LE PALPATION REVIEWER

REFERENCES: Brunnstrom’s Clinical Kinesiology by Peggy A. Houglum & Dolores B. Bertoti, and
Physical Examination of the Spine & Extremities by Stanley Hoppenfield

HIP AND PELVIS

STRUCTURE PROCEDURE
Bony Palpation (Anterior Aspect)
Anterior Superior Iliac Spine Stand in front of the patient and place
your hands upon the sides of his waist
with your thumbs on the anterior superior
iliac spines and your fingers on the
anterior portion of his iliac crests.
Iliac Crest BRUNN: Subject with “hands on hips” so
that whole hand depicts the location of the
iliac crest with the index finger on the
ASIS and thumb on the PSIS
Iliac Tubercle HOPP: Keep your thumb upon the
anterior superior iliac spine (ASIS) and
move your fingers posteriorly along the
lateral lip of iliac crest. About three inches
from the top of the crest, you can palpate
the iliac tubercle, which marks the widest
point of the crest.
Greater Trochanter HOPP: With your thumbs still in place on
the ASIS, move your fingers down from
the iliac tubercles to the greater
trochanters of the femurs. The posterior
edge of the greater trochanter is relatively
uncovered and is easily palpable. The
anterior and lateral portions are covered
by muscles and are less accessible to
palpation

Pubic Symphysis (topmost) (Reference: landmarks only :( ) Start from

the ASIS then follow along the inguinal
ligament in a oblique direction towards
the pubic tubercles. Move medially in the
area between the two tubercles to feel the
amphiarthrodial joint.

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Pubic Tubercle
Superior Aspect of Superior Ramus of
Pubis
Bony Palpation (Posterior Aspect)
Posterior Superior Iliac Spine
Ischial Tuberosity (side lying)
Ischial Tuberosity (sitting)
Ischial Tuberosity (standing)
Sacroiliac Joint
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With your fingers anchored on the
trochanters, move your thumbs along the
inguinal creases medially and obliquely
downward until you can feel the pubic
tubercles. (Hoppenfield)
With the patient lying in supine position,
Locate first the ASIS then move the
palpating finger medially and inferiorly
following the inguinal ligament where we
can locate the pubic tubercle. From the
pubic tubercle, move again the palpating
finger laterally and superiorly and just
below the inguinal ligament is where the
Superior ramus of pubis located.
From the iliac crest, continue palpating
posteriorly, following the end of the iliac
crest. This is easily located for it lies
directly underneath the visible dimples
just above the buttocks.
Flex the subject’s hip so that the gluteus
maximus moves upward and the ischial
tuberosity becomes easily palpable. With
your fingers in place upon the greater
trochanter, move your thumb from the
posterior superior iliac spine to the ischial
tuberosity. (Hoppenfield)
Easily to locate when sitting on a hard
chair. (Houglum)
The tuberosities may be palpated when a
subject stands in front of a table or parallel
bars. He or she flexes trunk toward while
supporting the weight of the trunk on the
hands. The ischial tuberosities are
palpated when the individual in this
position and then returns to the erect
posture, using the arms to push up the
trunk into extension rather than the hip
extensor muscles. (Houglum)
Not palpable due to the overhang of the
ilium and the obstruction of the
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 supporting ligaments. The center of the
joint, at S2, is crossed by an imaginary line
drawn between the posterior superior iliac
spines.
Soft Tissue Palpation
Femoral Artery
The femoral artery passes under the
inguinal ligament at about its midpoint. Its
pulse is palpable just inferior to the
inguinal ligament, at a point halfway
between the ASIS and the pubic tubercle
(Hopp).

Sciatic Nerve Have the patient remain on his side, with

his back to you. The sciatic nerve is located
midway between the greater trochanter
and the ischial tuberosity. When the hip is
extended, the nerve is covered by the
gluteus maximus muscle, but moves out of
the way when the hip is flexed. Palpate the
greater trochanter and ischial tuberosity
and press firmly into the soft tissue
depression at the midpoint (Hopp).
Psoas Major With subject in supine or sitting, subject
relaxes abdominal muscles. The palpating
fingers are placed at waist, between lower
ribs and iliac crest, probing deeply but
gently toward posterior wall of abdominal
cavity, near vertebral column. The round,
firm belly of the psoas major may be felt as
the muscle contracts.
Rectus Femoris BRUNN: With subject supine, resist hip
flexion and knee extension: rectus femoris
is palpated proximally in the “V” formed
between laterally running TFL and
medially running sartorius; muscular
portion can be palpated and followed
down the anterior thigh to attachment
onto superior patella
Sartorius Passively position the subject’s hip in
lateral rotation with both knee and hip

