palpations Flashcards
(103 cards)
1
Q
Tragus
A
- Flap of skin just anterior to the external auditory meatus
* Anterior to the EAM
2
Q
Zygomatic arch
A
- Anterior to ear canal, merges with the orbit
- -Formed by temporal and zygomatic bones
3
Q
Movement of the Mandibular Condyle
A
- Place fingers just in front of ear and anterior to mastoid process
- Have partner perform different motions to feel
- -Open / Close
- -Deviate right / left
- -Protrude / Retract
- Also feel with little fingers inside the ear or listen with a sthethescope
4
Q
Temporalis
A
- Place fingers 1 inch superior to zygomatic arch
- Have partner clench/relax their jaw
- Move fingers around and try to outline it
5
Q
Masseter
A
- Place fingers between zygomatic arch and angle of mandible
* Have your partner clench/relax their jaw
6
Q
Digastric
A
- Place fingertips along the underside of the mandible
* Have partner place tip of tongue firmly against roof of the mouth
7
Q
Superficial Temporal Artery
A
*Palpate anterior to the ear and superior to the zygomatic arch
8
Q
Facial Artery
A
*Locate masseter’s anterior border, place fingers next to the base of the mandible and feel for the artery
9
Q
Platysma
A
- Felt of lateral sides of the neck.
* Ask partner to grimace (depress lower lip and angle of mounth)
10
Q
Iliac Crest
A
- Most superior aspect of the pelvis
* Lay hands flat along the most superior aspect to check for symmetry
11
Q
Iliac Tubercle
A
- 3 iches from top of crest
* Widest point of the crest
12
Q
ASIS
A
- Move anterior until you feel the bump
- Drop off and hook under and check for symmetry
- Sartorius and TFL originate here
13
Q
AIIS
A
- Inferior and slightly medial to ASIS
- Rectus Femoris originates here
- Ask patient to initiate hip flexion with knee extension.
14
Q
Pubic Tubercle
A
- Superior bony aspect of the pubic symphysis
- Two approaches
- -Start with palmar contact, fingers towards belly button and slide down until it bumps against the tubercles and replace your palm with index fingers
- -Have patient find and then replace with your fingers
- -Check for symmetry
15
Q
Rubic Rami
A
*Laterally from the tubercle
16
Q
PSIS
A
- Directly under the dimple on the posterior aspect of the spine just above the buttocks.
- Check for symmetry and movement
- -Bending forward
17
Q
SI joint
A
- Just medial to PSIS (Not “Entire Joint”)
* Common location of pain for patients with SI joint dysfunction
18
Q
Spinous Process of S2
A
Between PSIS’s
19
Q
Sacral Sulcus
A
- “Dip” between the S2 spinous process and the PSIS
- Check the depth comparing sides
- -Could give you an idea of any sacral torsions
20
Q
Inferior Lateral Angle (ILA)
A
- Angle formed at the inferior apex of the sacrum proximal and lateral to the coccyx
- -Can assist in revealing a rotation of the sacrum
- -Used as a manipulation contact for mobilization of the ILA joint
21
Q
Ischial Tuberosity
A
- Level of the gluteal fold
- Palm up, move up until ischial tuberosity rests between the thenar/hypothenar eminences
- Replace with the fingers
- Pain here could be ischial bursitis or possible hamstring strain
*Can also try in side lying and bending hip into flexion
22
Q
Greater Trochanter
A
- Most prominent lateral aspect of the femur
- Common source of pain due to trochanteric bursa
- -Just posterior to the most lateral aspect
- Used as landmark to clinically check for hip anteversion or retroversion
23
Q
Lesser Trochanter
A
- Located in proximal medial thigh, difficult to palpate.
* With patient in relaxed and supported hip flexion/external rotation, press down against femur.
24
Q
Psoas
A
- Pt hooklying or in supported 90/90 position
- 2 inches lateral and then two inches inferior to umbilicus
- -Lateral to rectus
- Must go deep (breathe), ask patient to initiate hip flexion to feel it contract
25
Iliacus
* Palpate medial to ASIS and deep
* As patient breathes out attempt to go deeper and press in and laterally
* Ask patient to attempt to flex hip to feel contract
* Use a pad touch and not a tip touch bc tip touch will hurt more
26
Iliopsoas and Pectineus
* Palpate over anterior hip ~1.5 inches below the center of the inguinal ligament.
* Ask patient to attempt to flex hip
* Iliopsoas will be lateral, pectineus medial
27
Hamstrings
* To palpate their common origins, have patient lay on side and bring knee up to chest.
- -Tenderness could be direct damage to hamstrings or ischial bursitis
* Have patient lay prone and resist knee flexion and palpate along medial and lateral hamstring tendons/muscles.
