distally toward the 5th metacarpal.

Have the client extend and ulnar deviate the wrist to further bring out this muscle.

Temporalis Muscle

P: Temporal fossa

D: Coronoid process and the ramus of the mandible

1. Elevates the mandible at the temporomandibular joint

Palpation of Temporalis

Have client supine Place palpating fingers on the

temporal fossa. Ask client to clench and relax the

teeth. Feel for the contraction and

relaxation of the muscle. The inferior attachment on the

coronoid process of the mandible can be palpated if the client opens mouth widely. Difficult to distinguish from the masseter.

Trapezius muscleP: Occiput, nuchal ligament,

and SPs of C7-T12

D: Lateral clavicle, acromion process, and spine of scapula

1. Laterally flexes the neck and the head at the spinal joints (upper)

2. Extends the neck and the head at the spinal joints (upper)

3. Contralaterally rotates the neck and the head at the spinal joints (upper)

4. Elevates the scapula at the scapulocostal joint (upper)

5. Retracts (adducts) the scapula at the scapulocostal joint (entire muscle)

6. Depresses the scapula at the scapulocostal joint (lower)

Palpation of the Trapezius

Have the client prone Place palpating hand over the upper

trapezius. Have client actively abduct the arm

at the shoulder joint and retract the scapula

Repeat above to palpate the middle and lower trapezius

To further bring out the upper trapezius, have the client slightly extend the neck

Levator scapulaeP: TPs of C1-C4

D: Medial border of the scapula, from the superior angle to the root of the spine of the scapula

1. Elevates the scapula at the scapulocostal joint

2. Extends the neck at the spinal joints

3. Laterally flexes the neck at the spinal joints

Palpation of the Levator Scapulae

Client seated with the forearm in the small of the back

Place palpating hand just superior to the superior angle of the scapula

Have client perform short, quick range of motion of active elevation of the scapula and feel for the contraction of the levator scapulae.

Continue palpating superiorly into the posterior triangle of the neck

Sternocleidomastoid P: Sternal head:

Manubrium of the sternum

Clavicular head: Medial clavicle

D: Mastoid process of the temporal bone

1. Flexes the head at the spinal joints

2. Laterally flexes the neck and the head at the spinal joints

3. Contralaterally rotates the neck and the head at the spinal joints

Palpation of the Sternocleidomastoid

Have client seated with the neck and head rotated to one side.

Stand on the opposite side. Place palpating hand on the

anterolateral neck of the side where you are standing.

Now resist the client from laterally flexing the neck and head toward the side you are standing and feel for contraction of the SCM.

Week 5, 6, and 7

Palpation Review For Final Exam

Latissimus Dorsi

P: SPs of T7-L5, posterior sacrum, and the posterior iliac crest

D: Medial lip of bicipital groove of the humerus

1. Medially rotates the arm at the shoulder joint

2. Adducts the arm at the shoulder joint

3. Extends the arm at the shoulder joint

4. Anteriorly tilts the pelvis at the lumbosacral joint

Have client seated with hands at their sidesPlace palpating hand on the client’s posterior

axillary foldAsk the client to push down on the table with

both hands, attempting to elevate the pelvis and trunk off the table. Feel for the contraction of the latissimus dorsi

Continue palpating the muscle toward its humeral attachment. It can be difficult to distinguish the tendon of the latissimus dorsi from the tendon of the teres major because they often blend together.

Palpation of Latissimus Dorsi

Rhomboid Major and Minor

P: SPs of C7-T5 D: Medial border of

the scapula from the root of the spine of the scapula to the inferior angle of the scapula

1.Retracts (Adducts) the scapula at the scapulocostal joint

2.Elevates the scapula

Have client seated with hand placed in the small of the back

Place palpating hand between the scapula at a level that is between the inferior angle and the root of the spine of the scapula and the spine

Ask the client to lift the hand away from the back and feel for the contraction of the rhomboids

Palpation of Rhomboid Major and Minor

Erector Spinae Group

O: PelvisI: Spine, ribcage, and head

1. Extends the trunk, neck, and the head at the spinal joints

2. Laterally flexes the trunk, neck, and head at the spinal joints

3. Ipsilaterally rotates the trunk, neck, and head at the spinal joints

4. Anteriorly tilts the pelvis at the lumbosacral joint

Have client prone Place palpating hands lateral to the SPs of

the vertebral column in the lumbar region and feel for the vertical orientation of the fibers of the muscle

Continue palpating inferiorly and superiorly Ask the client to actively extend the upper

part of the body off the table and feel for contraction of the erector spinae group

To palpate the erector spinae of the neck it is easier to have the client supine

Plapation of Erector Spinae

Pectoralis Major

P: Medial clavicle, sternum, and the costal cartilages of ribs 1-7

D: Lateral lip of the bicipital groove of the humerus

1. Adducts the arm at the shoulder joint

2. Medially rotates the arm at the shoulder joint

3. Flexes the arm at the shoulder joint (clavicular head)

Have client seated Have client raise arm to 90 degrees of abduction

at the shoulder joint Place palpating hand on the belly of the muscle Ask the client to actively horizontally flex the

arm at the shoulder joint against resistance and feel for the contraction of the pectoralis major