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 flexed to 90°. From the ASIS, move distally
and medially going to the upper medial
surface of tibia.
Tensor Fascia Lata With the patient lying in supine position,
TFL can be identified near the hip, lateral
to the upper portion of Sartorius. Strong
contraction of TFL is brought out by
resisting flexion of the internally rotated
hip.
Adductor Longus Position the subject in supine with legs
abducted away from the midline. From the
area of pubic symphysis, move distally
toward the middle of the thigh.
Gracilis The gracilis crosses the knee, attaching on
the anteromedial side of tibia beside
Sartorius and semitendinosus; resistance
to knee flexion activates hamstrings and
gracilis; hamstrings run laterally to ischial
tuberosity while gracilis belly is medial,
attaching on inferior pubic ramus (Brunn).
Gluteus Maximus BRUNN: In prone or standing, gluteus
maximus is easily observed by simply
“setting” it without any joint motion being
carried out; stronger activation of the
muscle seen with hip extension and lateral
rotation. Strong contraction of the gluteus
maximus also observed in climbing stairs,
in running and jumping.
Hamstring as a group HOPP: With the subject turned to his/her
side and knees to their chest, the common
origins on the ischium can be palpated.
The muscles should be palpated
bilaterally and compared for consistency
and symmetry of size and shape. The
hamstring muscles consist of the biceps
femoris on the lateral side and the
semitendinosus and semimembranosus
on the medial side and can be palpated
from origin to insertion.
Biceps Femoris Position the subject in prone with flexed
knee and tibial lateral rotation. At the
posterior lateral thigh, locate the ischial

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 tuberosity then move distally going to the
head of the fibula.
Semimembranosus BRUNN: With subject prone, the distal
portion can be palpated while resisting
knee flexion or knee knee flexion with
medial tibial rotation.
Semitendinosus BRUNN: With subject
prone,Semitendinosus tendon is palpated
just proximal to the posterior medial knee
with the knee flexed.
Gluteus Medius BRUNN: palpate laterally below below the
crest of ilium superior to greater
trochanter during active abduction of the
pt.’s leg. HISLOP: To make the muscle pop
out even more, put resistance on the
lateral aspect of the knee while the patient
abducts.

KNEE
STRUCTURE PROCEDURE
Bony Palpation
Femoral Condyles For the palpation of femoral condyles (
medial and lateral) it can be palpated best
with the subject sitting with knee relaxed
in 90 degree of flexion (BRUNN)/ more
than 90 degree of flexion (HOPP). Femoral
condyles can be felt anteriorly on both
sides of the patella but the lateral femoral
condyle may have less surface available
for palpation than Medial femoral condyle
as the lateral femoral condyle is covered
by the patella.
Femoral Epicondyles The lateral femoral epicondyle lies lateral
to the lateral femoral condyle, and the
medial femoral epicondyle medial to the
medial femoral condyle.
Adductor Tubercle HOPP: start from the medial surface of the
medial femoral condyle and move further
posteriorly until you locate the adductor
tubercle in the distal end of the natural

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 depression between the vastus medialis
and hamstring muscles

Tibiofemoral Joint Lines BRUNN: With a normal knee relaxed in

extension, the joint line is palpated
laterally and medially just inferior from the
patella’s inferior pole. This can be
confirmed by passively rotating or
extending the knee while feeling the
motion of the tibial condyles on the femur.
Tibial Plateaus Ask the subject to sit with their knee flexed
to 90°. To palpate the lateral and medial
tibial plateaus, place both right and left
thumbs on the medial and lateral soft
tissue depression of the patient’s knee
then push your thumb inferiorly until you
feel the sharp upper edge.
Tibial Tuberosity From the inferior aspect of the patella,
follow the infrapatellar tendon distally to
where it inserts into the tibial tubercle.
Gerdy’s Tubercle With the subject in sitting position, the
elevation is palpated as a semicircular
structure directly inferior to the edge of
the tibial plateau. It is usually easy to locate
the area of roughness and its borders by
again using several flattened fingers to
stroke over the anterolateral side of the
tibia slightly inferior to the joint space.
Crest of Tibia The sharp crest of the tibia divides the
bone into medial and lateral aspects and
may be palpated distally to the ankle
(Brunn).
Head of Fibula
From the lateral humeral epicondyle,
move your thumb inferiorly and across the
joint line. The fibular head is situated at
about the same level as the tibial tubercle
(Hopp).

