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
|
á Supine.
Laterally rotate and abduct the shoulder to 45 degrees. Locate the fibers of the pectoralis
major. This tissue forms the
axillaÕs anterior wall and will be a
good reference point for locating coracobrachialis. á Lay one hand along the medial side of the arm and
move your fingerpads into the armpit. á Have your partner horizontally adduct gently
against your resistance (diagram92) á Isolate the solid edge of the pectoralis major then
slide off itÕs fibers posteriorly (into the
axilla) and explore for the slender contracting belly of
coracobrachialis. á Its belly may be visible upon adduction. á Make sure the muscle you are palpating is on the
medial side of the upper arm. á Make sure itÕs belly lie posterior to the overlying flap of the
pectoralis major and that you can strum along itÕs cylindrical belly. |
á The coracobrachialis is a small, tubular muscle
located in the axilla. Sometimes
known as the armpit muscle. á It is a secondary flexor and adductor of the
shoulder. á In anatomical position, the coracobrachialis is
deep to the pectoralis major and anterior deltoid and lies anterior to the
axillary artery and brachial plexus. á Abducting the shoulder (opening up the axilla)
brings the belly of coracobrachialis to a superficial and palpable position. á (activation: Òadduct your shoulderÓ) á PA: coracoid process á DA: the middle medial surface of shaft of humerus á A: flexes and adducts GH joint (combing your hair) |
|
Latissimus Dorsi p.69-70
|
á Prone
with arm off side of table.
Locate the scapulaÕs lateral
border. á Using your fingers and thumb, grasp the thick wad
of muscle tissue lateral to the lateral border. This is the latissimus dorsi
(and maybe some of teres major).
á Note how this muscle tissue flairs off the side of
the trunk. á Feel the latissimus fibers contract by asking your
partner to medially rotate his shoulder against your resistance. á ÒSwing your hand up toward your hip.Ó á As this occurs, follow the latissimus fibers
superiorly into the axilla and inferiorly on the ribs. á Make sure you are not just lifting the skin. Grasp the tissue and slowly let it
slip out btwn your fingers. á Supine. Cradling the arm in a flexed
position, grasp the tissue of latissimus located beside the lateral border. á Ask your partner to extend his shoulder against
your resistance. á ÒPress your elbow toward your hip.Ó This
will force the latissimus to contract. (diagram70) |
á The latissimus dorsi is the broadest muscle of the
back. ItÕs thin superficial fibers originate at the low
back, ascend the side of the trunk and merge into a thick, bundle at the
axilla. (diagram69). á Both ends of the latissimus dorsi are difficult to
isolate; however, itÕs middle
portion next to the lateral border of the scapula is easy to grasp. á The latissimus dorsi and teres major are sometimes
called the handcuff muscles, since their actions collectively bring the arms
into the Òarresting positionÓ (ie: extension, adduction, medial rotation) á The latissimus dorsi not only moves the arm, but
b/c of its broad origin, can also affect the trunk and spine. á Contraction of the left latissimus dorsi assists in
lateral flexion of the trunk to the left. If the arm is fixed, as when hanging froma bar, the
latissimus dorsi will assist in extension of the spine and tilting of the
pelvis anteriorly and laterally. á (activation: Òextend and medially rotate your shoulderÓ) á MA: T6-T12 SP, thoracolumbar fascia, iliac crest, ribs 9-12, sometimes
the inferior angle of scapula á LA: the floor (bottom surface) of the bicipital
groove á A: (MA fixed) medial rotation, extension, and
adduction of GH joint. (handcuff position) (LA
fixed) chin ups, accessory muscle to respiration
(arms at hips to ease breathing) |
|
Teres Major p.69-70
|
á Prone with arm off the side of the table. á Locate and grasp the latissimus dorsi fibers btwn
your fingers and thumb. á Move your fingers and thumb medially to where you
feel the scapulaÕs lateral border. The muscle
fibers that lie medial to the latissimus and attach to the lateral border
will be the teres major. á Follow these fibers toward the axilla where they
blend with the latissimus dorsi. á (hint:
lay your thumb on the inferior aspect of the lateral border and have your
partner medially rotate the shoulder joint to distinguish the teres major
from the latissimus dorsi (diagram70).
á The fibers of both muscles will contract; those
that attach directly to the lateral border belong to teres major; the more
lateral fibers belong to latissimus dorsi. á (hint:
touch on the inferior angle) |
á The teres major is called Òthe latÕs
little helperÓ because it is a complete
synergist with the latissimus dorsi. (diagram69) á It is superficial and located along the scapulaÕs lateral border btwn the latissimus dorsi and
teres minor. á Although they share names, the teres major and
teres minor rotate the arm in opposite directions Ð the major medially, the minor laterally. á Teres major, (along with latissimus dorsi) are
sometimes called Òthe handcuff musclesÓ since their actions collectively bring the arms
into the arresting position. (extension, adduction, and medial rotation) á PA: inferior angle of scapula á DA: bicipital groove, medial lip (aka crest of the
lesser tubercle) á A: adduction, extension, and medial rotation of
humerus (handcuff positon) |
|
Levator Scapula p.79-80
|
á Prone, supine, or sidelying. Palpating through the trapezius,
locate the superior angle of the scapula. (diagram80) and the upper region of
the medial border. á Place your fingers just off the superior angle and
firmly strum across the belly of the levator. The fibers will likely have a ropy texture. á Follow these fibers superiorly as they extend to
the lateral side of the neck to the transverse processes of the cervical
vertebrae. á Try to differentiate btwn the fibers of levator and
trapezius. Levator fibers should
lead you toward the lateral side of the neck. Alternative method: á Locate upper fibers of trapezius á Roll 2 fingers anteriorly off the trapezius and press
into the tissue of the neck. á Gently strum your fingers anteriorly and
posteriorly across the levator fibers. (diagram80) Often you will feel a distinct band of tissue that leads
superiorly toward the lateral neck and inferiorly under the trapezius. á Place your fingertips on the levator and ask your
partner to alternately elevate and relax his scapula. á You should feel it contract and relax beneath your
fingertips. á ***** SUPINE. Passively rotate the head 45 degrees away from the side you are palpating
will shift the cervical transverse processes further anteriorly. Also it gives the levator scapula
more palpable tension. á Conversely, this position shortens and softens the
overlying trapezius fibers. |
á Located along the lateral and posterior sides of
the neck. Its inferior portion is deep to the upper trapezius; however, as
the levator ascends the lateral side of the neck, its fibers come out from
under the trapezius and become superficial. (diagram79) á Its belly is aprox. 2 fingers wide with fibers that
naturally twist around themselves. á It attaches to the transverse processes of the
cervical vertebrae. (diagram79)
Located on the lateral side of the neck, all of these small
protuberances extend laterally at aprox. The same width, except for the
processes of C1 which are broader. á When accessing the processes to locate the origin
of the levator scapula, begin by using your soft fingerpads to avoid
compressing a brachial plexus nerve. á The levator is completely accessible by palpating
either through the upper fibers of the trapezius or directly from the side of
the neck. á The levator is situated btwn the splenius capitis
and posterior scalene muscles on the lateral side of the neck. (diagram79) á It can be distinguished from these neighbouring
muscles during palpation b/c it moves the scapula. á No other muscle deep to the upper trapezius or
attaching to the lateral cervical vertebrae is capable of this action. á (activation: Òelevate your scapulaÓ) á SA: C1-C4 TVP á IA: superior part of medial border of scapula á A: (SA fixed) (1) downward rotation (medial
rotation) of scapula; (2)
elevation of scapula with upper trapezius á (IA fixed) (1) lateral flexion of neck; (2)
ipsilateral rotation of neck |
|
Serratus Anterior p.81-82
|
á Palpating along the sides of the ribs can tickle,
so use slow, firm pressure. á If accessing the left serratus, it may be easier to
stand on the right side of the table. á Supine. Isolate the location of the serratus by
abducting the arm slightly and locating the lower edge of the pectoralis
major. (diagram82) Then locate
the anterior border of the latissimus dorsi. á Place your fingerpads along the side of the ribs
btwn pec major and the lat dorsi. á Strum your fingers across the ribs and palpate for
the serratus anterior fibers. To
differentiate btwn the ribs and the serratus fibers (both have a similar Òspeed bumpÓ
shape), remember that the ribs are deep and have a solid texture while the
serratus fibers are superficial and malleable. á OrÉ ask your
partner to flex his shoulder so his fist is raised toward the ceiling. Place one hand upon the serratus
fibers and your other hand on top of his raised fist. á Ask him to alternately abduct his scapula and
relax: Òreach toward the ceiling and
then relax.Ó You should fell the fibers contract and soften. You can also follow the fibers along
the ribs to where they tuck underneath the lat dorsi. á OrÉ turn your
partner sidelying with his arm at his side. Locate the medial border of the scapula to access the
insertion of the serratus anterior.
