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Palpation Review For Final Exam
 

Palpation Review For Final Exam

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    Palpation Review For Final Exam Palpation Review For Final Exam Presentation Transcript

    • Palpation Review for Final Exam
      Muscles from Weeks One, Two, And Three
    • Supraspinatus
      P: Supraspinous Fossa of the scapula
      D: Greater tubercle of the humerus
      1. Abducts the arm at the shoulder joint
      Part of the rotator cuff muscle group
    • Palpation of Supraspinatus
      Client seated with arm medially rotated and hanging at the side
      Place palpating hand just superior to the spine of the scapula
      Ask the client to perform a short, quick range of motion of active abduction of the arm at the shoulder joint
    • Deltoid
      P: Lateral clavicle, acromion process, and the spine of the scapula
      D: Deltoid tuberosity of the humerus
      1. Abducts the arm at the shoulder joint (entire muscle)
      2. Flexes the arm at the shoulder joint (anterior deltoid)
      3. Extends the arm at the shoulder joint (posterior deltoid)
      4. Medially rotates the arm at the shoulder joint (anterior deltoid)
      5. Laterally rotates the arm at the shoulder joint (posterior deltoid)
    • Palpation of the Deltoid
      Have client seated
      Middle deltoid: Place palpating hand just proximal to the deltoid tuberosity. Have client actively abduct the arm
      Anterior deltoid: Place hand on anterior shoulder. Have client actively horizontally flex the arm at the shoulder joint
      Posterior deltoid: Place palpating hand just inferior to the spine of the scapula. Have client actively horizontally extend the arm at the shoulder joint
    • Biceps Brachii
      P: Long head: Supraglenoid tubercle of the scapula
      Short head: Coracoid process of the scapula
      D: Radial tuberosity
      Flexes the forearm at the elbow joint (entire muscle)
      Supinates the forearm at the radioulnar joints (entire muscle)
      Flexes the arm at the shoulder joint (entire muscle)
    • Palpation of Biceps Brachii
      Have client seated with the forearm supinated
      Place palpating hand on the anterior arm and feel for the biceps brachii
      Have the client actively flex the forearm at the elbow joint against resistance with the forearm fully supinated
    • Triceps Brachii
      P: Long head: Infraglenoid tubercle of the scapula
      Lateral head: Posterior shaft of the humerus
      Medial head: Posterior shaft of the humerus
      D: Olecranon process of the ulna
      1. Extends the forearm at the elbow joint
    • Palpation of Triceps Brachii
      Have client prone with arm perpendicular to the body and the forearm hanging off the table
      Long head: Have client extend elbow. Palpate in the proximal medial 2/3 of the arm
      Medial head: Most of the medial head is deep to the other two heads. Palpate just proximal to the medial and lateral epicondyles
      Lateral head: Palpate the proximal lateral 2/3 of the arm
    • Flexor Carpi Radialis
      P: Medial epicondyle of the humerus
      D: Radial hand on the anterior side
      Flexes the hand at the wrist joint
      Radially deviates (abducts) the hand at the wrist joint
    • Plapation of Flexor Carpi Radialis
      Client seated
      Place palpating hand across anterior wrist
      Have client actively flex and radially deviate the hand at the wrist joint and feel for the distal tendon on the radial side just lateral to the palmaris longus
      Palpate proximally toward the medial epicondyle
      It is difficult to palpate the proximal tendon because it blends with the common flexor tendon of the elbow
    • Palmaris Longus
      P: Medial epicondyle of the humerus
      D: Palm of hand
      1. Flexes the hand at the wrist joint
    • Palpation of Palmaris Longus
      Have client seated
      Place palpating hand on anterior wrist
      Ask the client to cup the hand (bring thenar and hypothenar eminence together)
      Ask client to flex the hand at the wrist joint against resistance with the fingers fully extended; feel for the distal tendon of the palmaris longus in the center of the wrist.
      Palpate distally to the common flexor tendon of the elbow
    • Flexor Carpi Ulnaris
      P: Medial epicondyle of the humerus
      D: Ulnar hand on the anterior side
      Flexes the hand at the wrist joint
      Ulnar deviates (adducts) the hand at the wrist joint
    • Palpation of Flexor Carpi Ulnaris
      Have client seated
      Place palpating hand across anterior wrist
      Have client actively flex and ulnar deviate the hand at the wrist joint and feel for the distal tendon on the medial side of the anterior wrist.