Trochlear Groove After placing your thumbs over the medial

and lateral joint lines, move upward along
the two femoral condyles to the highest
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 point of the patella. Then, above the
patella, palpate toward the midline until
you reach the depression of the trochlear
groove. (Hoppenfield)
Patella BRUNN: The patella is best palpated when
the subject is supine with the knee
extended and relaxed.
Soft Tissue Palpation
Medial (Tibial) Collateral Ligament HOPP: Relocate first the medial joint line
then, move medially and posteriorly. The
ligament lies directly under your
fingertips.
Lateral (Fibular) Collateral Ligament HOPP: Have the pt. cross his legs so that
his ankle rests upon the opposite knee.
When the knee is flexed to 90 deg and the
hip is abducted and externally rotated, the
iliotibial band relaxes and the LCL is
isolated.
Medial Meniscus HOPP: The edge of medial meniscus can
be palpated if the palpating finger is
placed on the joint line of the anterior
margin of medial collateral ligament and
when the tibia is internally rotated.
Lateral Meniscus HOPP: Best palpated when the pt.’s knee
is in slight flexion, for it usually disappears
within the joint upon full extension. It is
secured to the edge of the tibial plateau
by coronary ligaments.
→ Relax iliotibial band and LCL.
Iliotibial band/tract HOPP: It is palpable to the point where it
inserts to the lateral tibial tubercle. The
tract is more conveniently palpable when
the knee is extended and the leg raised.
Or when the knee is flexed against
resistance.
Infrapatellar Tendon This tendon runs from the inferior border
of the patella, and is palpable to its
insertion into the tibial tubercle.
Common Peroneal Nerve The nerve is palpable where it crosses the
neck of the fibula. It can be rolled gently
between the tip of your finger and the
neck of the fibula, slightly inferior to the

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 insertion of the biceps femoris (fibular
head) (Hopp).
Rectus Femoris When the hip is flexed, the tendon of
origin may be observed and palpated in
the V-shaped area between the sartorius
and the tensor fascia lata. The muscular
portion is superficial and may be followed
down to its attachment on the patella.
Becomes more prominent upon isometric
contraction. (Houglum; Hoppenfield)
Vastus Lateralis The muscle may be seen and palpated
from just below the greater trochanter
down to the patella. Becomes more
prominent upon isometric contraction
(Houglum; Hoppenfield)
Vastus Medialis BRUNN: The vastus medialis can be
palpated in the medial lower third of the
thigh. It’s bulky mass is more distal
compared to the vastus lateralis. To make
it more prominent, have the patient do
isometric contraction by letting them hold
the knee extension.

Vastus Intermedius BRUNN: With patient sitting and knees

extended, it may be palpated underneath
the rectus if approached from the medial
or lateral side of the rectus
Biceps Femoris BRUNN: When knee flexion is resisted and
subject in prone, the long head of the
biceps femoris may be observed and
palpated from its attachment on the head
of the fibula to the ischial tuberosity. The
short head is covered largely by the long
head and is, therefore, difficult to identify.
Semimembranosus Have the patient in prone position first.
With resistance over the flexing knee, the
semitendinosus tendon pops up in the
medial thigh. You can palpate the
semimembranosus on both sides of this
tendon.
Semitendinosus Position the subject in prone with resisted
knee flexion. To palpate the

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 semitendinosus from its tendon to the
muscle belly, place palpating fingers from
the medial aspect of tibia near the knee
joint, move proximally and obliquely
toward the ischial tuberosity.
Gastrocnemius Position the subject in prone with resisted
knee flexion and plantarflexion. This
subject’s position can help us see the
contraction of the gastrocnemius muscle
belly. To palpate it, from above the
posterior medial and lateral femoral
condyles, move distally to feel the muscle
belly then toward the posterior surface of
calcaneus to feel its tendon.
Other way: Standing with tip toe so the
gastrocs contract