á Curl your fingers beneath the medial border onto
the beginnings of the subscapular fossa and explore the area where the
serratus attaches. |
á Lies along the posterior and lateral ribcage. á Its oblique fibers extend from the ribs underneath
the scapula and attach to its medial border. á Most of the serratus is deep to the scapula,
latissimus dorsi, or pectoralis major; however, the portion of the serratus
below the axilla (armpit) is superficial and easily accessible. (diagram81) á It is unique in its ability to abduct the scapula,
making it an antagonist to the rhomboids. á The inferior/lateral aspect of the breast covers
the serratus anterior. á It supports the weight of the trunk and stabilizes
the pectoral girdle against the thorax during a push-up. á (activation:Óabduct your scapulaÓ) á PA: lateral external surfaces of 1st 9
ribs. á DA: anterior medial border of scapula á A: (PA fixed): (1) abduction and protraction of
scapula; (2) lower fibers may depress scapula; (3) upper fibers may elevate
scapula á (DA fixed): elevates ribs and can assist in forced
respiration. á Isometrically fixed (everything fixed): isometric stabilizes scapula (ie,
prevents winging). It holds the
medial border of the scapula firmly against the thorax in a properly executed
push-up. |
|
Subscapularis p.71-74
|
á Sidelying. Flex the shoulder and
pull the arm anteriorly as much as possible. This will allow easier access to the scapulaÕs anterior surface. á Hold the arm with one hand while the thumb of the
other locates the lateral border. á Hint:
slide your thumb underneath the lat dorsi and teres major fibers instead of
going through them. (diagram74) á Slowly and gently curl your thumb onto the
subscapular fossa. You may not
feel the subscapularis fibers immediately, but if your thumb is on the
anterior surface of the scapula, you will be accessing a portion of the
fibers. á Hint: ask your partner to gently rotate his
shoulder medially. You can feel
the subscapularis fibers contract beneath your thumb. á OrÉ
supine. Cradle the arm in a
flexed position and locate the lateral border. Slowly sink your thumbpad onto the subscapular fossa,
adjusting the arm and scapula as you progress. (diagram74) |
á Part of the rotator cuff muscles which encompass,
and stabilizes the glenohumeral joint á The deep subscapularis is located on the scapulaÕs anterior surface and is sandwiched btwn the
subscapular fossa and the serratus anterior muscle. (diagram71) á With only a small portion of its muscle belly
accessible, subscapularis is the only rotator cuff muscle that attaches to
the humerusÕ lesser tubercle. á It rotates the shoulder medially á (activation: Òmedially rotate your shoulderÓ) á PA: subscapular fossa á DA: lesser tubercle á A: medial rotation of humerus |
|
Upper trapezius p.67-68
|
á Prone.
These fibers form the easily accessible flap of muscle lying across
the top of the shoulder. Along
the posterior neck they are surprisingly skinny, each being only an inch in
diameter. á Grasp the superficial tissue on the top of the
shoulder and feel the upper trapezius fibers. Take note of their slender
quality. á Follow the fibers superiorly toward the base of the
head at the occiput. To feel the
fibers along the posterior neck contract, stand at the head of the table and
ask your partner to extend his head a quarter inch off the face cradle. Then
follow the fibers inferiorly to the lateral clavicle. á Remember: the muscle should be thin and
superficial. Grasp the fibers
along the top of the shoulder and have your partner elevate his scapula
gently toward his ear. The
fibers should become taut. |
á The trapezius lies superficially along the upper
back and neck. It has broad, thin fibers. á Fiber direction of the upper traps is superomedial. á The upper and lower traps are antagonists in
elevation and depression of the scapula. á Activation:Ó elevate or depress your shoulderÓ á MA: (1) medial 1/3 of superior nuchal line of
occiput; (2) inion aka external
occipital protuberance; (3) C2-C7 SP; (4) ligamentum nuchae (a fibroelastic
band joining C7 SP to the inion and the spines of the cervical vertebrae SPs
to one another. á LA: (1) lateral ½ of clavicle; (2) acromion,
medial side á A: (MA fixed): (1) elevates scapula (with levator
scapulae); (2) upward rotation of scapula á (LA fixed): (Unilateral movements): (1) lateral
flexion of neck (to ipsilateral side);
(2) contralateral rotation of neck. á (Bilateral insertion fixed): extension of neck |
|
Lower trapezius p.67-68
|
á Locate the edge of the lower fibers by drawing a line
from the spine of the scapula to the spinous process of T12 (diagram68) á Palpate along this line and push your fingers into
the edge of the lower fibers.