* Trace down the muscle and distinguish between the different insertions distally at the knee joint.
28
Sartorius
* Palpate ASIS in supine, externally rotate the hip slightly and resist flexion.
- A “V” is formed
- -TFL laterally
- -Sartorius medially
- -Space between and distally is rectus femoris
*Work you way down the lateral thigh/leg to knee palpating and attempting to “bend” ITB.
29
Gluteus Medius/Minimus
* In side lying or standing, palpate below iliac crest asking the patient to perform 1st few degrees of abduction.
* Palpate down towards greater trochanter.
*Minimus is deep to medius and originates distally.
30
Gluteus Maximus
* Most posterior and superficial glut muscle
| * Resist hip extension with knee bent to feel it contract.
31
Piriformis
* Palpate deep to gluteus maximus.
* One finger on the sacrum just inferior to PSIS and the other on the uppermost aspect of the greater trochanter marks the line of pull. Work deep and run fingers perpendicular to the fibers to feel.
- -Two different functions depending on amount of hip flexion
- -Try to find the superior and inferior borders
32
Sciatic Nerve
* Prone
- -Approximately half way to a third the distance of the piriformis and distal/deep to that
* Sidelying with hip flexed
- -midway between greater trochanter and ischial tuberosity
33
Femoral Triangle Surface Palpation
```
Superior Border
--Inguinal ligament
Lateral Border
--Sartorius
Medial Border
--Adductor longus
Floor
-Medial
---Pectineus
---Adductor longus
-Lateral
---Iliopsoas
```
34
Hip Flexion
* Patient supine with knees extended and no hip abduction/adduction and rotation.
* Keep contralateral LE flat
- -Provides additional stabilization
- -Also use hand to prevent posterior tilting of pelvis
* As patient flexes hip allow knee to bend
- -Reduces hamstring tension.
* When ROM is complete, move hand stabilizing pelvis to hold/position proximal arm
35
Hip Abduction
* Patient supine with knees extended and hips in neutral abd/adduction and rotation.
- -Starting position is 90° on the goniometer
* Position patient to opposite end of table of leg being tested
- -Lets the table support the moving leg.
36
Hip Adduction
* Patient supine with knees extended and hips in neutral abd/adduction and rotation.
- -Starting position is 90°
* Position contralateral extremity in abduction.
- -Provides sufficient space to complete full adduction ROM.
37
Hip Extension
* Patient prone with both knees extended and neutral abd/adduction and rotation
* Stabilize pelvis with one hand while patient extends hip raising it from the table
- -Keep contralateral extremity flat on table.
* Keep knee in extension
- -Reduce tension on rectus femoris.
* At end ROM the therapist can use distal hand to support the femur and keep distal goniometer arm in alignment.
38
Hip IR
* Patient sitting with knees flexed to 90° over a supported surface
* Place hip in 0° abd/adduction and in 90° of flexion.
- -Towel roll under distal end of femur.
* Stabilize distal end of femur
- Prevents compensations
- -Abd/adduction
- -Flexion
- -Lateral tilting of pelvis
39
Hip ER
* Patient sitting with tested knee at 90° and contralateral knee flexed beyond 90°
- -Allows hip being measured to complete full ROM
* Place hip in 0° abd/adduction and in 90° of flexion.
- -Towel roll under distal end of femur.
* Stabilize distal end of femur
- Prevents compensations
- -Abd/adduction
- -Flexion
- -Lateral tilting of pelvis
40
Thomas Test
* Patient supine, whole body on table
- -Ask patient to bring their knee to chest (non-tested leg)
- -Some hold it tight to stomach
- -Some pull just prior to a posterior pelvic tilt
* Can assist the patient by holding the knee toward chest to maintain a flat back
* Thigh should be down in contact with table
*To quantify the muscle length use same landmarks as measuring hip flexion/extension
41
Modified Thomas Test
* Patient resting against end of table with glutes against edge then lay down with resting leg off table
* May need to straighten knee to reduce tightness of rectus – 80 deg of flexion considered normal
42
Ober Test
* Patient side lying with hip and knee both flexed to 90 deg
* While stabilizing the pelvis with contact on the iliac crest, passively abduct slightly and extend the hip to neutral keeping the knee at 90 deg.
* With the hip in neutral, drop the leg slowly into adduction (bring it toward table).