ANKLE AND FOOT

STRUCTURE PROCEDURE
Bony Palpation
Anterior Ridge of Tibia BRUNN: From the tibial tuberosity then go
distally along the shin.
Inferior Tibiofibular Joint HOPP: This joint lies immediately
proximal to the talus. Since the anterior
inferior tibiofibular ligament overlies this
joint, clear palpation of the joint itself is
impossible; however, you can feel a
slight depression directly over it.
Medial Malleolus From the head of the talus, move
proximally until you feel a bony
prominence.
Head of Fibula
From the lateral femoral epicondyle, move
your thumb inferiorly and posteriorly
across the joint line. The fibular head is
situated at about the same level as the
tibial tubercle.
Lateral Malleolus HOPP: The lateral malleolus, located at
the distal end of the fibula, extends
further distally and is more posterior

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 than the medial malleolus. Its
configuration permits the ankle mortise
to point 15° laterally, and its additional
distal extension acts as a deterrent to
eversion ankle sprains.

BRUNN: The most distal end of the bone is

the lateral malleolus, an easily observed
landmark on the lateral aspect of the ankle.
Palpation of the malleoli reveals that the
lateral malleolus projects farther distally
than the medial one.
Medial Side of Head of Talus This is proximal to the navicular and can be
found by inverting and everting the
forefoot. By eversion, the talar head
becomes more prominent.
Anterior Aspect of Dome of Talus HOPP: Keep the patient’s foot in
plantarflexion and inversion. Greater
portion is palpable at the lateral side.
BRUNN: Passively plantarflex the pt.’s
ankle.
→ From the lateral malleolus, go
diagonally and distally to the convexity of
the ankle.
Neck of Talus Place your thumb into the sinus tarsi, then
ask the patient to invert the foot. Then by
pushing your thumb deeper into the sinus,
you may be able to palpate the lateral side
of the talar neck.
Sinus Tarsi Stabilize the patient’s foot at the calcaneus
with one hand and place the thumb of your
free hand into the soft tissue depression
just anterior to the lateral malleolus.
Navicular Tuberosity Move inferiorly from the medial malleolus.
The first prominent bony landmark you
could feel is the navicular tuberosity
Medial Tubercle of Talus The medial tubercle of the talus is small
and barely palpable. It lies immediately
posterior to the distal end of the medial
malleolus (Hopp). The medial talus
becomes more prominent when the foot is
passively everted (Brunn).

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Sustentaculum Tali HOPP: Move plantarward approximately a
finger’s breadth from the distal end of the
malleolus until you find the sustentaculum
tali.
BRUNN: Horizontal shelf of talus wherein is
a slight protuberance at the distal end of
medial malleolus.
Medial and Lateral Tubercle of The medial tubercle of lies on the medial
Calcaneum plantar surface of calcaneus. The medial
tubercle is weight-bearing and is in
contact with the ground, while the lateral
tubercle is not (Brunn and Hopp).
Peroneal Tubercle HOPP: Lies on the calcaneus, distal to
the lateral malleolus. Normally, it is
about a quarter of an inch in length, but
may vary somewhat in different patients.
Navicular HOPP: Moving proximally along the
medial border of the foot, the next large
bony prominence is the navicular tubercle.
BRUNN: Between the head of talus and the
three cuneiforms. It is prominent and
palpated about a finger’s width anterior to
the sustentaculum tali; or an inch in each
direction inferiorly and anteriorly from the
inferior of med. malleolus.
Lateral Cuneiform BRUNN: Lies in line with the third
metatarsal bone, respectively, articulating
proximally with the navicular bone. The
lateral cuneiform articulates with the
medial cuboid.
Intermediate Cuneiform BRUNN: Lies in line with the second
metatarsal bone, articulating proximally
with the navicular bone. The intermediate
cuneiform is the smallest of the
cuneiforms.
Medial Cuneiform Lies in between the base of the first
metatarsal and the navicular tuberosity.
Cuboid Place your thumb on the styloid process of
the 5th Metatarsal bone along the lateral
side of the foot. Then, move proximally
until you feel a depression. Palpate with

