Palpation Review For Final Exam

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

Deltoid P: 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 Flexes the forearm at the elbow joint (entire muscle) Supinates the forearm at the radioulnar joints (entire muscle) 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 Brachii P: 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 Flexes the hand at the wrist joint 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 Flexes the hand at the wrist joint 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 Extends the hand at the wrist joint 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 Extends the hand at the wrist joint 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 Extends the hand at the wrist joint 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 muscle P: Occiput, nuchal ligament, and SPs of C7-T12 D: Lateral clavicle, acromion process, and spine of scapula Laterally flexes the neck and the head at the spinal joints (upper) Extends the neck and the head at the spinal joints (upper) Contralaterally rotates the neck and the head at the spinal joints (upper) Elevates the scapula at the scapulocostal joint (upper) Retracts (adducts) the scapula at the scapulocostal joint (entire muscle) 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 scapulae P: TPs of C1-C4 D: Medial border of the scapula, from the superior angle to the root of the spine of the scapula Elevates the scapula at the scapulocostal joint Extends the neck at the spinal joints 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 Flexes the head at the spinal joints Laterally flexes the neck and the head at the spinal joints 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 Medially rotates the arm at the shoulder joint Adducts the arm at the shoulder joint Extends the arm at the shoulder joint Anteriorly tilts the pelvis at the lumbosacral joint

Place palpating hand on the client’s posterior axillary fold

Ask 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 latissimusdorsi

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

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 Retracts (Adducts) the scapula at the scapulocostal joint 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: Pelvis I: Spine, ribcage, and head Extends the trunk, neck, and the head at the spinal joints Laterally flexes the trunk, neck, and head at the spinal joints Ipsilaterally rotates the trunk, neck, and head at the spinal joints 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 Flexes the trunk at the spinal joints 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 glutealtuberosity of the femur Extends the thigh at the hip joint Laterally rotates the thigh at the hip joint Abducts the thigh at the hip joint (upper 1/3) Adducts the thigh at the hip joint (lower 2/3) Posteriorly tilts the pelvis at the hip joint

Place palpating hand on the lateral sacrum

Palpate 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 crestPalpation of Gluteus Maximus

Gluteus Medius P: External Ilium D: Greater trochanter of the femur Abducts the thigh at the hip joint (entire muscle) Flexes the thigh at the hip joint (anterior fibers) Medially rotates the thigh at the hip joint (anterior fibers) Extends the thigh at the hip joint (posterior fibers) Laterally rotates the thigh at the hip joint (posterior fibers) Posteriorly tilts the pelvis at the hip joint (posterior fibers) Anteriorly tilts the pelvis at the hip joint (anterior fibers)

Middle 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 difficultPalpation of the Gluteus Medius

Tensor Fasciae Latae (TFL) P: Anterior Superior Iliac Spine D: Iliotibial band (ITB) Flexes the thigh at the hip joint Abducts the thigh at the hip joint Medially rotates the thigh at the hip joint 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) Flexes the thigh at the hip joint Abducts the thigh at the hip joint Laterally flexes the thigh at the hip joint Flexes the leg at the knee joint 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: TibialTuberosity Extends the leg at the knee joint Flexes the thigh at the hip joint 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: Ischialtuberosity Short head: Linea aspera D: Head of the fibula Flexes the leg at the knee joint (entire muscle) Extends the thigh at the hip joint (long head) 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: Ischialtuberosity D: Pes Anserine tendon Flexes the leg at the knee joint Extends the thigh at the hip joint Poseteriorly tilts the pelvis at the hip joint

Palpation Review For Final Exam

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