Anatomy: Palpation List Term2
HEAD, NECK, FACE
Bones
NAME |
What to doÉ |
What to
sayÉ |
|
Mastoid
process p.199
|
á Locate the mastoid process
by placing your finger behind the ear lobe. Sculpt around its edges, exploring the entire surface. á The bone should feel round
and superficial. á You can palpate posteriorly
onto the superior nuchal line of the occiput. |
á The mastoid process forms a
larger, superficial bump directly behind the ear lobe. á It is an attachment site
for the sternocleidomastoid, longissimuss capitis, and splenius capitis
muscles. (check accuracy) |
|
Styloid
process p.199 |
á Palpate btwn the mastoid
process and the posterior edge of the mandible. á It is deep to overlying
muscles and it is NOT directly palpable. á Explore gently. |
á The styloid process is
located behind the ear lobe bwtn the mastoid process and the posterior edge
of the mandible. á Its fanglike shape serves
as an attachment site for several ligaments and muscles includingÉ á It is deep to overlying
muscles and tissue and is not directly palpable; however, its location can be
accessed. á The styloid process of the
temporal bone is fragile and is deep to the facial nerve, so exploration in
this area should be very gentle. |
|
Zygomatic
arch p.199
|
á Locate the mastoid process
by placing finger behind the ear lobe.
á Explore the zygomatic arch
by placing your finger anterior to the ear canal. Mover anteriorly along the arch, outlining its sides with
your thumb and finger. (diagram)
Follow it anteriorly as it merges with the orbit of the eye. á The ridge of the arch
should run horizontal and it should be level with the ear canal. á Use thumb and index finger
to trace and Ôpinch the boneÕ |
á The superficial zygomatic
arch forms the cheekbone. á It is composed by the temporal
and zygomatic bones. á It is an attachment site
for the masseter muscle. á The space btwn the
zygomatic arch and the cranium is filled by the thick temporalis muscle. |
|
Angle
of the mandible p.201-202
|
á Slide posteriorly along the
base of the mandible to the angle.
Clarify your location by asking your partner to open his mouth and
noting the movement of the angle. á Slide superiorly from the
angle á Trace along the base of the
mandible until you reach the angle. |
á The superficial angle of the
mandible is located at the posterior end of the base Òjaw lineÓ. á It forms part of the
attachment for the masseter. |
|
Condyle
of the mandible p.201-202
|
á Place your fingerpad
anterior to the ear canal and below the zygomatic arch. á Ask your partner to open
his mouth fully and slowly. With
this action, the condyle will become more palpable as it slides anteriorly
and inferiorly. á (hint: You should be anterior to the ear
canal, below the zygomatic arch. As your partner opens his mouth, you should
be able to palpate both condyles simultaneously.) |
á This is one of the 2
temporomandibular joints which articulates the mandible with the cranium. á The superficial condyle is
located just anterior to the ear canal and inferior to the zygomatic
arch. á The deeper, inaccessible
head of the condyle forms the articulating surface of the mandible at the
temporomandibular joint. á The condyle is not conguent
with itÕs articulating surface.
As such, there is a lifesaver-shaped disc which lies on top of the
condyle which helps to create more congruity bwtn the joint surfaces,
reducing the potential for bone deterioration. |
|
Ramus
of the mandible p.201-202 |
á Slide superiorly from the
angle onto the ramus which is deep to the masseter muscle. |
á The flat ramus is the
posterior, vertical portion of the mandible and is deep to the masseter. |
|
Coronoid
process of the mandible p.201-202
|
á Place your fingerpad on the
middle aspect of the zygomatic arch. á Drop half an inch
inferiorly and ask your partner to open her mouth fully. As the jaw drops, the large process
will press into your finger. (diagram p.202) á With the mouth still open,
explore the surfaces of the process. á (hint: You should be inferior to the
zygomatic arch. When the mouth is open, you should feel the anterior edge of
the process.) |
á The coronoid process is
located an inch anterior to the condyle of the mandible and is the attachment
site of the temporalis muscle.
When the jaw is closed, the coronoid process lies underneath the
zygomatic arch and is inaccessible.
Opening the mouth fully, however, will bring the coronoid process out
from under the arch and allow the process to be accessed. á (try and find any other m.
attachments to this process) |
|
Digastric
p.214
|
á Partner supine with practitioner
at head of table. Locate the mastoid process of the temporal bone and the
hyoid bone (see hyoid section below) á Draw an imaginary line
between these points. Using your
index finger, palpate along this line for the skinny, posterior digastric
(diagram p.215) á Draw an imaginary line bwtn
the hyoid bone to the underside of the chin and palpate for its anterior
belly. á To feel the digastric
contract, place your finger under the chin and ask your partner to try to
open her mough against your gentle resistance. This contraction will
sometimes allow both of the digastric bellies to be located more easily. á (hint: the muscle should be superficial
and pencil-width. It should
extend from the mastoid process to the hyoid bone to the chin.) |
á The long, round digastric
muscle is composed of a posterior and an anterior belly. The posterior belly runs from the
mastoid process to the hyoid bone and then loops through a tendinous sling on
the hyoidÕs anterior surface. It
continues on as the anterior belly to attach at the underside of the chin.