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Metatarsal Heads
Sesamoid Bones at 1st Metatarsal Head
Phalanges and its parts
Soft Tissue Palpation
Anterior Talofibular Ligament
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firm pressure medially into this
depression, and the cuboid can be felt.
Move laterally and palpate each
metatarsal head by placing your thumb
on the plantar surface and the index on
the dorsal surface. The transverse arch of
the forefoot is located immediately
behind the metatarsal heads (Hopp).
Have the patient extend his leg with the
sole of his foot facing you, and stabilize the
lower limb by holding his leg posterior to
the ankle joint. From the medial tubercle
of the calcaneus, palpate distally along the
medial longitudinal arch past the base of
the first metatarsal bone to the first
metatarsophalangeal joint. If you press
firmly on the first metatarsal, you can feel
the two small sesamoid bones that lie
within the flexor hallucis brevis tendon.
Palpated in standing or sitting position.
The great toe has two phalanges which
are the proximal and distal phalanx and
the succeeding toes have three phalanx
which are the proximal, middle and distal.
The heads of the proximal phalanges are
trochlear, which fit into the bases of their
adjacent phalanges. The middle
phalanges are broader than the proximal
phalanges but shorter whereas the distal
phalanges are flatter and smaller
In short sitting position with the feet not
touching the floor. Since the anterior
inferior tibiofibular ligament overlies this
joint, a clear palpation of the joint itself is
impossible. But, this joint lies immediately
proximal to the talus.
So, start first by palpating for the dome of
the talus. A small portion of the dome
becomes palpable by asking the patient to
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 invert and plantar flex their foot. From the
dome, going superiorly and medially, you
will feel a slight depression directly over
the inferior tibiofibular joint.
Gastrocnemius BRUNN: It is easily seen contracting when
the pt. rises on tiptoes.
Soleus Patient in prone position. Place palpating
fingers just distal to the gastrocnemius
heads. The foot should be slightly resisted
on the plantar side.

Knees flex and ankles plantarflexed

against slight resistance
Tibialis Posterior Pt position: sitting with one limb crossed
over the other so that foot is relaxed and in
plantarflexed position.
Let the subject invert the foot and the
tendon is visible behind and inferior to the
medial malleolus.
Flexor Digitorum Longus Let the subject flex the toes then apply
resistance. The FDL tendon does not
become very prominent but you can feel
its motion, immediately behind the tibialis
posterior above the medial malleolus.
Flexor Hallucis Longus FHL is quite difficult to identify but it can be
palpated on the medial aspect of the
medial malleolus when the toes are flexed,
and can be confirmed using rhythmical
active flexion of the first toe.
Peroneus Longus The muscular portion of the peroneus
longus is identified below the head of the
fibula and may be followed down the
lateral side of the leg. Its tendon may be
palpated over the lateral plantar aspect of
the cuboid when the foot is plantarflexed
and everted
Peroneus Brevis Let the subject sit with one limb crossed
over the other with plantarflexion and
eversion. The tendon can be palpated to
its insertion into the styloid process of 5th
metatarsal.

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Tibialis Anterior Palpate it distally at its insertion in the
medial aspect of the base of the 1st
metatarsal and the first cuneiform
proximally along the tendon to the
muscle belly on the lateral side of the
tibial shaft. To palpate, ask the patient to
dorsiflex and invert his or her foot
Extensor Hallucis Longus with the pt. in sitting position, EHL tendon
can be palpated by resisting dorsiflexion
of the great toe, and by that, the tendon of
the EHL over the dorsum of the foot may
be observed. we can palpate it along the
dorsum of the foot to its insertion into the
base of distal phalanx of the big toe.
Extensor Digitorum Longus To better see and palpate the tendons of
the toe extensors without simultaneous
contraction of the tibialis anterior, have the
subject sit on a chair and lift the toes off the
floor while maintaining the sole on the
floor. If resistance is given to the four lesser
toes, the individual tendons stand out
better
Peroneus Tertius The extensor digitorum longus and
peroneus tertius form a common tendon
that passes on the dorsum of the ankle,
and is held down by the transverse and
cruciate ligaments. The tendon of the
peroneus tertius, when toes are
EXTENDED, is seen lateral to the EDL
tendon going to the fifth toe
Extensor Digitorum Brevis The muscular portion of the EDB can be
seen on the lateral side of the dorsum of
the foot by assisting extension of 1st, 2nd,
3rd, and 4th toes. The muscle action
produces a muscle bulge and that is the
EDB.
Tibial Nerve Tibial nn. is difficult to palpate but it can
be located immediately posterior and
lateral to the posterior tibial artery which is
located behind the tibialis posterior and
flexor digitorum longus tendon.
Others