Ask your partner to hold his arms out in front of him (like Superman)
and feel for the superficial fibers of the trapezius. á Attempt to lift the lower fibers btwn your fingers,
raising it off the underlying musculature. á Hint:
another action would be to ask your partner to depress his
shoulder. The lower fibers run
at a gentle angle toward the scapula (rather than parallel with the vertebral
column like the erector spinae muscles) |
á Same as above. á MA: T6-T12 SP á LA: root of scapula aka apex of spine of scapula á A: (MA fixed): (1) upward rotation of scapula; (2)
depression of scapula with pec minor. á (rotation is achieved thru a force couple) |
|
Clavicular head of
Pectoralis Major p.83-84
|
á Caution: palpate around breast tissue, and not
directly into it. á Remember: communicate your intentions to your
partner. Encourage her to let
you know if at any time she wishes to stop. á Positioning: Supine allows easier access to the
sternal and upper pectoral regions, but may crowd the axillary area. (ask her
to hold her breast medially or use the back of your hand to push the tissue
medially) á In sidelying, the breast tissue will fall medially
opening up the axillary region. The axilla can be opened up further by
passively shifting the shoulder anteriorly. (diagram83) á Main instructionsÉ á Supine. With your partnerÕs shoulder slightly abducted, sit or stand facing
him. á Locate the medial shaft of the clavicle and move
inferiorly onto the clavicular fibers. á Explore the surface of the pectoralis major. Follow the fibers laterally as they
blend with the deltoid and attach at the greater tubercle. á Grasp the belly of the pectoralis by sinking your
thumb into the axilla. Ask your
partner to medially rotate his shoulder against your resistance. ÒPress your hand toward your bellyÓ (diagram84)
Note the contraction of the pectoralis. á NOTE: the clavicular fibers run parallel with the
anterior deltoid. Get a sense of
its thickness and how it lies across the ribcage. |
á The pectoralis major is a broad, powerful muscle
located on the chest. Except for
the part beneath breast tissue, its convergent, superficial fibers are
accessible. á It is divided into 3 segments Ð the clavicular, sternal, and costal. á The upper and lower fibers perform opposing actions
at the shoulder joint Ð flexion and
extension, respectively Ð making this
muscle an antagonist to itself. á Activation: Òadduct your shoulderÓ á NOTE: the clavicular fibers run parallel with the
anterior deltoid. Get a sense of
its thickness and how it lies across the ribcage. á MA: (clavicular fibers): medial ½ of
clavicle á LA: crest of greater tubercle aka lateral lip of
bicipital groove á A: (of the whole muscle): (1) adduction of the GH
joint; (2) medial rotation of GH joint; (3) horizontal adduction aka
horizontal flexion á A: (clavicular head) flexes the humerus |
|
Sternal head of Pectoralis
Major p.84
|
á Same as above, but palpate along the sternum. |
á Same as above á MA: (sternal fibers): anterior surface of sternum á LA: crest of greater tubercle aka lateral lip of
bicipital groove. á A: extends humerus (brings it back from flexion) |
|
Triceps p.90-91
|
á Prone.
Bring the arm off the side of the table and palpate the posterior
aspect of the arm. Outline the
edge of the posterior deltoid and then explore the size and shape of the
triceps. á Locate the olecranon process to outline the distal
tendon of the triceps. Then ask
your partner to extend his elbow as you apply resistance at his forearm.
(diagram91) Slide your other
hand off the olecranon process proximally and onto the broad triceps tendon. á With your partner still contracting, widen your
fingers and palpate the medial and lateral heads on either side of the
tendon. á Hint: the muscle should tighten when your partner
extends his elbow. The medial and lateral triceps heads should bulge
on either side of the distal tendon. |
á The only muscle located on the posterior arm. á It creates extension at the elbow and shoulder and
is an antagonist at both these joints to the biceps brachii. á It has 3 heads: long, lateral, and medial. á The long head exends off the infraglenoid tubercle
of the scapula, weaving btwn the teres major and minor. á The lateral head lies superficially beside the
deltoid. á The medial head lies mostly underneath the long
head. á All 3 heads converge into a thick, distal tendon
proximal to the elbow. á Aside from its proximal portion, which is deep to
the deltoid, the triceps is superficial and easily accessible. á PA: (long head): infraglenoid tubercle and neck of
scapula á (lateral head): humerus, posterior surface superior
to the radial (spiral) groove. á (medial head): humerus, posterior surface inferior
to the radial (spiral) groove á DA: olecranon á A: (whole muscle): extension at the elbow joint á (long head): extends GH joint (weak) |
|
Tendon of the long head of
triceps brachii p.91
|
á Prone.
Place one hand on the proximal elbow and ask your partner to bring his
elbow toward the ceiling against your resistance. This action will contract the long head of the triceps. á Locate itÕs
belly along the proximal and medial aspects of the arm. Follow the muscle proximally by
strumming across the belly. Note
how it disappears underneath the posterior deltoid toward the infraglenoid
tubercle. á With the arm relaxed, press through the posterior
deltoid and strum across its skinny tendon as it attaches to the infraglenoid
tubercle. á Hint: the long head of the triceps crosses over the
teres major and under the teres minor.
You can follow the long head up to the division f the teres
muscles. á Have your partner medially and laterally rotate his
shoulder to differentiate the teres muscles. (diagram91) |
á Hint: it is the only band of muscle on the
posterior arm that runs superiorly along the proximal and medial aspect of
the arm. The deltoid fibers run
at a more diagonal direction than the long head of the triceps. á See above for attachments. |
FOREARM AND HAND
|
Head of radius p.108
|
á Shake hands and locate the lateral epicondyle. á Slide distally off the epicondyle, across the small
ditch btwn the humerus and radius and onto the head of the radius.
(diagram108) á The head of the radius is the only bony structure
in this vicinity. Explore its
ring-shaped, superficial surface. á You should be distal to the lateral
epicondyle. Place your thumb on
the head and, with your other hand, slowly supinate and pronate the forearm.
(diagram108) á You should be able to feel the headÕs rotating movement under your thumb. |
á The head of the radius is distal to the humerusÕ lateral epicondyle. á It forms the radiusÕ proximal end and has a circular, bell shape. á The head is stabilized by the annular ligament and
is a pivoting point for supination and pronation of the forearm. á Although it is deep to the supinator and extensor
muscles, the headÕs posterior, lateral aspect
can be accessed. |
|
Head of the Ulna p.107
|
á Slide your fingers distally along the ulnar shaft. á Just proximal to the wrist, the shaft will bulge to
become the head of the ulna.
Palpate all sides of the bulbous head. (diagram107) á The knob you are palpating should be connected to
the shaft of the ulna. á In a neutral position, it should be on the
posterior and medial side of the forearm. |
á The shaft of the ulna swells to form the head of
the ulna. á The head is the superficial knob visible along the
posterior, medial side of the wrist that can disrupt the placement of a
watchband. á |
|
Lunate and Capitate p.115
|
á Locate ListerÕs tubercle and the base of the 3rd
metacarpal. With the wrist
sligthly extended, lay your thumb btwn these points and notice how it falls
into a small cavity. This is the
location of the lunate and capitate. (diagram115) á Set your thumb at the proximal end of this
cavity. Then flex the wrist and
feel the lunate press into your finger (diagram115). á Next, extend the wrist and feel this carpal
disappear back into the wrist. á Shift your thumb to the distal end of the cavity
and notice how it bumps into the base of the 3rd metacarpal. á Passively flex the wrist, noting how the capitate
rolls into your finger, ÒfillingÓ its own cavity. á You should be btwn the ListerÕs Tubercle and the shaft of the 3rd
metacarpal. á To isolate the Lunate, you should be just distal to
the edge of ListerÕs
Tubercle. á You should feel a small knob press into your thumb
upon flexion. |
á The lunate is the most frequently dislocated
carpal. á Located just distal to ListerÕs Tubercle, it is relatively inaccessible when the
wrist is in a neutral position; flexing the wrist, however, will slide the
lunate to the dorsal surface. á It is accessible on the dorsal surface and can be
isolated btwn ListerÕs Tubercle
and the shaft of the 3rd metacarpal. |
|
Scaphoid p.113
|
á Beginning on the wristÕs radial surface, locate the radiusÕ styloid process. á Slide your thumb distally off the process, falling
btwn the superficial tendons and into the natural ditch where the scaphoid
will be found. (diagram) á Maintain your position and passively adduct the
wrist. As you do so, feel for
the scaphoid to bulge into your thumb. (diagram) Now abduct the wrist and feel how the scaphoid disappears
back into the wrist. á From here, explore the scaphoidÕs dorsal and palmar surfaces. On the palmar surface, along the
flexor crease, is the scapoid tubercle. (diagram) á You should be distal to the end of the styloid
process of the radius. á During adduction and abduction, you can feel the
scapoid protrude and then disappear. |
á The peanut-shaped scaphoid (aka navicular) is the
most commonly fractured carpal. á It is located on the radial side of the hand,
distal to the styloid process of the radius. á Although it forms the floor of the tendinous Òanatomical snuffboxÓ,it is still accessible from the dorsal, palmar,
and ulnar sides of the wrist. |
|
Pisiform p.111
|
á Locate the flexor crease of the wrist. Then slide over to the ÒpinkyÓ side
of the crease. á Move slightly distal to the crease, rolling your
thumbpad in small circles.