- -Don’t allow hip to flex
- -Don’t allow pelvis to laterally tilt
- -Don’t allow hip to internally rotate
* 10 deg of adduction is considered normal length
* Can be “Modified” by keeping the knee straight, ~23 deg being normal with the modification
*To quantify the muscle length use same landmarks as measuring hip abduction/adduction
43
Patella (supine or long sitting)
* Trace all edges
* Move the patella medial, lateral, superior, and inferior
- -When lateral, attempt to palpate the lateral facet
- -When medial, attempt to palpate the medial/odd facet (smaller than lateral)
44
Patellar Tracking Palpation (sitting with knee bent)
* With fingers on the medial and lateral aspect of the patella, ask patient to slowly extend and bend knee
- -Note tracking and/or crepitis
45
Tibial Tuberosity
*Distal end of patellar tendon, may have excessive overgrowth due to Osgood-Schlatter Disease
46
Tibial Plateaus
*Sharper edges superior and lateral from the tibial tuberosity.
47
Femoral Condyles
*Easier with knee bent, palpate the medial and lateral condyles just medial/lateral to the patella.
48
Trochlear Groove
*Highest point of the femoral condyles, superior to patella and should feel depression of the trochlear groove between condyles
49
Lateral Epicondyle
*Most lateral aspect for the lateral femoral condyle
50
Lateral Tibial Plateau
* Distal from lateral epicondyle and across the joint line
| - -may feel "sharp"
51
Lateral Tubercle of Tibia
* Lateral to the infrapatellar tendon and immediately below tibial plateau
* Attachment site for ITB
52
Fibular Head
* Approximately the same level as the tibial tuberosity on the lateral aspect of the knee
* Attachment site for LCL and biceps femoris
53
Medial Epicondyle
* Superior aspect of the medial condyle
| * Level with the base of the patella
54
Adductor Tubercle
* Most superior and posterior aspect of the medial condyle
| * Attachment site for adductor magnus
55
Medial Tibial Plateau
* Inferior to soft tissue depression made in the sitting position
* Attachment site for medial meniscus
56
Quadriceps
* Palpate as a whole group and as individual muscles
* Note difference between VM and VL
- -Both location and ability of contraction
* Cannot palpate intermedius due to overlapping rectus
- -Rectus is on right leg of picture
57
Infrapatellar Ligament (patellar Tendon)
*Trace from apex of patella to tibial tuberosity
58
Infrapatellar Fat Pad
* May be palpable immediately medial/lateral to patellar tendon
* Irritation here is called Hoffa’s Syndrome
59
Medial (Tibial) Collateral Ligament
* Between medial tibial plateau and femur
| * Part of joint capsule and attached to medial meniscus
60
Medial Hamstrings
* Semimembranosus is more medial and flatter
* Semitendinosus is more posterior and tendon-like
- -Don’t confuse with gracilis and sartorius
61
Medial Meniscus
* Superior to medial tibial plateau
* Palpated deeper within the joint space
* Tibial internal rotation can make it more prominent
62
Pes Anserine
From Superior to Inferior (Anterior to Posterior)
* Sartorius
- -More muscular vs tendon
* Gracilis
- -Contracts more with tibial internal rotation
* Semitendinosus
- -Most posterior and inferior tendon
* Bursa is located here and can be a source of pain
63
Lateral Collateral Ligament
* Between the femoral condyle and fibular head
| * Best palpated with leg in “guy” crossed leg position
64
Lateral Meniscus
* Superior to lateral tibial plateau
| * Best palpated with knee in slight flexion
65
Iliotibial Band (ITB)
* Inserts onto the lateral tibial tubercle
| * Best palpated with knee in extension
66
Biceps Femoris Tendon
* Inserts onto the fibular head
| * Resist flexion to feel it contract
67
Common Peroneal Neve
* Inferior to biceps femoris insertion
* Crosses neck of fibula
* Common site of compression or stretch
68
Medial and Lateral Heads of Gastrocnemius
* Attach to medial/lateral femoral condyles
* Have patient plantarflex to feel contract
- -Or resist going into dorsiflexion
69
Soleus
* Deep to and broader than gastrocnemius
| * Palpate distally near where gastrocnemius turns into Achilles
70
Popliteal Fossa
* Superior Lateral Border
- -Biceps femoris tendon
* Superior Medial Border
- -Semitendinsus and Semimembranosus
* Inferior Medial Border
- -Medial head of gastrocnemius
* Inferior Lateral Border
- -Lateral head of gastrocnemius
71
Hamstrings Muscle length testing
* "90/90”, “Popliteal Angle”
- -Patient supine with hip flexed to 90 deg
- -Passively extend knee as straight as possible
- -Look for compensation at hip joint
- ---Hip extension
* To quantify the muscle length measure the amount of knee flexion contracture is taken
* Traditionally performed passively, however, can be done actively
72
Ely's Test
* Tests for Rectus Femoris
- -Patient prone
- -Passively flex the patient’s knee by bringing the heel as close to buttocks.