      Palpate proximally toward the medial epicondyle and the common flexor tendon of the elbow.
    • Brachioradialis
      P: Lateral supracondylar ridge of the humerus
      D: Styloid process of the radius
      1. Flexes the forearm at the elbow joint
    • Palpation of the Brachioradialis
      Have client seated with forearm flexed at the elbow 90 degrees, and in a position halfway between pronation and supination.
      Place palpating hand on lateral forearm.
      Resist client from further flexing the forearm and feel for contraction of the brachioradialis.
      Palpate distally to the styloid process of the radius and proximally to the lateral supracondylar ridge of the humerus.
    • Extensor Carpi Radialis Longus
      P: Lateral supracondylar ridge of the humerus
      D: Radial hand on the posterior side
      Extends the hand at the wrist joint
      Radially deviates (abducts) the hand at the wrist joint
    • Palpation of Extensor Carpi Radialis Longus
      Have client seated
      Place palpating hand posterior to brachioradialis
      Ask client to make a fist in a slightly extended position and feel for contraction of the muscle.
      Continue palpating proximally toward the lateral supracondylar ridge of the humerus.
      Continue palpating distally to the 2nd metacarpal
    • Extensor Carpi Radialis Brevis
      P: Lateral epicondyle of the humerus
      D: Radial hand on the posterior side
      Extends the hand at the wrist joint
      Radially deviates (abducts) the hand at the wrist joint
    • Palpation of the Extensor Carpi Radialis Brevis
      Client seated
      Pinch the radial group of forearm muscles with your thumb on one side and your fingers on the other and slightly pull them away from forearm.
      The fingers on the posterior aspect of the radial group are on the extensor carpi radialis brevis
      Have client actively extend and/or radially deviate the hand at the wrist to feel for contraction of the muscle.
      The distal tendon can be palpated by having the client make a fist with the wrist slightly extended. Attaches to 3rd metacarpal.
    • Extensor Carpi Ulnaris
      P: Lateral epicondyle of the humerus and the ulna
      D: Ulnar hand on the posterior side
      Extends the hand at the wrist joint
      Ulnar deviates (adducts) the hand at the wrist joint
    • Palpation of Extensor Carpi Ulnaris
      Have client seated
      Place palpating hand directly posterior to the shaft of the ulna and feel for the belly of the extensor carpi ulnaris.
      Continue palpating proximally toward the lateral epicondyle of the humerus and distally toward the 5th metacarpal.
      Have the client extend and ulnar deviate the wrist to further bring out this muscle.
    • Temporalis Muscle
      P: Temporal fossa
      D: Coronoid process and the ramus of the mandible
      1. Elevates the mandible at the temporomandibular joint
    • Palpation of Temporalis
      Have client supine
      Place palpating fingers on the temporal fossa.
      Ask client to clench and relax the teeth.
      Feel for the contraction and relaxation of the muscle.
      The inferior attachment on the coronoid process of the mandible can be palpated if the client opens mouth widely. Difficult to distinguish from the masseter.
    • Trapezius muscle
      P: Occiput, nuchal ligament, and SPs of C7-T12
      D: Lateral clavicle, acromion process, and spine of scapula
      Laterally flexes the neck and the head at the spinal joints (upper)
      Extends the neck and the head at the spinal joints (upper)
      Contralaterally rotates the neck and the head at the spinal joints (upper)
      Elevates the scapula at the scapulocostal joint (upper)
      Retracts (adducts) the scapula at the scapulocostal joint (entire muscle)
      Depresses the scapula at the scapulocostal joint (lower)
    • Palpation of the Trapezius
      Have the client prone
      Place palpating hand over the upper trapezius.
      Have client actively abduct the arm at the shoulder joint and retract the scapula
      Repeat above to palpate the middle and lower trapezius
      To further bring out the upper trapezius, have the client slightly extend the neck
    • Levator scapulae
      P: TPs of C1-C4
      D: Medial border of the scapula, from the superior angle to the root of the spine of the scapula
      Elevates the scapula at the scapulocostal joint
      Extends the neck at the spinal joints
      Laterally flexes the neck at the spinal joints
    • Palpation of the Levator Scapulae
      Client seated with the forearm in the small of the back
      Place palpating hand just superior to the superior angle of the scapula
      Have client perform short, quick range of motion of active elevation of the scapula and feel for the contraction of the levator scapulae.
