Palpation-A&P2Lab
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| 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)
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| 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) |
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| Triquetrum | just distal to ulnar styloid process ("try" in SLTPTTCH) |
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| Trapezium | distal to scaphoid- begin on thumb-> move proximal= trapezium ("that" in SLTPTTCH) |
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| Trapezoid | just proximal to base of the 2nd metacarpal ("they" in SLTPTTCH) |
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| Capitate | just proximal to the base of the 3rd metacarpal ("can't" in SLTPTTCH) |
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| Hamate | just proximal to ases of 4th and 5th metacarpals ("handle" in SLTPTTCH) |
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| 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
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| Ulnar Artery | anterior forearm, between flexor carpi ulnaris and palmaris longus, just proximal to wrist crease |
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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 |
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| Brachial Artery | locate medial and posterior to the tendon of b. brachii at elbow |
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| Median Cubital Vein | medial and distal to tendon of b. brachii at elbow |
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| Radial Nerve | distal to elbow crease, just lateral to brachioradialis | lateral epicondylitis "tennis elbow"
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| 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)
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| 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
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| 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
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| 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
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| 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
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| Coracoid Process | hand on person's oppo. shoulder and thumb should land on coracoid | attach here: short head of b. brachii, bracoradialis, coracobrachialis
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| 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
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| 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
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| 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
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| 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
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| 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
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| Sustentaculum tali | shelf-like promenence located a fingers-width below medial malleolus |
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| Cuneiforms (3) | medial- just prox. to base of 1st metatarsal intermediate- prox. to base of 2nd metatarsal lateral- prox. to base of 3rd metatarsal |
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| Tarsal tunnel | just posterior and inferior to the medial malleolus contains tendons of TP, FDL, and FHL, posterior to tibial artery and tibial nerve |
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| 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
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| Dorsal Pedis Artery | top of foot, just lateral to tendon of EHL |
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| Posterior Tibial Artery | invert foot and palpate posteriorly to the medial malleolus |
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| Sartorius | supine- leg in slight figure4, have patient lift knee vs. resistance-- connects at hip and below inner knee | longest muscle in the body
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| 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 |
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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 |
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| 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) |
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| 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) |
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| 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
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| abdominal aorta | supine with knees bent 3 fingers palpate 1 fingerbreadth lateral to linea alba just above umbilicus | favors left side
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| spinous process C2- L5 | locate spinous processes- A&P 1 |
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| sacral base | prone- palpate the superior aspect of the sacrum |
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| medial sacral crest | middle posterior aspect of sacrum- use broad fingertip contact |
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| sacral hiatus | depression at caudal end of medial sacral crest |
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| lateral border of sacrum | prone- approach medially with prone patient's gluteal muscle relaxed |
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| coronoid process | mouth open 1 inch anterior to mandibular condyle | temporalis attaches here
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| 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
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