Explore under the thick tissue of the palm for the nuggetlike
pisiform. (diagram) á Passively flex the wrist and notice how the
pisiform can be wiggled from side to side. (diagram) á Extend the wrist and observe how it becomes
immobile. (this immobility is
due to the tension created by the flexor carpi ulnaris tendon.) á Then, ask your partner to actively adduct her
wrist. You should feel the
tendon of flexor carpi ulnaris as it comes down the medial wrist and attach
to the pisiform. |
á The knobby pisiform is an attachment site for the
flexor carpi ulnaris. Protruding
along the ulnar/palmar surface of the wrist, the pisiform is just distal to
the flexor crease. |
|
Hook of Hamate p.112
|
á Locate the pisiform. Draw an imaginary line from the pisiform to the base of
the 1st finger. (diagram) á Using your thumbpad, slide off the pisiform along
this line. (diagram)
Approximately half of an inch from the pisiform, explore for this
subtle mound beneath the padding of the hand. á You should be btwn the pisiform and the base of the
1st finger. á Using gentle pressure, you should sense a small
ditch btwn the pisiform and the hamateÕs hook. á Keeping your thumbpad in place and rolling it
gently around the hook will give you the best sense of its shape and locale. |
á Located distal and lateral to the pisiform, the
hamate has a small protuberance or ÒhookÓ, that is palpable on the handÕs palmar surface. á The pisiform and the hook of hamate serve as
attachment sites for the flexor retinaculum, the CT band that forms the ÒroofÓ of
the carparl tunnel. á The flat surface of the hamateÕs body is accessible on the handÕs dorsal surface where the bases of the 4th
and 5th metacarpals merge.
When palpated, the hook is often tender. á The pisiform and hook of hamate form a small
channed called the Tunnel of Guyon. |
|
Brachialis p.120
|
á Shake hands with your partner and flex the elbow to
90degrees. It is important to
distinguish the muscle tissue of the biceps brachii from that of the
brachialis. Ask your partner to
flex her elbow against your resistance and isolate the edges of the round
biceps brachii belly. á With the arm relaxed, slide laterally half an inch
off the distal biceps. The edge
of the brachialis can be detected by rolling your fingers across its
surface. As you strum across its
solid edge, you will feel a pronounced ÒthumpÓ.
(diagram) á Continuing to strum across its edge, follow it
distally to where it disappears into the elbow. á Locate the distal biceps tendon. Palpate along either side of the
tendon for portions of the deeper brachialis. (diagram) á You should be rolling across a distinct wad of
muscle on the lateral side of the arm and be able to follow it distally
toward the inner elbow. á Locate the triceps and biceps brachii. The brachialis fibers should be btwn
them on the lateral arm. á AlternativelyÉ locate the deltoid tuberosity. Slide distally straight down the
lateral side of the arm and explore for the edge of the brachialis. á (activation: Òflex your elbowÓ) |
á The brachialis is a strong elbow flexor that lies
deep to the biceps brachii on the anterior arm. á It has a flat, yet thick belly. á Ironically, itÕs girth only helps the biceps to bulge further from
the arm, making it the bicepÕs best friend. á Although it lies underneath the biceps, portions of
brachialis are accessible. Its
lateral edge, sandwiched btwn the biceps and triceps brachii, is both
superficial and palpable. The
distal aspect of the brachialis is also accessible as it passes along either
side of the biceps tendon. á PA: distal ½ of the anterior surface of
humerus á DA: ulnar tuberosity and coronoid process á A: forearm flexion |
|
Brachioradialis p.121
|
á Shake hands with your partner and flex the elbow to
90 degrees. With the forearm in
a neutral position (thumb toward the ceiling), ask your partner to flex her
elbow against your resistance. á Look for the brachioradialus bulging out on the
lateral side of the elbow. If it
is not visible, locate the lateral supracondylar ridge of the humerus and
slide distally. á With your partner still contracting, use your other
hand to palpate its superficial, tubular belly. (diagram) Try to pinch its belly btwn your
fingers and follow it as far distally as possible. As it becomes more tendinous, strum across its distal
tendon toward the styloid process of the radius. á Upon resisted flexion of the elbow, the belly
should contract and bulge out.
It should be superficial and extend off the lateral epicondyle of the
humerus. |
á The brachioradialis is superficial on the lateral
side of the forearm. á It has a long, oval belly which forms a helpful
dividing line btwn the flexors and extensors of the wrist and hand. á Its muscle belly becomes tendinous halfway down the
forearm. It á It is the only muscle that runs the length of the
forearm but does not cross the wrist joint. á Resisted flexion of the elbow causes it to visibly
protrude on the forearm and become easily palpable. á (activation: Òflex your elbow against my resistanceÓ) á PA: it forms the main fleshy mass of the radial aka
lateral border of the forearm. á Proximal lateral supracondylar ridge of humerus. á DA: lateral distal end of radius (styloid process) á A: (1) most effective in neutral aka mid-prone
position (ie, hand shaking, beer drinking); (2) flexes forearm |
|
Extensor pollicis longus
p.135-138
|
á With the wrist in a neutral position, ask your
partner to extend her thumb: ÒBring your
thumbnail toward your elbow.Ó á Just distal to the styloid process of the radius will
be a small trough formed by the surrounding tendons. This is the anatomical snuffbox. If not seen immediately, change the
angle of the thumb. á Follow the tendons that form the snuffbox (extensor
pollicis longus, brevis, and abductor pollicis) proximally as they slide over
the posterior surface of the radius.