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Posterior Tibial Artery Lies between the FDL and FHL tendons.
To palpate, first locate the FDL and the
FHL. You may feel the pulse by pressing
gently into the soft tissue space behind the
tibialis posterior and the flexor digitorum
longus tendons.
Dorsalis Pedis Artery It lies between the extensor hallucis longus
and extensor digitorum longus tendons
on the dorsal surface of the foot. It is
subcutaneous and its pulse is easy to
detect.

TEMPOROMANDIBULAR JOINT
STRUCTURE PROCEDURE
Bony Palpation
Mandibular Condyle Just anterior to the external auditory
canals, the condyles of the mandible can
be palpated. When the subject opens the
mouth or deviates the jaw, the condyles
can be felt to move on the glenoid fossa
and tubercle of the temporal bones. The
mandibular condyles also can be felt by
placing the finger in the ear canal and
pressing anteriorly.
Ramus of Mandible From the angle of mandible, movee
proximally beside the ear.
Body of Mandible The body of the mandible is subcutaneous
and easily palpable. Begin palpating the
inferior border of the body of the
mandible anteriorly and continue
palpating it laterally and posteriorly until
the angle of the mandible is reached.
Angle of Mandible From the body of the mandible, move
posteriorly until you feel a sharp bony
prominence.
Soft Tissue Palpation
Temporalis Move inferiorly from the zygomatic arch
and ask the patient to clench his/her jaw.

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Masseter Move superiorly from the zygomatic arch
and ask the patient to clench his/her jaw.
CERVICAL SPINE AND SKULL
Bony Palpation
Hyoid bone It is a horseshoe-shaped structured
situated above the thyroid cartilage. To
palpate the hyoid, cup your hand around
the anterior portion of the patient’s neck,
just above the thyroid cartilage. Probe with
a pincer like action of your finger and
thumb to palpate its two stems. Ask the
patient to swallow to feel the movement of
the bone.
Facet joints of cervical vertebrae In supine position, From the spinous
process of C2, move each hand laterally
about one inch and begin to palpate the
joints of the vertebral facets that lie
between the cervical vertebrae.
Mastoid process As you palpate laterally from the lateral
edge of the superior nuchal line, you will
feel the rounded mastoid processes of the
skull.
Spinous process of cervical vertebrae B: spinous processes of c2-c6 are best
(C2-C6) palpated with the subject in supine to
relax the muscle of the neck.
H: begin at the base of the skull. C2
spinous process is the first one that is
palpable.
Reichert: it is not possible to accurately
identify the c3 and c4 spinous processes.
only the spinous process of c5-c7 can be
felt reasonably well and can be
differentiated from one another by
placing the pt. cervical spine in lordosis or
by tilting the head backward.
During that movement, c5 spinous
process first moves anterior ( if the pt is in
supine) direction after the light lordosis
has been achieved. c6 spinous process
starts moving anteriorly at the end of the
lordotic range, while c7 spinous process
tends to remain stationary.
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C7 Spinous process and differentiation When the subject flexes the neck forward,
from T1 these processes are identified more easily.
When two processes in this region seem to
be equal in size, they are identified as
those of C-7 and T-1. The prominence of
its spinous process is longer and sturdier
than those of the other cervical vertebrae.
Soft Tissue Palpation
Sternocleidomastoid The Sternocleidomastoid is most
palpable during contralateral lateral
rotation and ipsilateral flexion.
Longus capitis/ Longus colli Place your fingers medially and deep to
the sternocleidomastoid (SCM) muscle
near the anterolateral surface of the
cervical vertebrae. Have the subject rotate
the head to the same side to relax the SCM
and then resist neck flexion with the other
hand so that the muscle contraction can be
felt by the palpating fingers.
Anterior scalene BRUNN: Palpate just above the clavicle
and behind the SCM.
Middle scalene Isolate first the SCM by asking the subject
to rotate the head on the opposite side.
Then palpate the anterior scalene behind
the SCM. Move laterally to palpate the
middle scalene.
Suboccipital muscles BRUNN: Palpated with fingertips when the
subject is supine and the neck muscles are
relaxed.
THORACOLUMBAR PALPATION
Bony Palpation
Spinous process of T3 B: spinous process of t3 is located at the
same horizontal plane as the root of the
pine of the scapula.
Spinous process of T7 The spinous process of T7 is said to be
aligned with the inferior angle of the
scapula. Recalling our UE palpation, the
inferior angle is most palpable when the
patient’s hand is placed at the small of his
or her back.