(diagram p214) á Both bellies are
superficial, yet difficult to distinguish from the deeper suprahyoid muscles. á (activation: Òdepress your jawÓ or ÒswallowÓ) á S.A. : inferior border of mandible near
symphysis á I. A. : intermediate tendon to hyoid á A : (1) elevates and pulls
hyoid anteriorly; (2) assists in
depressing mandible (I.A. fixed) |
|
Hyoid
p.203
|
á Supine or seated. Place your index finger upon the
thyroid cartilage (place fingers on AdamÕs Apple, then ask your partner to
swallow, you will feel it move up and down.) á Roll your fingerpad
superiorly over the thyroid cartilage and onto the hyoid. á Then gently palpate the
sides of the hyoid with your first finger and thumb. (diagram) The hyoid will
be wider than the trachea. á Using gentle pressure, explore
the surface of the hyoid as well as its small side to side movements. á If you have difficulty
accessing the hyoid, ecourage your partner to relax her tongue and jaw. á Hint: you should be
superior to they thyroid cartilage. You should be able to move the hyoid from
side to side. á With your first finger and
thumb on either side of the hyoid, ask your partner to swallow. You should be able to feel the hyoid
rise up and then return. (diagram) |
á The hyoid bone is
horse-shoe shaped. á Located superior to the
thyroid cartilage. á It is roughly an inch in
diameter and lies parallel to the base of the mandible (jaw line) and the 3rd
and 4th cervical vertebra. á It serves as an attachment
site for the supra and infrahyoid muscles. It is accessible and elevates upon swallowing. |
|
Sternocleidomastoid
p.207
|
á Supine with practitioner at
head of table. Locate the mastoid process of the temporal bone, the medial
clavicle and the top of the sternum. á Draw a line btwn these
landmarks to delineate the location of the muscle. Note how both sides form
the ÒVÓ on the front of neck. á Ask your partner to raise
her head very slightly off the table as you palpate the muscle. (diagram
208) It will usually protrude
visibly. (To make the muscle
more distinct, rotate the head slightly to the opposite side and then ask her
to flex her neck.) á Palpate along the borders
of the muscle, follow it behind the ear lobe, and then down to the clavicle
and sternum (diagram 208).
Sculpt around the skinny sternal tendon and the wider clavicular
tendon. á (hint: With your partner relaxed, you
can grasp the muscle btwn your fingers and outline its thickness and
shape. There should be aprox.
2-3 inches btwn the clavicular attachments of the muscle and the trapezius.) |
á The sternocleidomastoid is
located on the lateral and anterior aspect of the neck. It has a large belly with 2 heads: a
flat, clavicular head and a slender, sternal head. (diagram p.207) á Both heads merge to attach
behind the ear at the mastoid process.
á The carotid artery passes
deep and medial to it; á The external jugular lies
superficial to it. á The sternocleidomastoid is
superficial, completely accessible and often visible when the head is turned
to the side in Lord Byron-like fashion (diagram 207) á (action: Òflex your neckÓ or Òinhale deeplyÓ) á S.A. : mastoid process á I. A : sternum, clavicle á A : Bilateral: á (1) extends the head if the
head is extended á (2) flexes the head and
neck if the head is erect or flexed. á (3) stabilizes the head (with
the trapezius) during movements of the mandible (ie, talking, eating) á (4) accessory muscle of
inspiration á A: Unilateral á (The same cranial nerve
innervates the upper traps and SCM, so their actions will be similar.) á (1) contralateral rotation á (2) ipsilateral flexion |
|
Temporalis
p.213
|
á Supine with practitioner at
head of table. Locate the zygomatic arch. á Place your fingerpads 1
inch superio to the arch and ask your partner to alternately clench and relax
jaw. You should feel the strong
temporalis contracting beneath your fingers. (diagram213) á To locate the attachment
site of the temporalis tendon, ask partner to open her mouth wide. á Locate and explore the
coronoid process (diagram213).
Although the coronoid process is easily accessed, you may not be able
to isolate the tendon of the temporalis. á To outline the wide origin
of the temporalis, place your fingers in various positions on the side of the
head and ask your partner to alternately clench and relax her jaw. If your fingers are on the muscle,
you will feel the temporalis fibers tighten and soften. If you are off the muscle, you will
not feel anything. á (hint: you should be superior to the
zygomatic arch on the side of the head.