Lay your fingers along the posterior surface of the radius as your
partner circumducts her thumb in order to feel a portion of these muscles
contract. (diagram) |
á The belly of extensor pollicis longus lie along the
posterior aspect of the forearm, deep to the wrist extensors. á The distal tendons are superficial and form the Òanatomical snuff boxÓ. á PA: the proximal attachment of 3 snuff muscles,
posterior of forearm á DA: base of 1st distal phalanx,
posterior side á A: extends thumb |
HIP AND THIGH
|
Greater Trochanter p.235 |
á Locate the middle of the iliac crest á Slide your fingerpads inferiorly 4-6 inches along
the lateral side of the thigh until you reach the superficial mass of the
greater trochanter. á Explore and sculpt around all sides of its wide
hump. á Medially and laterally rotate the hip as you
palpate the trochanter. á You should feel its wide, knobbly surface swivel
back and forth under your fingers. |
á Located distal to the iliac crest, the greater
trochanter is the large, superficial mass located on the side of the hip. á It is easily palpable and serves as an attachment
site for the gluteus medius, gluteus minimus, and deep rotator muscles. |
|
Adductor Tubercle p.284
|
á Partner supine with knee flexed. Locate the medial epicondyle of the
femur. á Slide superiorly along the medial side of the
femur. As the outline of the
femur drops off into the soft tissue, explore for the small point of the
tubercle. (diagram) á Strum across the adductor magnus tendon by rubbing
your thumbpad anteriorly and posteriorly. á You should be directly proximal to the medial
epicondyle. á With your thumb on the proximal aspect of the
tubercle (on the adductor magnus tendon), have your partner gently adduct his
hip. The tendon of the magnus
should become taut and press into your finger. |
á The adductor tubercle is located proximal to the
medial epicondyle, btwn the belly of the vastus medialis and the hamstring
tendons. á Its small tip sticks out from the top of the medial
epicondyle and is an attachment site for the adductor magnus tendon. á It is often tender to the touch. |
|
Adductor Longus and
Gracilis p.256-258
|
á Supine with the hip slightly flexed and laterally
rotated. Place the flat of your
hand at the middle of the medial thigh.
Ask your partner to adduct his hips slightly. á While your partner contracts, slide your fingers
proximally to the pubic bone and locate the taut, prominent tendon(s) of the
gracilis and adductor longus extending off (or nearby) the pubic tubercle. á Strum your fingertip across this tendon and follow
it distally as it develops into muscle tissue. (diagram) If the muscle belly slowly angles
into the medial thigh, you are palpating adductor longus. If the belly is slender and continues
down the medial thigh toward the knee, you are accessing gracilis. á Hint: you should be btwn the hamstrings and the
quadriceps femoris group. |
á The adductors are located along the medial thigh
btwn the hamstrings and quadriceps femoris muscles. á Their proximal tendons attach at specific locaions
along the base of the pelvis. Together, these tendons forma CT drape that
extends from the superior ramus of the pubis to the ischial tuberosity. á When the thigh is viewed anteriorly, the muscle
bellies of the adductors lie in 3 layers. á Adductor longus is one of the most anterior
muscles. á Gracilis lies superficially on the medial
thigh. It is the only adductor
that crosses the knee. á The superficial tendon of gracilis and/or adductor
longus is prominent extending off of or nearby the pubic tubercle. In some cases, it is a merging of
both tendons. á (activation: Òsqueeze your thighs togetherÓ) ADDUCTOR LONGUS: á PA: anterior pubis á DA: distal to brevis á A: adduction of femur, assist in hip flexion ADDUCTOR GRACILIS á PA: anterior pubis á DA: tibia, proximal, anteromedial á A: (1) adducts at hip; (2) flexes knee; (3) medial
rotation of knee when knee is flexed |
|
Biceps Femoris and
Semitendinosis p.250-252
|
á Prone. Ask your partner to hold his knee in a
flexed position. Explore the
bellies of the hamstrings. á Locate the ischial tuberosity. Slide your fingertips distally 1 inch
and strum across the large, solid tendon of the hamstring and follow
distally. á The lateral half of the hamstring belly is the
biceps femoris. Its belly will
lead toward the head of the fibula.
Palpate on the lateral side of the knee for the long, prominent tendon
of the biceps femoris and follow it toward the head of the fibula. á The medial half of the hamstrings consists of the
layered bellies of the semitendinosus and semimembranosus. Move to the medial side of the knee
and palpate for the tendons of these muscles. (diagram) á The most superficial tendon will be the semitendinosus. Turn your partner supine and follow
it distally as it merges with the pes anserinus tendon. á Hint: the tendons along the back of the knee should
be slender and superficial. á The biceps femoris tendon should lead to the head
of the fibula. You should be
able to follow the semitendinosus as it disappears into the medial knee. |
á The hamstrings are located along the posterior
thigh btwn the vastus lateralis and adductor magnus. á They are not as massive as the quadriceps femoris
group, but they are strong hip extensors and knee flexors. á All 3 have a common origin: the ischial tuberosity. á Biceps femoris is the lateral hamstring á It has 2 heads Ð a superficial long head and a deeper,
indiscernible short head. á (activation: Òbend your kneeÓ or Òextend
your thighÓ) BICEP FEMORIS á PA: á short head: femur, linea aspera á long head: ishcial tuberosity á DA: head of fibula á A: (1) extension, hip joint; (2) flexes knee; (3)
laterally rotates the flexed knee |
|
Gluteus medius p.253-255
|
á Sidelying.
Isolate the shape of the gluteus medius by placing the webbing of one
hand along the iliac crest (from PSIS to nearly the ASIS) while the hand
locates the greater trochanter. á Your hands will form the pie-shaped outline of the
gluteus medius. (diagram) á Palpate in this area from just below the iliac
crest to the greater trochanter for the dense fibers of the gluteus medius. á Sink your fingers deep to the gluteus medius in
order to explore for the density and mass of the gluteus minimus. á Ask your partner to abduct his hip slightly and you
should feel the medius contract. |
á The gluteus medius is located on the outside of the
hip and is also superficial, except for the posterior portion which is deep
to the maximus. á It is a strong extensor and abductor of the hip. á It has convergent fibers that pull the femur in
multiple directions. As such, it
is often thought of as the Òdeltoid
muscle of the coxal jointÓ. á (activation: Òabduct your hipÓ) á PA: ilium, external surface, anterior ¾ á DA: greater trochanter, lateral surface á A: hip abduction á (DA fixed): stabilizes pelvis during single limb
stance (main function) á Anterior fibers: medially rotate á Posterior fibers: laterally rotate |
|
Piriformis p.264-265
|
á Prone.