Continue palpating the muscle medially and superiorly toward its attachment s on the trunk and distally toward its humeral attachment

Palpation of the Pectoralis Major

Rectus Abdominis

P: Pubis D: Xiphoid process

and the cartilage of ribs 5-7

1. Flexes the trunk at the spinal joints

2. Posteriorly tilts the pelvis at the lumbosacral joint

Have the client supine with a pillow under the knees

Place palpating hands between the xiphoid process of the sternum and the adjacent ribs superiorly and the pubis inferiorly

Ask the client to alternate between mild flexion of the trunk and relaxation so that you can feel for the contraction of the muscle

Palpate the rectus abdominis superiorly toward its ribcage attachment and inferiorly toward its pelvic attachment

Palpation of the Rectus Abdominis

Gluteus Maximus

P: Posterior iliac crest, posterolateral sacrum, and the coccyx

D: Iliotibial band (ITB) and gluteal tuberosity of the femur

1. Extends the thigh at the hip joint

2. Laterally rotates the thigh at the hip joint

3. Abducts the thigh at the hip joint (upper 1/3)

4. Adducts the thigh at the hip joint (lower 2/3)

5. Posteriorly tilts the pelvis at the hip joint

Have client lay pronePlace palpating hand on the lateral sacrumPalpate the gluteus maximus from its medial

attachment (lateral sacrum) to its lateral attachment (ITB)

Have the client actively extend and laterally rotate the thigh at the hip joint to further bring out the muscle.

The gluteus maximus does not cover the entire buttocks; the gluteus medius is just inferior to most of the posterior iliac crest

Palpation of Gluteus Maximus

Gluteus Medius

P: External Ilium

D: Greater trochanter of the femur

1. Abducts the thigh at the hip joint (entire muscle)

2. Flexes the thigh at the hip joint (anterior fibers)

3. Medially rotates the thigh at the hip joint (anterior fibers)

4. Extends the thigh at the hip joint (posterior fibers)

5. Laterally rotates the thigh at the hip joint (posterior fibers)

6. Posteriorly tilts the pelvis at the hip joint (posterior fibers)

7. Anteriorly tilts the pelvis at the hip joint (anterior fibers)

Have client side lyingMiddle portion: Place palpating hand between the iliac

crest and the greater trochanter of the femur. Ask client to abduct the thigh at the hip joint

Anterior portion: Place palpating hand just posterior and inferior to the ASIS and feel for the anterior fibers. Ask client to flex and medially rotate the thigh at the hip joint.

Posterior portion: Palpate just deep to the superolateral portion of the gluteus maximus and have the client extend and laterally rotate the thigh at the hip joint.

Distinguishing gluteus medius from glut max and piriformis can be difficult

Palpation of the Gluteus Medius

Tensor Fasciae Latae (TFL)

P: Anterior Superior Iliac Spine

D: Iliotibial band (ITB)

1. Flexes the thigh at the hip joint

2. Abducts the thigh at the hip joint

3. Medially rotates the thigh at the hip joint

4. Anteriorly tilts the pelvis at the hip joint

Have client supine Place palpating hand just distal and slightly

lateral to the ASIS Have client actively hold the thigh in a

position of flexion and medial rotation at the hip joint

Resist the client from further flexion of the thigh at the hip joint and feel for the contraction of the TFL

Continue palpating the TFL distally and slightly posteriorly toward ITB attachment

Palpation of Tensor Fascia Latae

Sartorius

P: Anterior superior iliac spine (ASIS)

D: Pes Anserine Tendon (at the proximal anteromedial tibia)

1. Flexes the thigh at the hip joint

2. Abducts the thigh at the hip joint

3. Laterally flexes the thigh at the hip joint

4. Flexes the leg at the knee joint

5. Anteriorly tilts the pelvis at the hip joint

Have client supine Place palpating hand just distal and

slightly medial to the ASIS Ask client to actively flex and laterally

rotate the thigh at the hip joint and feel for the contraction of the sartorius

Continue palpating the sartorius from the ASIS to the pes anserine tendon

To further bring out the muscle give the client resistance

Palpation of the Sartorius

Rectus Femoris

P: Anterior Inferior iliac spine (AIIS)

D: Tibial Tuberosity

1. Extends the leg at the knee joint

2. Flexes the thigh at the hip joint

3. Anteriorly tilts the pelvis at the hip joint

Have client supine with a pillow under their knees

Place palpating hand just proximal to the patella

Resist the client from actively extending the leg at the knee joint and feel for the contraction of the rectus femoris

