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Palpation-A&P2Lab
| Question | Answer | O, I, A, N or Clinical |
|---|---|---|
| Scaphoid | deep in the anatomical snuffbox ("some" in SLTPTTCH) | Scaphoid fractures- most commonly fractured carpal, most commonly missed wrist fracture susceptible to FOOSH (Fall On OutStretched Hand) |
| Lunate | medial to scaphoid, have patient flex wrist to expose the lunate-- hollow on back of hand b/t extensor digitorum tendons ("lovers" in SLTPTTCH) | |
| Triquetrum | just distal to ulnar styloid process ("try" in SLTPTTCH) | |
| Trapezium | distal to scaphoid- begin on thumb-> move proximal= trapezium ("that" in SLTPTTCH) | |
| Trapezoid | just proximal to base of the 2nd metacarpal ("they" in SLTPTTCH) | |
| Capitate | just proximal to the base of the 3rd metacarpal ("can't" in SLTPTTCH) | |
| Hamate | just proximal to ases of 4th and 5th metacarpals ("handle" in SLTPTTCH) | |
| Radial Artery | anterior forearm, between flexor carpi radialis and the radial shaft just proximal to wrist crease where the pulse is taken/analyzed | dominant artery in 90% of people |
| Ulnar Artery | anterior forearm, between flexor carpi ulnaris and palmaris longus, just proximal to wrist crease | |
| Median Nerve | locate distal tendon of palmaris longus and displace it laterally very superficial palpable cord | Carpal Tunnel Syndrome- #1 most common upper extremity nerve entrapment- compression of median nerve in carpal tunnel |
| Ulnar Nerve | locate distal tendon of flexor carpi ulnaris and move just lateral paplate nerve by rolling it over the tendon of flexor digitorum superficialis (5th) | Cubital Tunnel Syndrome- inflammation of Ulnar nerve due to chronic compression or stretching |
| Brachialis | Find biceps tendon- pinch grip to feel behind- flex elbow vs. resistance- feel area fill up, that's brachialis | strong elbow flexor b. brachii overlies brachialis O: distal 1/2 of humeral anterior surface I: tuberosity and coronoid process of ulna A: flex humeroulnar joint N: musculocutaneous |
| Pronator Teres | medial and inferior to b. brachii tendon- forceful handshake v. resistance | O: meidal epicondyle of humerus, common fleor tendon and coronoid process of ulna I: middle of lateral surface of radius A: pronate RU joint(rapid or forceful pronation); synergist to elbow flexors (very weak) N: meidan-> actually goes through the musc |
| Supinator | come directly lateral (& maybe anterior) and it will be the only thing that tenses up on supination | O: radial collateral ligament, annular ligament, and superior crest of ulna I: lateral surface of proximal radial shaft A: supinate RU joint (slow supination- if faster upinateion is required, biceps brachii is recruited) N: radial |
| Ulnar groove | found between the tip of the loecranon and the medial epicondyle CAUTION nerve is very superficial at this point "hitting your funny bone" 1/2way b/t medial epicondyle and olecranon process and extend forearm- groove forms- ulnar nerve | |
| Brachial Artery | locate medial and posterior to the tendon of b. brachii at elbow | |
| Median Cubital Vein | medial and distal to tendon of b. brachii at elbow | |
| Radial Nerve | distal to elbow crease, just lateral to brachioradialis | lateral epicondylitis "tennis elbow" |
| Pectoralis minor | 1. coracoid process press down straight through to pec minor- position patient with arm bend and hand up, move arm (elbow) down 2. locate pec maj in coronal plane- poke through- submarine- have them do same motion | O: ribs 3. 4. 5 I: coracoid process of scapula A: depress ST joint, abduct scapula, assists in inhalation N: medial pectoral can entrap brachial plexus(TOS) |
| Coracobrachialis | supine- shoulder is ext. rotated and abducted- locate coracoid, have patient horizontally adduct proximal to biceps on medial surface of mid-humerus medial aspect roll medial to short head of biceps | O: coracoid process of the scapula I: medial surface of mid-humeral shaft A: flex GHJ, adduct GHJ N: musculocutaneous |
| Serratus Anterior | coronal plane inferior to latissimus and have patient 1in. punch | accessory breathing muscle weakness= winged scapula test= standing (wall) push up "boxer's muscle" O: surfaces ribs 1-8 I: ant surface of med border of scapula A: aBduct, depress, hold med. border of scap. N: long thoracic |
| Subscapularis | prone- handcuff, come in under medial border OR arms up in EXT rotation grab hunk in coronal plane | 3 of 4 rotator cuff muscles O: subscapular fossa of the scap I: lesser tubercle of humerus A: internally rotate GHJ, stabilize head of humerus in glenoid N: subscapular nerve |
| Levator Scapulae | prone- posterior to SCM and anterior to trapezius- middle of posterior triangle- rotate head ipsilaterally | elevates scapula O: TP of C1-C4 I: upper medial border and superior angle of scapula A: unilaterally- elevate scapula, rotate scap downward, lat. flex neck ipsilaterally, rotate head ipsilaterally N: dorsal scapular and cervical nerves |
| Coracoid Process | hand on person's oppo. shoulder and thumb should land on coracoid | attach here: short head of b. brachii, bracoradialis, coracobrachialis |
| Extensor Digitorum Longus | (middle above ankle- most lateral below ankle) | O: proximal ant. shaft of fibula and interosseous membrane I: middle and distal phalanges of 2-5 digits A: extend 2-5 digits, dorsiflex and evert foot N: deep peroneal |
| Extensor Hallucis Longus | (most lateral above ankle- middle below ankle) pinch snuffbox- dorsiflex v. resistance mid snuffbox= EHL | O: middle ant. surface of fibula and interosseous membrane I: distal phalange of hallux A: extend hallux, dorsiflex and invert the foot N: deep peroneal |