Locate the coccyx, PSIS, and greater trochanter. Together, these landmarks form a ÒTÓ. á The piriformis is located along the base of the ÒTÓ. (diagram) á Place your fingers along this line. Working through the thick gluteus
maximus, roll your fingers across the belly of the slender piriformis. á Strum across the belly to clarify its location,
staying mindful of the deeper sciatic nerve. (diagram) á Hint: with your fingers on the piriformis, bend the
knee to 90 degrees and ask your partner to rotate his hip laterally against
your gentle resistance. (diagram)
You may feel gluteus maximus contract, but also piriformis beneath it. |
á Located deep to the gluteus maximus and creates
lateral rotation of the hip. á Attaches to aspects of the greater trochanter and
fan medially to attach to the sacrum and pelvis. á Unlike the other lateral hip rotators, piriformis
lies superficial to the large sciatic nerve. And if, overcontracted, can
compress it. á One of the more discernible rotators. á Reptiles have very powerful piriformis, used for
extending the femur while running. á (activation: Òlaterally rotate your hipÓ) á PA: anterior sacrum á DA: greater trochanter á A: lateral rotation at the hip |
|
Rectus Femoris p. 246-248
|
á Supine with knee bolstered. Locate the AIIS and the patella. á Draw an imaginary line btwn these 2 points and
follow the path of the rectus femoris. á Palpate along this line and strum across the rectus
fibers. (It will be 2-3 fingers wide.) á Ask your partner to flex his hip and hold his foot
up off the table. (diagram) This position contracts the rectus femoris,
making it more pronounced. á Hint: you should be on the anterior surface of the
thigh. |
á The cylindrical, superficial rectus femoris is
located on the anterior thigh and is the only quadriceps that crosses 2 joints
Ð the hip and the knee. á It primarily extends the knee. á All 4 quadriceps muscles converge into a single
tendon above the knee. The
tendon connects to the top and sides of the patella before attaching to the
tibial tuberosity. á (activation: Òstraighten your kneeÓ or Òflex
your hipÓ) á PA: AIIS, superior acetabular rim á DA: tibial tuberosity via the patella á A: flexes hip, extends knee |
|
Vastus Medialis p.246-249
|
á Supine with knee bolstered. Ask your partner to fully contract
his quadriceps by extending his knee.
Palpate just medial and proximal to the patella for thebulbous shape
of the medialis. á Locate the rectus femoris and sartorius, noting how
these muscles surround the medialis to form its long Òtear dropÓ
shape. á Hint: you should be medial to the rectus femoris. á You should be able to make out the round shape of
the vastus medialis and follow its fibers to the patella. |
á Same as above. á Aka Vastus Medialis Obliqus á The palpable aspect of vastus medialis forms a Òtear dropÓ shape
at the distal portion of the medial thigh. á Upon full extension of the knee, vastus medialis
extends further distally than the vastus lateralis b/c of the tracking of the
patella. The angle of the femur, combined with the pull of the quadriceps,
causes the patella to track laterally.
This is prevented in 2 ways: (1) the edge of the lateral condyle of
the femur is elevated, forming a lateral wall, and (2) the distal fibers of
vastus medialis are set at an angle, pulling the patella medially. (diagram) á PA: medial lip of linea aspera á DA: tibial tuberosity via the patella á A: extends knee |
|
Tensor Fasciae Latae p.260
|
á Supine.
Locate the ASIS. Place
the flat of your hand posterior and distal to the ASIS and iliac crest. á Ask your partner to alternate medial rotation with
relaxatio of the hip. Upon
medial rotation, the TFL will contract into a solid, oval mound beneath your
hand. (diagram) á Palpate its vertical fibers, outline its width, and
follow it distally until the TFL blends into the iliotibial tract. á Hint: you should be posterior and distal to the
anterior iliac crest. á If you ask your partner to rotate the hip
laterally, the TFL should not contract. |
á The tensor fasciae latae is a small, superficial
muscle located on the lateral side of the upper thigh. á It is aprox. 3 fingers wide, and is easily accessed
btwn the upper fibers of the rectus femoris and the gluteus medius. á It attaches to the iliotibial band along with
gluteus maximus. á (activation: Òmedially rotate your hipÓ) á PA: ASIS, external surface á DA: lateral tubercle of tibia via IT band á A: (hip): medial rotation, flexion, abduction á (knee): may assist in extension of the knee |
|
Iliotibial band p.260-261
|
á Sidelying.
Locate the biceps femoris tendon just proximal to the back of the
knee. á Slide anteriorly from the biceps femoris tendon to
the lateral thigh. Roll your
fingers horizontally across the fibers of the iliotibial tract and explore
for its tough, superficial quality.
Its most distal aspect may feel similar in size and shape to the
biceps femoris tendon. á Follow it distally as it disappears toward the
tibial tubercle. Explore
proximally and note how it becomes broader and thinner as it progresses up
the thigh. Feel the tension of
the iliotibial tract change by asking your partner to alternately abduct and
relax his hip. (diagram) á Hint: the fibers should feel superficial and stingy
compared to the deeper, fleshier vastus lateralis fibers. á The fibers should run vertically down the thigh and
converge into a thin, cablelike tendon at the tibial tubercle. |
á The iliotibial tract is a superficial sheet of
fascia with vertical fibers that runs along the lateral thigh. á It emerges from the gluteal fascia, is wide and
dense over the vastus lateralis muscle and funnels into a strong cable along
the side of the knee before inserting at the tibial tubercle. (diagram) á TFL fibers and some fibers of gluteus maximus
attach to the proximal aspect of the IT band. á The iliotibial tract has a thick, matted texture
(similar to packing tape) that makes it a strong stabilizing component of
hipand knee. á It is entierly accessible. The distal cable portion, anterior to
the biceps femoris tendon, is the easiest part of the iliotibial tract to
isolate. á (activation: Òabduct your hipÓ) |
LEG AND FOOT
|
Peroneal Tubercle
p.288-289 |
á Supine or seated. With the ankle in dorsiflexed position, locate the lateral
malleolus. á Slide roughly an inch inferiorly and explore for
the small, superficial tubercle.
It may feel like a short ridge on the surface of the calcaneus.
(diagram) Passively everting the
foot will soften the surrounding tissues. á Sculpt around its edges, noting the soft tissues
just distal to the tubercle. á Hint:
you should be distal to the lateral malleolus. á If you slide off the tubercle distally, you should
feel the thick tissues of the foot. á Ask you partner to alternately evert and relax her
foot. The peroneal tendons
should pass along either side of the tubercle. |
á The peroneal tubercle is located on the lateral
side of the foot. á Roughly an inch distal to the lateral malleolus,
the tubercle is a small, superficial prominence that protrudes from the
calcaneal surface to help stabilize the peroneal muscles. (diagram) |
|
Navicular Tubercle p.294
|
á Partner seated or supine. Locate the base of the first metatarsal. á Sliding along the footÕs medial side, move proximally across the surface
of the medial cuneiform and the slender joint btwn the medial cuneiform and
the navicular. á As you move onto the surface of the navicular,
explore the shape and size of the navicular tuberosity. (diagram) á The tuberosity will lie aprox. 1-2 inches distal to
the medial malleolus. á Hint: the navicular bone should project more
medially than the surfaces of the other bones on the medial foot. á If you place a finger on the tuberosity of the 5th
metatarsal and the navicular tuberosity simultaneously, the metatarsal
tuberosity should lie slightly distal to the navicular tuberosity. (diagram) |
á (The bean-shaped navicular is sandwiched btwn the
medial and middle cuneiforms and the calcaneus. Its dorsal and medial surfaces are superficial and
palpable.) á The superficial navicular tubercle bulges out of
the medial side of the foot and is an attachment site for the tibialis
posterior muscle and the spring ligament. (diagram) |
|
Sustentaculum Tali p.288
|
á Supine or seated. Place the ankle in a neutral position and locate the
medial malleolus. á Slide aprox. 1 inch distal to the small tip of the
sustentaculum. (diagram) á Passively inverting the foot will soften the
surrounding tissues. á Sculpt around its sides noting the soft tissues
just distal to it. á Hint: you should be distal to the medial
malleolus. If you slide distally
off the sustentaculum tali, you should feel the thick tissues at the sole of
the foot. |
á The sustentaculum tali is located on the medial
side of the calcaneus, roughly 1 inch distal to the medial malleolus.