PALPATION PROCEDURES FOR THE LOWER

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 Once the inferior angle is palpated, ask
the patient to place his/her back to the
side and follow the change of the location
of the inferior angle.

From the inferior angle, move medially

Palpate one of the true ribs
Costal margin
Spinous process of L4 and L5
Soft Tissue Palpation
Intercostal muscles
towards the spine and there you will feel
na spinous process of the seventh
thoracic vertebrae.
(2nd rib) From the sternal angle move
laterally to feel the second costal cartilage
then more laterally to palpate the 2nd rib.
snell: costal margin is the curved lower
margin of the thoracic wall and is formed
in front by the cartilages of the 7th, 8th,
9th, and 10th ribs and behind by the
cartilages of the 11th and 12 th ribs.
Sit on a stool behind the standing patient.
Then, place your fingers on the tops of the
iliac crests and your thumbs on the midline
of the back at the L4/L5 junction (the same
level as the tops of the iliac crests) and
palpate the interspace between the
vertebrae. The spinous processes of L4
and L5 lie above and below the interspace.
May be palpated with patient standing or
sitting by inserting a fingertip between two
ribs. When the ribs move, the muscles are
activated and are palpated more easily.

Have the patient reach overhead the left

arm, then lateral flex the contralateral
trunk., This motion will spread the ribs
apart on the left side. Then have the
subject return the trunk to the upright
position. The intercostals on the left side
may be identified during both parts of this
movement.
Diaphragm BRUNN: With the patient in supine and the
knees flexed, place your finger to the

PALPATION PROCEDURES FOR THE LOWER

EXTREMITIES, SPINE, AND TMJ | OPT 2101 & OPT ERFTM|plmcpt|bspt 2-1
2101.1
 bottom edge of the rib cage. Then
instructing the patient to breathe in this
should put pressure on the abdominal
contents, causing the abdomen to rise
outward.
Erector Spinae Action of the erector spinae as a group
may be observed best in the lumbar and
lower thoracic regions when the subject, in
the prone position, raises the upper part of
the body off the floor.
Rectus abdominis Have the patient in supine position. Then,
place your palpating fingers on the
anterior abdomen, just lateral to the
midline. Then, ask the patient to raise the
head and the shoulders so the spine
flexes, and feel for the contraction of the
rectus abdominis. Once felt, strum across
the rectus abdominis to determine its
width. Then continue palpating to its
superior and inferior attachments by
strumming perpendicularly to its fibers as
the patient alternately contracts and
relaxes the muscle.
Transverse abdominis BRUNN, MA’AM AMORES: Patient should
be in a hook lying position. ASIS is used as
a reference point to palpate the muscle.
Move the palpating fingers a little medial
and superior (or 1 inch medial and 1 inch
inferior) from the ASIS, then instruct the
patient to draw in maneuver or cough as
stimulus (abdominal muscles move
inwards towards spine). While the patient
is holding tension, note that pt not to lift
neck and shoulder to check if muscle is
working. Check if muscle goes inward or
outward
For class discussion
Transverse process of C1 Protrudes more laterally in this region.
Palpated and found just below the tip of
the mastoid process

PALPATION PROCEDURES FOR THE LOWER

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1st rib Medial space in between the neck and
the clavicle
2nd rib Above the clavicle and move lateral at the
base of the neck
11th and 12th rib Glide fingers along the costal margin up
until you go posteriorly
Then upon palpating the inferior and
posterior aspect of the thoracic cage,
proceed on palpating 11th and 12th rib

Transverse process of L4 and L5 2 finger breadth away from the spinous

process
Facet joints of L4 and L5 1 finger breadth away from the spinous
process

PALPATION PROCEDURES FOR THE LOWER

EXTREMITIES, SPINE, AND TMJ | OPT 2101 & OPT ERFTM|plmcpt|bspt 2-1
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