| Tibialis posterior | prone- below gastroc.- hold foot at inversion/dorsiflexion- resisted eversion-> mid 1/3 of leg feel it tighten (L to M, FHL->TP->FDL) | too many toes test limits pronation of foot supinator post. shin splints O: prox. post. shaft of tibia, prox. tibia and interosseous membrane I: navicular, cuneiforms, cuboid and bases of 2-4 metatarsals A: inversion and plantarflexion N: tibial |
| Flexor Hallucis Longus | dorsiflex & curl big toe- lat. 1/3 (L to M, FHL->TP->FDL) | O: middle 1/2 posterior fibula I: distal phalange of hallux A: flex hallux at MTP and IP joints, invert foot, weak plantarflexion N: tibial |
| Flexor Digitorum Longus | flex digits, invert foot (L to M, FHL->TP->FDL) | O: middle posterior surface of tibia I: distal phalange of 2-5 digits A: flex 2-5 digits at MTP, PIP and DIP joints, invert foot, weak plantarflexion N: tibial |
| Sustentaculum tali | shelf-like promenence located a fingers-width below medial malleolus | |
| Cuneiforms (3) | medial- just prox. to base of 1st metatarsal intermediate- prox. to base of 2nd metatarsal lateral- prox. to base of 3rd metatarsal | |
| Tarsal tunnel | just posterior and inferior to the medial malleolus contains tendons of TP, FDL, and FHL, posterior to tibial artery and tibial nerve | |
| Anterior talofibular ligament | plantarflex and adduct foot to expose ligament runs from middle part of ant. surface of lateral malleolus and inserts into the lateral talus | #1 ankle sprain tear |
| Dorsal Pedis Artery | top of foot, just lateral to tendon of EHL | |
| Posterior Tibial Artery | invert foot and palpate posteriorly to the medial malleolus | |
| Sartorius | supine- leg in slight figure4, have patient lift knee vs. resistance-- connects at hip and below inner knee | longest muscle in the body |
| Popliteal artery | prone- divide knee joint vertical and horizontal, artery will be in superior-medial quadrant, just off the angle, slowly flex knee and press in deep to feel pulse | |
| piriformis | prone- knee bent- resisted external rotation of thigh-- near distal end of glutes | PPS- referred pain into posterior thigh NOT PAST KNEE J O: anterior surface of sacrum I: greater trochanter AL ext. rotate hip, aBduct when hip is flexed N: branch of sacral plexus |
| Adductor magnus | supine near edge of table leg in full ABduction- have patient aDduct with toe rotated outward (slightly distal and medial to longus) | deepest of adductor group horizontal and vertical fibers O: inferior ramus of pubis, ramus of ischium and ischial tuberosity I: medial lip of linea aspera and adductor tubercle A: adduct and iINT rotate hip; assist with hip flexion N: obturator and t |
| Adductor longus | supine- leg in full ABduction- have patient aDduct with toe toward sky | most anterior of adductor group O: pubic tubercle I: medial lip of linea aspera A: adduct and INT rotate hip; assist w/hip flexion N: obturator |
| Tensor Fascia Lata and Iliotibial tract | side lying (bottom leg bent)- ASIS- ABduct coronal plane- ASIS- inf/post (still ant. to coronal) ABduct leg and TFL will pop up | TFL controls IT Band O: iliac crest, posterior to ASIS I: iliotibial tract AL flex hip, abduct hip, internal rotation of hip N: superior gluteal |
| Gracilis | seated- adduct and flex knee at same time, gracilis will pop out OR INT rotate and flex at same time FLEXION IS KEY (partial ADduction) (most medial adductor- crosses knee) | O: inferior ramus of pubis and ramus of ischium I: proximal medial shaft of tibia at pes anserine tendon A: adduct hip, internally roatate hip, flex knee, and internally rotate flexed knee N: obturator |
| Femoral artery | with hip in neutral position, palpate 1/2way b/t the ASIS and pubic symphysis with light pressure and feel for the pulse | |
| femoral nerve | as with the femoral artery, palpate slightly lateral to the artery to feel for the cord-like nerve (ant/med thigh and leg) | |
| sciatic nerve | with patient sidelying or prone, palpate 1/2way b/t with greater trochanter and the ischial tuberosity the nerve is approx. the width of finger and easy to feel (deep) | |
| multifidus | prone- paraspinal gutter- L2 find spinous process-> gutter, bottom out- feel structure of multifidus sup-med,inf-lat like little chevrons S1 base of sacrum- paraspinal gutter- deep to erector spinae | deep to erector spinae, span 3-4 levels above, TP locales C3, T4-5, L2, S1 O: sacrum and transverse process of L-C vert. I: spinous processes of L-2nd C vert. A: uni-rotate spine contralat bi- extend spine N: dorsal rami of lacal spinal nerves |
| abdominal aorta | supine with knees bent 3 fingers palpate 1 fingerbreadth lateral to linea alba just above umbilicus | favors left side |
| spinous process C2- L5 | locate spinous processes- A&P 1 | |
| sacral base | prone- palpate the superior aspect of the sacrum | |
| medial sacral crest | middle posterior aspect of sacrum- use broad fingertip contact | |
| sacral hiatus | depression at caudal end of medial sacral crest | |
| lateral border of sacrum | prone- approach medially with prone patient's gluteal muscle relaxed | |
| coronoid process | mouth open 1 inch anterior to mandibular condyle | temporalis attaches here |
| Pronator quadratus | band slightly proximal to wrist crease-shake hands v. resistance | O: med. ant. surface of distal ulna I: lat. ant. surface of the distal radius A: PRONATE Radiounlar joint N: MEDIAN |
Created by:
VKwonRo
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