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