      Continue palpating superiorly into the posterior triangle of the neck
    • Sternocleidomastoid
      P: Sternal head: Manubrium of the sternum
      Clavicular head: Medial clavicle
      D: Mastoid process of the temporal bone
      Flexes the head at the spinal joints
      Laterally flexes the neck and the head at the spinal joints
      Contralaterally rotates the neck and the head at the spinal joints
    • Palpation of the Sternocleidomastoid
      Have client seated with the neck and head rotated to one side.
      Stand on the opposite side.
      Place palpating hand on the anterolateral neck of the side where you are standing.
      Now resist the client from laterally flexing the neck and head toward the side you are standing and feel for contraction of the SCM.
    • Week 5, 6, and 7
      Palpation Review For Final Exam
    • Latissimus Dorsi
      P: SPs of T7-L5, posterior sacrum, and the posterior iliac crest
      D: Medial lip of bicipital groove of the humerus
      Medially rotates the arm at the shoulder joint
      Adducts the arm at the shoulder joint
      Extends the arm at the shoulder joint
      Anteriorly tilts the pelvis at the lumbosacral joint
      • Have client seated with hands at their sides
      • Place palpating hand on the client’s posterior axillary fold
      • Ask the client to push down on the table with both hands, attempting to elevate the pelvis and trunk off the table. Feel for the contraction of the latissimusdorsi
      • Continue palpating the muscle toward its humeral attachment. It can be difficult to distinguish the tendon of the latissimusdorsi from the tendon of the teres major because they often blend together.
      Palpation of LatissimusDorsi
    • Rhomboid Major and Minor
      P: SPs of C7-T5
      D: Medial border of the scapula from the root of the spine of the scapula to the inferior angle of the scapula
      Retracts (Adducts) the scapula at the scapulocostal joint
      Elevates the scapula
    • Have client seated with hand placed in the small of the back
      Place palpating hand between the scapula at a level that is between the inferior angle and the root of the spine of the scapula and the spine
      Ask the client to lift the hand away from the back and feel for the contraction of the rhomboids
      Palpation of Rhomboid Major and Minor
    • Erector Spinae Group
      O: Pelvis
      I: Spine, ribcage, and head
      Extends the trunk, neck, and the head at the spinal joints
      Laterally flexes the trunk, neck, and head at the spinal joints
      Ipsilaterally rotates the trunk, neck, and head at the spinal joints
      Anteriorly tilts the pelvis at the lumbosacral joint
    • Have client prone
      Place palpating hands lateral to the SPs of the vertebral column in the lumbar region and feel for the vertical orientation of the fibers of the muscle
      Continue palpating inferiorly and superiorly
      Ask the client to actively extend the upper part of the body off the table and feel for contraction of the erector spinae group
      To palpate the erector spinae of the neck it is easier to have the client supine
      Plapation of Erector Spinae
    • Pectoralis Major
      P: Medial clavicle, sternum, and the costal cartilages of ribs 1-7
      D: Lateral lip of the bicipital groove of the humerus
      1. Adducts the arm at the shoulder joint
      2. Medially rotates the arm at the shoulder joint
      3. Flexes the arm at the shoulder joint (clavicular head)
    • Have client seated
      Have client raise arm to 90 degrees of abduction at the shoulder joint
      Place palpating hand on the belly of the muscle
      Ask the client to actively horizontally flex the arm at the shoulder joint against resistance and feel for the contraction of the pectoralis major
      Continue palpating the muscle medially and superiorly toward its attachment s on the trunk and distally toward its humeral attachment
      Palpation of the Pectoralis Major
    • Rectus Abdominis
      P: Pubis
      D: Xiphoid process and the cartilage of ribs 5-7
      Flexes the trunk at the spinal joints
      Posteriorly tilts the pelvis at the lumbosacral joint
    • Have the client supine with a pillow under the knees
      Place palpating hands between the xiphoid process of the sternum and the adjacent ribs superiorly and the pubis inferiorly
      Ask the client to alternate between mild flexion of the trunk and relaxation so that you can feel for the contraction of the muscle
      Palpate the rectus abdominis superiorly toward its ribcage attachment and inferiorly toward its pelvic attachment
      Palpation of the Rectus Abdominis
    • Gluteus Maximus
      P: Posterior iliac crest, posterolateral sacrum, and the coccyx
      D: Iliotibial band (ITB) and glutealtuberosity of the femur
      Extends the thigh at the hip joint
      Laterally rotates the thigh at the hip joint
      Abducts the thigh at the hip joint (upper 1/3)
      Adducts the thigh at the hip joint (lower 2/3)
      Posteriorly tilts the pelvis at the hip joint
      • Have client lay prone
      • Place palpating hand on the lateral sacrum
      • Palpate the gluteus maximus from its medial attachment (lateral sacrum) to its lateral attachment (ITB)
      • Have the client actively extend and laterally rotate the thigh at the hip joint to further bring out the muscle.