Continue palpating the muscle toward the ASIS To palpate the proximal attachment passively

flex the thigh at the hip joint and palpate slightly distal to the ASIS

Palpation of the Rectus Femoris

Vastus Lateralis

P: Linea Aspera of the femur

D: Tibial tuberostiy

1. Extends the leg at the knee joint

Have client supine Place palpating hand just distal to

the greater trochanter Ask the client to contract the

quadriceps femoris group and feel for contraction of the vastus lateralis

Continue palpating distally toward the patella

Palpation of the Vastus Lateralis

Vastus Medialis

P: Linea Aspera of the femur

D: Tibial tuberosity

1. Extends the leg at the knee joint

Have client supine Place palpating hand just proximal and

medial to the patella Ask the client to contract the quadriceps

femoris group and feel for the contraction of the vastus medialis

Continue palpating the vastus medialis proximally as far as possible

The vastus medialis is best palpated medially in the distal 1/3 of the thigh

Palpation of the Vastus Medialis

Vastus Intermedius

P: Anterior shaft and the linea aspera of the femur

D: Tibial tuberosity

1. Extends the leg at the knee joint

Deep and difficult to palpate Have client supine Place palpating hand just proximal to the patella If the rectus femoris can be lifted and/or moved

aside, the distal vastus intermedius may be palpated deep to the rectus femoris when approached from either the medial or lateral side

To feel the vastus intermedius deep to the rectus femoris, make sure that the direction of your pressure is directed toward the middle of the femur

Palpation of Vastus Intermedius

Biceps Femoris

P: Long head: Ischial tuberosity

Short head: Linea aspera

D: Head of the fibula

1. Flexes the leg at the knee joint (entire muscle)

2. Extends the thigh at the hip joint (long head)

3. Posteriorly tilts the pelvis at the hip joint (long head)

The biceps femoris is superficial for most of its course in the posterolateral thigh and is easy to palpate

Have the client prone with the leg partially flexed at the knee joint

Place palpating hand on the distal posterolateral thigh

Resist the client from performing further flexion of the leg at the knee joint and feel for the distal tendon of the biceps femoris

Continue palpating the biceps femoris toward the ischial tuberosity

Palpation of the Biceps Femoris

Semitendinosus

P: Ischial tuberosityD: Pes Anserine

tendon

1. Flexes the leg at the knee joint

2. Extends the thigh at the hip joint

3. Poseteriorly tilts the pelvis at the hip joint

The semitendinosus is superficial for most of its course in the posteromedial thigh and is easy to palpate

Have the client prone with the leg partially flexed at the knee joint

Place palpating hand on the posteromedial thigh Further resist flexion of the leg at the knee joint

and feel for the distal tendon of the semitendinosus

Continue palpating the muscle proximally toward the ischial tuberosity. Its attachment is just medial to the long head of the biceps femoris

Palpation of the Semitendinosus

Semimembranosus

P: Ischial tuberosityD: Medial condyle of

the tibia

1. Flexes the leg at the knee joint

2. Extends the thigh at the hip joint

3. Posteriorly tilts the pelvis at the hip joint

Best palpated distally in the posterior thigh, medial to the belly of the semitendinosus, and on either side of the distal tendon of the semitendinosus

Have the client prone with the leg partially flexed at the knee joint

Place palpating hand on the distal posteromedial thigh

Resist the client from performing further flexion of the leg at the knee joint and feel for contraction of the semimembranosus

The proximal attachment on the ischial tuberosity is lateral to the attachment of the long head of the biceps femoris

Palpation of the Semimembranosus

Tibialis Anterior

P: Proximal anterior tibia

D: Medial foot

1. Dorsiflexes the foot at the ankle joint

2. Inverts the foot at the tarsal joints

Have client supine Place palpating hand just lateral to

the shaft of the tibia Ask the client to actively dorsiflex

and invert the foot and feel for the contraction of the tibialis anterior

Palpation of Tibialis Anterior

Fibularis Longus

P: Proximal lateral fibula

D: Medial foot

1. Everts the foot at the tarsal joints

2. Plantarflexes the foot at the ankle joint

Have the client supine Place palpating hand on the proximal lateral leg just

distal to the head of the fibula Ask the client to actively evert the foot and feel for

contraction of the belly of the fibularis longus from the head of the fibula to the point where it becomes tendon halfway down the leg

Continue palpating the tendon distally. The distal tendon is superficial to the fibularis brevis muscle belly

Just proximal and posterior to the lateral malleolus, the tendon of the fibularis longus will be more superficial and posterior than the tendon of the fibularis brevis

Fibularis Longus

Gastrocnemius

P: Medial and lateral femoral condyles

D: Calcaneus via the calcaneal tendon

1. Plantarflexes the foot at the ankle joint

2. Flexes the leg at the knee joint

Have the client prone with the leg extended at the knee joint

Place palpating hand on the proximal posterior leg

Ask the client to actively plantarflex the foot at the ankle joint against resistance and feel for contraction of the muscle. It can be palpated all the way to its distal attachment

Palpation of the Gastrocnemius