Palpations Flashcards
(36 cards)
What is a great tip to use to palpate the iliac crest (It involves asking the patient to do something)?
Ask your partner to put their hands on their hips, and replace their hands with yours.
(ASIS/PSIS): Maintaining contact with the pelvis, follow the iliac crest anteriorly and inferiorly to where it terminates at the ASIS. Be sure you’re on the same spot on both ASISs. [Pro tip: Hook your thumbs just under the ASISs, as if trying to lift them with your thumbs, to be sure you’re on the same part of the bony landmark on both sides.]
ASIS
(ASIS/PSIS): Start again on the iliac crests. Now, maintaining contact with the pelvis with relatively firm pressure so you don’t lose your place, follow them posteriorly to their termination at the PSIS. You can look for the dimples of the PSIS if that helps, but you should get comfortable with trusting your hands more than your eyes.
PSIS
S2 spinous process: Bisect an imaginary line between the (AIIS/PSIS)s; there, the spinous process of S2 can be palpated.
PSIS
L4-5 intervertebral space: With your hands on the (AIIS’S/iliac crests), extend your thumbs while staying in the transverse plane, towards midline. You will land in the space between the L4 and L5 spinous processes. Palpate L5 spinous process and the base of the sacrum to confirm you are at the right location.
Iliac crests
Sacrum: starting in the lumbar erector spinae, apply pressure and slide your fingers (superiorly/inferiorly) until you come to a bony stop. This should be the base of the sacrum stopping you. Palpate along the base of the sacrum to midline and find the space between L5-S1 and the L5 spinous process to confirm.
inferiorly
(Ischial tuberosity/Greater trochanter): identify the gluteal fold bilaterally. From the midpoint of the gluteal fold, approaching palpation from the lateral side of the thigh, palpate deeply and superiorly to identify the ischial tuberosity.
Got it
(Ischial tuberosity/Greater Trochanter): starting at the superior point of the greater trochanter, maintain contact on the gluteal muscles and palpate inferiorly, staying in the frontal plane. The ischial tuberosity will be the next bony landmark, localized to the inferior surface of the pelvis. Or, draw an imaginary line between the greater trochanter and the PSIS, and bisect it. Follow that midpoint down the gluteal muscles to the inferior aspect of the hip, and the ischial tuberosity is the bony landmark there. [Pro tip: maintain contact as you palpate in this sensitive area so that the patient knows where you are and so that you know where you are.]
Ischial tuberosity
(Ischial Tuberosity/Greater trochanter): starting from the iliac crests, stay in the frontal plane and move inferiorly into the soft tissue off the iliac crest. The next bony stop you should find is the superior aspect of the greater trochanter. To confirm, passively ER/IR the hip to feel the greater trochanter moving under your hand. [Pro tip: use the palm of your hand along the lateral hip as you ER/IR the hip if you’re having trouble finding the greater tuberosity – give yourself more surface area to find it.]
Greater trochanter
(Ischial Tuberosity/Greater trochanter): can be found as described earlier, just in the sidelying position. Often, the greater trochanter can be found at the apex of the curve of the hip when a person lays sidelying, so you can place your hand on top of the hip and ER/IR the hip to confirm.
Greater trochanter
Erector spinae: typically visible muscle mass along the spine. Palpate the lumbar erector spinae to detect tone, atrophy, and pain.
In (supine/prone) have the patient lift their arms, chest, and head off of the table as the therapists palpates the lumbar region and mid-thoracic region. You can feel the muscles on either side of the spinous processes tighten.
prone
Surface where the lumbar (erector spinae/multifidi) lie: start at the lumbar spinous processes and move off just laterally – if you’re in the middle of the mass of the erector spinae, you’ve gone too far. Use a few fingertips, and don’t use too much pressure or you might miss it. Have your partner raise their ipsilateral arm into HABD and palpate for the multifidi to swell up into your fingers. If you don’t feel it right away, gently resist that HABD to try to make it more palpable.
multifidi
(Rectus abdominis/external oblique): find the umbilicus and palpate just to the side of it. Feel free to palpate along the expanse of the rectus abdominis, taking care if you need to palpate so inferiorly that you’re approaching the insertion on the pubic bone. To have your partner activate the rectus abdominis, you can ask them to lift their head (head only, not a crunch), cough, or laugh.
Rectus abdominis
(Rectus abdominis/External obliques/surface where internal obliques lie): lateral to the semilunar line, the external obliques are palpable; the internal obliques are obviously deep to them. As your partner to flex and rotate their trunk in a desired direction and determine if they’re using the external or the internal obliques where you are palpating.
External obliques/surface where internal obliques lie
(Surface where the internal obliques lie/Surface where the transverse abdominis lies): palpate just medial to the ASIS. Cue your partner to engage by asking them to draw in their belly button without flattening or arching their spine. You can cue them to try to dissociate the TA from the global abs by holding this drawn in maneuver while trying to breathe in and out. You can also ask them to perform a pelvic floor (Kegel) contraction to strengthen the TA activation.
Surface where the transverse abdominis lies
To palpate the pubic symphysis, have the patient start (above/below) their umbilicus and tell them to climb down until they find the first bony prominence. The therapist can now use their hand to go over this structure to assess for mobility and tenderness.
below
To palpate the L1-L5 (spinous/transverse) processes, have the patient fold their arms and flex forward to feel each individual spinous process. You can have them extend as well to feel the segments.
spinous
To palpate the lumbar spine (spinous/transverse) processes, first locate the lumbar spine spinous processes. Use your thumbs on either side of the spinous processes. Have the patient cross their arms and laterally flex or rotate to feel these processes.
transverse
(Pubic bone and pubic tubercle/pubic symphysis): Show the pt a pelvis to let them know where you’re going to palpate. Instruct them to find the bone for you first, by pushing their hands gently into their abdomen starting below their belly button. Once they find the superior pubic ramus, you can replace their hands with yours and palpate along the superior surface of the superior pubic ramus. Use a pisiform grip to palpate, or use the radial border of your thumb so that your fingers stay directed superiorly. The pubic tubercle a prominence found at the most superior lateral aspect of the superior pubic ramus.
Pubic bone and pubic tubercle
(Pubic bone and pubic tubercle/Pubic symphysis): Follow the superior pubic rami medially to where they meet at the pubic symphysis. The symphysis is typically palpable as a depression/indentation at midline.
Pubic symphysis
(Tibia/Patella): Typically visible at the anterior knee; follow the quad down distally to where it meets with the superior pole of the patella if you’re not sure. Palpate the medial and lateral edges and the superior and inferior poles.
Patella
Medial and lateral femoral (condyles/epicondyles): With the knee extended, the medial and lateral femoral epicondyles can be identified by starting at the medial or lateral border of the patella and moving directly posteriorly, staying in the same transverse plane. The medial and lateral femoral epicondyles will be the most prominent bony landmarks in that area.
epicondyles
Medial and lateral femoral (condyles/epicondyles): With the knee flexed, start at the fibular head (for lateral) and medial tibia (for medial). Visualize the path of the collateral ligaments from their distal insertions, and follow them proximally to the respective epicondyle.
epicondyles
(Patella/Patella tendon): From the inferior pole of the patella, palpate the soft tissue immediately inferior to it and follow it to the tibial tuberosity. With the knee flexed, the patella tendon should be taut, and more firm, than the surrounding patella fat pad.
Patella tendon