      • The gluteus maximus does not cover the entire buttocks; the gluteus medius is just inferior to most of the posterior iliac crest
      Palpation of Gluteus Maximus
    • Gluteus Medius
      P: External Ilium
      D: Greater trochanter of the femur
      Abducts the thigh at the hip joint (entire muscle)
      Flexes the thigh at the hip joint (anterior fibers)
      Medially rotates the thigh at the hip joint (anterior fibers)
      Extends the thigh at the hip joint (posterior fibers)
      Laterally rotates the thigh at the hip joint (posterior fibers)
      Posteriorly tilts the pelvis at the hip joint (posterior fibers)
      Anteriorly tilts the pelvis at the hip joint (anterior fibers)
      • Have client side lying
      • Middle portion: Place palpating hand between the iliac crest and the greater trochanter of the femur. Ask client to abduct the thigh at the hip joint
      • Anterior portion: Place palpating hand just posterior and inferior to the ASIS and feel for the anterior fibers. Ask client to flex and medially rotate the thigh at the hip joint.
      • Posterior portion: Palpate just deep to the superolateral portion of the gluteus maximus and have the client extend and laterally rotate the thigh at the hip joint.
      • Distinguishing gluteus medius from glut max and piriformis can be difficult
      Palpation of the Gluteus Medius
    • Tensor Fasciae Latae (TFL)
      P: Anterior Superior Iliac Spine
      D: Iliotibial band (ITB)
      Flexes the thigh at the hip joint
      Abducts the thigh at the hip joint
      Medially rotates the thigh at the hip joint
      Anteriorly tilts the pelvis at the hip joint
    • Have client supine
      Place palpating hand just distal and slightly lateral to the ASIS
      Have client actively hold the thigh in a position of flexion and medial rotation at the hip joint
      Resist the client from further flexion of the thigh at the hip joint and feel for the contraction of the TFL
      Continue palpating the TFL distally and slightly posteriorly toward ITB attachment
      Palpation of Tensor Fascia Latae
    • Sartorius
      P: Anterior superior iliac spine (ASIS)
      D: Pes Anserine Tendon (at the proximal anteromedial tibia)
      Flexes the thigh at the hip joint
      Abducts the thigh at the hip joint
      Laterally flexes the thigh at the hip joint
      Flexes the leg at the knee joint
      Anteriorly tilts the pelvis at the hip joint
    • Have client supine
      Place palpating hand just distal and slightly medial to the ASIS
      Ask client to actively flex and laterally rotate the thigh at the hip joint and feel for the contraction of the sartorius
      Continue palpating the sartorius from the ASIS to the pes anserine tendon
      To further bring out the muscle give the client resistance
      Palpation of the Sartorius
    • Rectus Femoris
      P: Anterior Inferior iliac spine (AIIS)
      D: TibialTuberosity
      Extends the leg at the knee joint
      Flexes the thigh at the hip joint
      Anteriorly tilts the pelvis at the hip joint
    • Have client supine with a pillow under their knees
      Place palpating hand just proximal to the patella
      Resist the client from actively extending the leg at the knee joint and feel for the contraction of the rectus femoris
      Continue palpating the muscle toward the ASIS
      To palpate the proximal attachment passively flex the thigh at the hip joint and palpate slightly distal to the ASIS
      Palpation of the Rectus Femoris
    • Vastus Lateralis
      P: Linea Aspera of the femur
      D: Tibial tuberostiy
      1. Extends the leg at the knee joint
    • Have client supine
      Place palpating hand just distal to the greater trochanter
      Ask the client to contract the quadriceps femoris group and feel for contraction of the vastus lateralis
      Continue palpating distally toward the patella
      Palpation of the Vastus Lateralis
    • Vastus Medialis
      P: Linea Aspera of the femur
      D: Tibial tuberosity
      1. Extends the leg at the knee joint
    • Have client supine
      Place palpating hand just proximal and medial to the patella
      Ask the client to contract the quadriceps femoris group and feel for the contraction of the vastus medialis
      Continue palpating the vastus medialis proximally as far as possible
      The vastus medialis is best palpated medially in the distal 1/3 of the thigh
      Palpation of the Vastus Medialis
    • Vastus Intermedius
      P: Anterior shaft and the linea aspera of the femur
      D: Tibial tuberosity
      1. Extends the leg at the knee joint