(diagram) á Shaped like a plank, the sustentaculum supports the
talus on the calcaneus. á It is also an attachment site for the deltoid
ligament and is deep to the flexor tendons. á Only its small tip is accessible. |
|
Head of Fibula p.282
|
á Partner seated with knee flexed. Locate the tibial tuberosity. (See frame below.) á Slide you fingers laterally 3-4 inches toward the
outside of the leg. Palpate for
the head of the fibula. (diagram) á Explore its inch wide tip. á Hint: the knob you are palpating should be lateral
to the tibial tuberosity. You
can scuplt a circle around it to outline its shape. á The biceps femoris tendon will lead you to the head
of the fibula. á Alternatively: partner prone, bend the knee to 90
degrees and follow the biceps femoris tendon distally to where it inserts
into the head of the fibula. |
á The head of the fibula is located on the lateral
side of the leg and sometimes protrudes visibly. á It is the attachment site for the biceps femoris
muscle and a portion of the soleus muscle as well as the lateral collateral
ligament. |
|
Tibial Tuberosity p.281 (re:
head of fibula)
|
á Partner seated with knee flexed. Locate the patella. á Slide your fingers 3-4 inches inferiorly from the
patella and using your thumbpad, explore for the tuberosity (diagram) á Hint: with your finger at the tibial tuberosity,
ask you partner to extend his knees slightly. With this action, the patellar ligament will tighten, and
you will be able to feel where it attaches to the tibial tuberosity. |
á |
|
Tibialis Posterior
p.307-308
|
á Supine, prone, or sidelying. Locate the medial malleolus. Slide off the malleolus posteriorly
and proximally into the space btwn the posterior shaft of the tibia and the
calcaneal tendon. á Explore this region for the distal bellies and
tendons of these muscles. (diagram)
Follow the tendons distally around the back of the medial malleolus. á It is difficult to isolate specific tendons;
however, tibialis posterior will be the most anterior. Have your partner invert his foot as
you follow this tendon around the ankle to the underside of the foot. á Hint: place your fingers on the distal bellies and
ask your partner to slowly wiggle all his toes. You should be able to feel the muscles or tendons shift. á You should be able to locate the malleolar groove
and feel the tendons in and posterior to it. á You may be able to locate the pulse of the tibial
artery. á TD anÕ H =
Tom, Dick anÕ, Harry corresponds to the
initials of the tendons and vessels in the order that they pass by the medial
malleolus: á Tibialis posterior (the most anterior) á Flexor Digitorum longus á The tibial Artery á Tibial Nerve á Flexor Hallucis longus |
á Buried deep to the gastrocnemius and soleus on the
posterior leg. á Responsible for inverting the foot and flexing the
toes. (along with flexor digitorum longus and flexor hallucis longus) á Virtually inaccessible except at the small gap btwn
the tibial shaft and the edge of the soleus/calcaneus tendon where the most
distal fibers and tendons of the flexors can be palpated directly. (diagram) á The tendon curves around the medial malleolus and
passes deep to the flexor retinaculum. á The tibial artery and tibial nerve are situated
btwn the tendons at the medial ankle. á (activation: Òplant and invert your footÓ) á PA: tibia, fibula á DA: navicular tuberosity and surrounding bones á A: (main): to slow down pronation after heel
contacts ground during gait; (2) plantar flexion; (3) inversion |
|
Peroneus Longus and Brevis
p.302-303
|
á Supine, prone, or sidelying. Place a finger at the head of the
fibula and the lateral malleolus. The peroneal bellies are located btwn these
2 landmarks. (diagram) á Lay your fingers btwn these landmarks and ask your
partner to alternately evert and relax your foot. Feel the peroneals tighten upon eversion. This action will sometimes create a
visible dimple of depression along the side of the leg. (diagram) á As your partner continues to evert and relax her
foot, follow the peroneus longus
proximally toward the head of the fibula. Now follow both muscles distally to where their tendons
wrap around the back of the lateral malleolus. á Follow the peroneus brevis tendon to the base of the 5th
metatarsal. (dragram) á Hint: you should be on the lateral side of the leg
btwn the head of the fibula and the lateral malleolus. á You may be able to differentiate the slender
peroneals from the lateral edge of the larger gastrocnemius and soleus. á You may be able to feel the tendon of the brevis
attach to the base of the 5th metatarsal. |
á The slender peroneal muscles are located on the
lateral side of the fibula. (diagram)
More specifically, they lie btwn the extensor digitorum longus and the
soleus. á A portion of the peroneus brevis lies deep to the
peroneus longus, yet both are accessible. á Their distal tendons are superficial and palpable
behind the lateral malleolus and along the side of the heel. á (activation: Òevert your footÓ) PERONEUS LONGUS: á PA: fibula, lateral, proximal including head á DA: 1st metatarsal, lateral surface; 1st
cuneiform, lateral surface á A: plantar flexion; eversion PERONEUS BREVIS: á PA: fibula, lateral, distal á DA: 5th MT, styloid process, proximal to
peroneus tertius á A: plantar flexion; eversion |
|
Tibialis anterior
p.304-305
|
á Supine.
Locate the shaft of the tibia and slide off it laterally onto the
tibialis anterior. á Ask your partner to dorsiflex (or invert) his foot
and palpate its long, inch-wide belly. (diagram) á With the foot dorsiflexed, palpate the muscle
distally as it becomes a thick, tendinous cord. Follow it to the medial side of the foot as it disappears
at the medial cuneiform. á Hint: as your partner alternately dorsiflexes and
relaxes his ankle, you may feel the tendon cross the top of the ankle. á Ask your partner to invert his foot and note
whether the tibialis anterior is involved. You may able to feel where the tendon passes under the
extensor retinaculum. |
á Located on the anterior aspect of the leg btwn the
shaft of the tibia and the peroneal muscles. á The tendon crosses beneath the extensor retinaculum
at the ankle. á The tibialis anterior is large and superficial and
the most clearly isolated of the group.
It lies directly lateral to the tibial shaft. á (activation: Òbring your foot/toes toward your kneeÓ) á PA: tibia, proximal, lateral á DA: 1st MT, base, medial surface; 1st
cuneiform, medial, plantar surface. á A: dorsiflexion (talocrural joint); inversion
(subtalor joint) |
|
Gastrocnemius p.297-299
|
á Ask your partner, supported by a chair, to stand on
her toes. á Palpate the posterior leg, sculpting out the gastrocnemiusÕ oval heads.
Follow both heads proximally to the back of the knee. Then follow them distally, noting how
the medial head extends further distal than the lateral head. (diagram) á Move distal to the gastrocnemius and palpate the
distal portion of soleus. Also explore the medial and lateral
sides of the soleus that bulge out from the gastrocnemius. á Follow both muscles distally as they blend into the
calcaneal tendon. á Hint: you can follow the gastrocnemius heads
proximally btwn the hamstring tendons.