Try to discern the muscle fiber direction and feel them converge.) |
á The temporalis muscle is
located on the temporal aspect of the cranium. Its broad origin attaches to the frontal, temporal, and
parietal bones. (diagram213) á Its fibers converge into a
thick mass, reaching under the zygomatic arch to connect at the coronoid
process. á Though deep to the temporal
fascia and artery, the temporalis is superficial and directly accessible. á (activation: Òclench your jawÓ) á Trailguide: á Origin: temporal fossa and fascia á Insertion: coronoid process
of the mandible á Action: (1) elevates the
mandible á (2) retracts the mandible |
|
Masseter
p.212
|
á Supine. Locate the zygomatic arch and angle
of the mandible. á Place your fingers btwn
these bony landmarks and palpate the surface of the masseter. á Ask your partner to
alternately clench and relax jaw as you sculpt out the square shape of the
belly (diagram212) á Clarify the masseterÕs fiber direction by strumming your
fingers horizontally across its muscle fibers. á Now ask your partner to relax
and try grasping the chunky bellies of the masseter. (diagram212) á (hint: as your partner clenches, you
should be able to outline the anterior edge of the masseter. If your partner opens her jaw as wide
as possible, you can feel the tissue lengthen.) |
á The masseter is the
strongest muscle in the body relative to its size. The two masseters together exert a biting force of nearly
150 pounds of pressure Ð enough to bite off a finger! The masseter is the primary chewing
muscle and is used in speaking and swallowing. á Located on the side of the
mandible, the square-shaped masseter is composed of 2 overlapping
bellies. The superficial belly
can be accessed from the face. (diagram212); the deep belly is palpable from inside the mouth
(diagram212). The masseter is
situated deep to the parotid gland (diagram212) yet is easily palpable. á (activation: Òclench your jawÓ) á Trailguide: á O: zygomatic arch á I: angle and ramus of
mandible á A: elevates the mandible
(temporomandibular joint) |
|
Middle
scalene p.208-211
|
á Supine, with practitioner
at head of table. Cradle the
head (passively flexing it) to allow for easier palpation. á Place your fingerpads along
the anterior and lateral sides of the neck btwn the sternocleidomastoid and
trapezius. á With the pads of your
fingers, use gentle pressure to palpate the stringy, superficial bellies in
this triangle. á (hint: make sure you are bwtn the
sternocleidomastoid and the trapezius).
á Ask your partner to inhale
deeply into her upper chest. As
she fully inhales, do you feel the muscles in this triangle contract?
(diagram210) á Rotate the head slightly to
the opposite side to better expose it.
á Gently palpate under the
sternocleidomastoidÕs lateral edge and roll past the belly of the anterior
scalene. á Move laterally to explore
the middle scalene, noting its similarly shaped belly. á (hint: the muscle should have a slender
stringy texture. If you follow
it inferiorly, they should sink beneath the clavicle in the direction of the
ribs. á You can follow them
superiorly to the transverse processes of the cervical vertebrae. á Ask your partner to flex
her head slightly and you should feel the scalenes contract. |
á The middle scalene (all 3)
are sandwiched bwtn the sternocleidomastoid and the anterior flap of the
trapezius on the anterior, lateral neck. á Their fibers begin at the
side of the cervical vertebrae, dive underneath the clavicle, and attach to
the first and second ribs. (diagram208) á During normal inhalation,
the scalenes perform the vital task of elevating the upper ribs. á The middle scalene is
slightly larger than the anterior scalene and lies lateral to it. The muscle belly is fully accessible. á (activation: Òinhale into your upper chestÓ or Òflex your neckÓ) á Trailguide: á O: TVP of 2nd to
7th cervical vertebrae (posterior tubercles) á I: 1st rib á A: Bilateral á (1) elevates the ribs
during inhalation (All) á (2) flex the neck
(anterior) á Unilateral á (1) With the ribs fixed,
laterally flex the neck to the same side. (All) á (2) Rotate head and neck to
the opposite side (All) |
SHOULDER AND ARM
|
Bicipital groove aka
intertubercular groove p.63
|
á Place your thumb on the greater tubercle
(diagram63) á Begin to rotate the arm laterally. As the humerus rotates, the greater
tubercle will move out from under your thumb and be replaced by the slender
ditch of the intertubercular groove. á As you continue to laterally rotate, your thumb
will rise out of the groove onto the lesser tubercle. á After placing thumb on the greater tubercle, try
passively rotating the arm medially and laterally. You should feel the Òbump-ditch-bumpÓ sequence as the 3 landmarks (greater
tubercle-bicipital groove-lesser tubercle) pass beneath your thumb. á Make sure you are horizontal to the level of the
coracoid process. |
á The bicipital groove aka intertubercular groove, is
situated btwn the greater and lesser tubercles, and is roughly a pencilÕs width in diameter. á Within the groove lies the tendon of the long head
of the biceps brachii, which can be tender, requiring a gentle touch |
|
Coracobrachialis p.92 |