    • Deep and difficult to palpate
      Have client supine
      Place palpating hand just proximal to the patella
      If the rectus femoris can be lifted and/or moved aside, the distal vastus intermedius may be palpated deep to the rectus femoris when approached from either the medial or lateral side
      To feel the vastus intermedius deep to the rectus femoris, make sure that the direction of your pressure is directed toward the middle of the femur
      Palpation of Vastus Intermedius
    • Biceps Femoris
      P: Long head: Ischialtuberosity
      Short head: Linea aspera
      D: Head of the fibula
      Flexes the leg at the knee joint (entire muscle)
      Extends the thigh at the hip joint (long head)
      Posteriorly tilts the pelvis at the hip joint (long head)
    • The biceps femoris is superficial for most of its course in the posterolateral thigh and is easy to palpate
      Have the client prone with the leg partially flexed at the knee joint
      Place palpating hand on the distal posterolateral thigh
      Resist the client from performing further flexion of the leg at the knee joint and feel for the distal tendon of the biceps femoris
      Continue palpating the biceps femoris toward the ischial tuberosity
      Palpation of the Biceps Femoris
    • Semitendinosus
      P: Ischialtuberosity
      D: Pes Anserine tendon
      Flexes the leg at the knee joint
      Extends the thigh at the hip joint
      Poseteriorly tilts the pelvis at the hip joint
    • The semitendinosus is superficial for most of its course in the posteromedial thigh and is easy to palpate
      Have the client prone with the leg partially flexed at the knee joint
      Place palpating hand on the posteromedial thigh
      Further resist flexion of the leg at the knee joint and feel for the distal tendon of the semitendinosus
      Continue palpating the muscle proximally toward the ischial tuberosity. Its attachment is just medial to the long head of the biceps femoris
      Palpation of the Semitendinosus
    • Semimembranosus
      P: Ischialtuberosity
      D: Medial condyle of the tibia
      Flexes the leg at the knee joint
      Extends the thigh at the hip joint
      Posteriorly tilts the pelvis at the hip joint
    • Best palpated distally in the posterior thigh, medial to the belly of the semitendinosus, and on either side of the distal tendon of the semitendinosus
      Have the client prone with the leg partially flexed at the knee joint
      Place palpating hand on the distal posteromedial thigh
      Resist the client from performing further flexion of the leg at the knee joint and feel for contraction of the semimembranosus
      The proximal attachment on the ischial tuberosity is lateral to the attachment of the long head of the biceps femoris
      Palpation of the Semimembranosus
    • Tibialis Anterior
      P: Proximal anterior tibia
      D: Medial foot
      Dorsiflexes the foot at the ankle joint
      Inverts the foot at the tarsal joints
    • Have client supine
      Place palpating hand just lateral to the shaft of the tibia
      Ask the client to actively dorsiflex and invert the foot and feel for the contraction of the tibialis anterior
      Palpation of Tibialis Anterior
    • Fibularis Longus
      P: Proximal lateral fibula
      D: Medial foot
      Everts the foot at the tarsal joints
      Plantarflexes the foot at the ankle joint
    • Have the client supine
      Place palpating hand on the proximal lateral leg just distal to the head of the fibula
      Ask the client to actively evert the foot and feel for contraction of the belly of the fibularislongus from the head of the fibula to the point where it becomes tendon halfway down the leg
      Continue palpating the tendon distally. The distal tendon is superficial to the fibularisbrevis muscle belly
      Just proximal and posterior to the lateral malleolus, the tendon of the fibularislongus will be more superficial and posterior than the tendon of the fibularisbrevis
      Fibularis Longus
    • Gastrocnemius
      P: Medial and lateral femoral condyles
      D: Calcaneus via the calcaneal tendon
      Plantarflexes the foot at the ankle joint
      Flexes the leg at the knee joint
    • Have the client prone with the leg extended at the knee joint
      Place palpating hand on the proximal posterior leg
      Ask the client to actively plantarflex the foot at the ankle joint against resistance and feel for contraction of the muscle. It can be palpated all the way to its distal attachment
      Palpation of the Gastrocnemius