á The medial gastroc head is slightly longer than the
lateral head. You may be able to
feel the difference in texture btwn the fleshy muscle bellies and the tough,
dense calcaneal tendon. (diagram) á AlternativelyÉ á Prone.
Bend the knee to 90 degrees and investigate the soft, massive bellies
of the gastrocnemius and soleus and the thick calcaneal tendon. á When the knee is flexed, the gastoc muscles is
shortened and ineffectual as a plantar flexor. Isolate the soleus by asking your partner to gently
plantar flex against your resistance. á Notice how the thick soleus contracts while the
thin, superficial bellies of the gastrocs remain flaccid. (diagram) á AlternativelyÉ. á From an anterior angle, with your partner standing,
locate the tibial shaft. á Slide medially off the shaft and feel the wad of
muscle that bulges along the medial side of the leg. (diagram) This tissue is the triceps surae. á Ask your partner to lie supine and with the tissue
relaxed, note how your thumb can sink around the medial edge of the tibial
shaft to specifically locate the soleus. |
á The large muscle mass of the posterior leg is
composed of the gastrocnemius and the soleus muscle. á Together, they form the Òtriceps suraeÓ that attaches to the strong calcaneal tendon. á Both muscles are easily accessible. á The superficial gastrocnemius has 2 heads and crosses 2 joints Ð the knee and ankle. Emerging from btwn the hamstrings tendons, the short
gastrocnemius heads extend halfway down the leg before blending into the
calcaneal tendon. It is also
quite thin when compared to the thick soleus. á The soleus is deep to the gastrocnemius, yet its medial and lateral fibers bulge
from the sides of the leg and extend further distal than the gastrocnemius
heads. The soleus is sometimes
called the Òsecondary heartÓ b/c of the important role its strong contractions
play in returning blood form the leg to the heart. á (activation for gastrocnemius: Òflex your kneeÓ or Òstep
down on the ball of your footÓ) á (activation for soleus: Òstep down on the ball of your footÓ) á PA: femoral condyles á DA: calcaneus á A: knee flexion (weak); plantar flexion (talocrural
joint) |
SPINE AND THORAX
|
Longissimus p.170-171
|
á Partner prone. Lay both hands along either side of the lumbar
vertebrae. Locate the region of
the lower erectors by asking your partner to alternately raise and lower his
feet slightly. The erectors do
not, of course, raise the feet, but they will contract in order to stabilize
the pelvis. Notice how the
strong, rounded erector fibers tighten and relax with this action. (diagram) á As your partner maintains this contraction, palpate
inferiorly onto the sacrum and then superiorly along the thoracic
vertebrae. Ask your partner to
extend his spine and neck slightly in order to contract the erectors in the
thoracic region. (diagram) á Follow the ropy fibers of the erectors btwn the
scapulae and along the back of the neck. These fibers are smallest in the cervical region and are
primarily situated lateral to the lamina groove. á With your partner relaxed, sink your fingers into
the erector fibers, feeling their ropy texture and vertical direction. á Hint: the fibers should run parallel to the spine. á SEE DIAGRAM 4.50 pg.171 |
á Part of the erector spinae group of muscles which
runs from the sacrum to the occiput along the posterior aspect of the
vertebral column. á The thick longissimus and lateral iliocostalis form
a visible mound alongside the lumbar and thoracic spine. á In the lumbar region, the erectors lie deep to the
thin but dense thoracolumbar aponeurosis. á In the thoracic and cervical areas, they are deep
to the trapezius, the rhomboids, and the serratus posterior superior and
inferior. á The upper fibers of longissimus (cervicis and capitis) assist in
lateral flexion and rotation of the neck and head. á (activation: Òextend your spineÓ or Òraise
your feet slightlyÓ) á forms the middle colum á is the longest of the erector spinae muscles á likely to palpate on TVP á 3 parts: thoracis, cervicis, capitis á (the superior attachment of capitis is the mastoid
process) á A: (bilateral): (1) extension á (unilateral): (2) lateral flexion of spine
(involves some rotation) (3)
eccentric contraction (lenghtening) while slowing flexion of the trunk. |
|
Multifidi p.173-174
|
á Partner prone. Locate the spinous processes of the lumbar vertebrae. Slide your fingers laterally off the
spinous processes, sinking btwn them and the erector spinae fibers. á Pushing the erectors laterally out of the way,
explore deeply for the dense, diagonal fibers of the multifidi.
(diagram) Progress inferiorly to
the sacrum, rolling your fingers in a perpendicular direction to the
multifidi fibers. á Move superiorly, exploring the lamina groove of the
thoracic and cervical areas.
Then turn your partner supine and palpate the cervical region. á Hint: you should be bwtn the spinous and transverse
processes. You can get a sense
of these smaller, deeper fibers that stretch at an oblique angle. |
á Multifidi is part of the transversospinalis muscle
group. á It extends the length of the vertebral column and
consists of many short, diagonal fibers. á These fibers form an intricate stitch-like design
that links the vertebrae together. á These muscle fibers extend at varying lengths from
the transverse and spinous processes of the vertebrae. á The surprisingly thick multifidi are directly
accessible in the lumbar spine.
They are the only muscles with fibers that lie across the posterior
surface of the sacrum. á It can be difficult to isolate the individual
bellies of the transversospinalis muscles as they are closely interwoven;
however, as a group, their mass or density can be easily felt along the
lamina groove of the thoracic and lumbar vertebrae. á (activation: Òextend and/or rotate your spineÓ) á as a group, goes from sacrum to T2 á multifidi crosses 1-4 vertebrae á best developed in the lumbar region á A: conventional action: contralateral rotation |
|
Splenius Capitus p.175-176
|
á Prone.
Locate the upper fibers of the trapezius. á Isolate the lateral edge of the trapezius by having
your partner extend his head slightly. á Ask your partner to relax. Palpate just lateral to the trapezius
for the splenius capitisÕ oblique
fibers, following them up to the mastoid process and inferiorly through the
trapezius. á Hint: the fibers should lead toward the mastoid
process. á You can distinguish the fibers of splenius capitis
by asking your partner to rotate his head slightly toward the side you are
palpating. You can feel these oblique fibers contract while the trapezius
remains passive. á AlternativelyÉ á Locate the mastoid process and slide medially and
inferiorly onto the superficial capitis fibers. |
á The long splenius capitis muscle is located along
the upper back and posterior neck. (diagram) á In contrast to the other neck muscles that run
parallel to the spine the splenii fibers run obliquely. á The splenius capitis is deep to the trapezius and
rhomboids. á Its fibers angle toward the mastoid process and are
superficial btwn the trapezius and sternocleidomastoid. (diagram) á (activation: Òrotate your headÓ to the same side being palpated) á IA: C4-T2 á SA: mastoid process of temporal bone; lateral half
of superior nuchal line of occiput á A: (1) ipsilateral rotation of head (unilateral);
(2) á (bilateral) extension of head and neck |
Anatomy:
Palpation List Term2 1
HEAD,
NECK, FACE 1
SHOULDER
AND ARM 8
FOREARM
AND HAND 17
HIP
AND THIGH 23
LEG
AND FOOT 30
SPINE AND THORAX 36