- -Look for compensation at the hip joint
- ---Hip flexion
- ---Hip rotation
*To quantify the muscle length measure the amount of knee flexion that occurs
73
Talus (Talar Dome)
* Palpate in the depressions anterior to the lateral and medial malleolus
- -Invert to feel lateral dome “pop out”
- -Evert to feel medial dome “pop out”
- -Find the neutral position
- ---Equal palpation of the medial and lateral dome.
74
Sinus Tarsi
* Small canal under the talus on the outer lateral aspect
| * Soft tissue depression just anterior to the lateral malleolus
75
Calcaneus/peroneal tubercle
*Bump on the lateral aspect of the calcaneus distal to the lateral malleolus
76
Cuboid
* Between the 5th metatarsal and calcaneus
- -Can be felt as an indentation between these structures
* Articulates with 4th and 5th metatarsals
77
5th Metatarsal
* Large palpable styloid process at the flared base.
- -Peroneus brevis inserts here
- -Styloid process can be an area of stress fracture (esp. for runners)
78
Medial Tubercle of Talus
* Posterior to the distal end of the medial malleolus
- -Posterior portion of the deltoid ligament attaches here
- -Area where plantar fascia usually pulls from when a pt has plantar fasciitis
79
Sustentaculum Tali
* Bony shelf approximately 1 finger width distal to the medial malleolus
- -Attachment site for the spring ligament
80
Navicular Tubercle
*Most medial prominence distal the the sustentaculum tali
81
1st Cuneiform
*Between navicular and the base of 1st metatarsal
82
Medial Calcaneal Tubercle
* Medial plantar aspect of the calcaneus
* Broad and large, may be sharp if patient has “heel spurs”
* 3 main things attach here
- -Medially
- ---Abductor Hallucis
- -Anteriorly
- ---Flexor digitorum brevis
- ---Plantar aponeurosis / fascia
83
Sesmoids
*Small bone located at the distal end of the 1st metatarsal
84
Deltoid Ligament
* Anterior to navicular
* Inferior to calcaneus
* Posterior to talus
85
Tibialis Posterior Tendon
* Most anterior of the Tom, Dick, an Harry group
| * Invert and plantar flex
86
Flexor Digitorum Longus Tendon
* Just behind tibialis posterior
| * Flex toes
87
Posterior Tibial Artery
* Posterior to FDL
| * Easier to palpate in non-weight bearing
88
Tibial Nerve
* Posterior and lateral to posterior tibial artery
| * Difficult to palpate in isolation
89
Flexor Hallucis Longus Tendon
* Posterior aspect of the TC joint
| * Flex great toe, though difficult to palpate due to achilles
90
ATFL
* Anterior lateral malleolus to anterolateral talar neck
* Resists excessive inversion
* 1st one “to go”
* Plantar flex and invert to tension
91
CFL
* Inferior lateral malleolus to calcaneus
* Resists maximum inversion
* Posterior to peroneal tubercle
* Invert with foot in neutral to tension
92
PTFL
* Posterior lateral malleolus to posterior talus
| * Resists ankle dorsiflexion, adduction (tilt), medial rotation, and medial translation of talus
93
Peroneus Longus
* Tendon is the inferior division at peroneal tubercle
* Inserts onto the 1st cuneiform and base of the 1st metatarsal
* Evert to contract
94
Peroneus Brevis
* Superior tendon
* Inserts onto the styloid process of the 5th metatarsal
* Evert to contract
95
Extensor Digitorum Brevis
*Palpate within the sinus tarsi while patient extends toes
96
Tibialis Anterior
* Most medial and prominent tendon on dorsum of ankle joint
| * Dorsiflex and invert to feel.
97
Extensor Hallucis Longus
* Lateral to tibialis anterior
| * Extend the great toe to feel
98
Extensor Digitorum Longus
* Lateral to extensor halluces longus
| * Extend the toes to feel
99
Dorsal Pedal Artery
*Between EHL and EDL on dorsum of the foot
100
Plantar Fascia
* Medial tubercle of the calcaneus to MTP
| * Will feel rough
101
Abductor Hallucis
* Most medial aspect of the plantar aspect of the foot
| * if unable to abduct great toe, shorten foot in standing
102
Gastrocnemius Muscle length testing (NWB)
* Patient supine with knee fully extended and foot in neutral inversion/eversion
* Passively dorsiflex the ankle
* Look for compensation at knee joint
- ---Knee flexion
103
Gastrocnemius Muscle length testing (weight bearing)
* Patient standing with knee fully extended and foot/heel in contact with floor
* Patient leans body forward keeping heel down
*To quantify the muscle length measure the amount of ankle dorsiflexion
