Palpation Techniques: Surface Anatomy for Physical Therapists

Palpation Techniques: Surface Anatomy for Physical Therapists
Title Page
Copyright
Contents
Foreword to the First English Edition
Preface
Acknowledgments
1 Basic Principles
	1.1 Why Do Clinicians Need Surface Anatomy?
	1.2 What Is Understood by Surface Anatomy in this Book?
	1.3 When Can Surface Anatomy Be Used?
		1.3.1 Physical Therapy Assessment
		1.3.2 Basic Principles of Regional or Local Treatment
	1.4 Workflow for Palpation
		1.4.1 Objective and Location
		1.4.2 The Reliable Result
		1.4.3 Central Aspects of the Procedure
		1.4.4 Pressure Applied during Palpation
	1.5 Palpatory Techniques
		1.5.1 Palpating the Skin
		1.5.2 Palpating Bony Edges
		1.5.3 Palpating Bony Prominences
		1.5.4 Palpating Muscle Bellies
		1.5.5 Palpating the Edge of Muscles
		1.5.6 Palpating Tendons
		1.5.7 Palpating Ligaments
		1.5.8 Palpating Capsules
		1.5.9 Palpating Bursae
		1.5.10 Palpating Peripheral Nerves
		1.5.11 Palpating Blood Vessels (Arteries)
	1.6 Palpation Aids
		1.6.1 Guiding Structures
		1.6.2 Connecting Lines
		1.6.3 Supporting Measures for Confirming a Palpation
		1.6.4 Marking Structures
		1.6.5 Starting Positions for Practice (Practice SPs)
2 Shoulder Complex
	2.1 Introduction
		2.1.1 Significance and Function of the Shoulder Region
		2.1.2 Common Applications for Treatment in this Region
		2.1.3 Required Basic Anatomical and Biomechanical Knowledge
	2.2 General Orientation—Posterior
		2.2.1 Summary of the Palpatory Process
		2.2.2 Topographical Position of the Scapula
	2.3 Local Palpation—Posterior
		2.3.1 Overview of the Structures to be Palpated
		2.3.2 Summary of the Palpatory Process
		2.3.3 Palpation of Individual Structures
	2.4 Local Palpation—Lateral
		2.4.1 Overview of the Structures to be Palpated
		2.4.2 Summary of the Palpatory Process
		2.4.3 Palpation of Individual Structures
	2.5 General Orientation—Anterior
		2.5.1 Starting Position
		2.5.2 Supraclavicular and Infraclavicular Fossae
	2.6 Local Palpation—Anteromedial
		2.6.1 Overview of the Structures to be Palpated
		2.6.2 Summary of the Palpatory Process
		2.6.3 Palpation of Individual Structures
		2.6.4 Tips for Assessment and Treatment
	2.7 Local Palpation—Anterolateral
		2.7.1 Overview of the Structures to be Palpated
		2.7.2 Summary of the Palpatory Process
		2.7.3 Palpation of Individual Structures
3 Elbow Complex
	3.1 Introduction
		3.1.1 Significance and Function of the Elbow Complex
		3.1.2 Common Applications for Treatment in this Region
		3.1.3 Required Basic Anatomical and Biomechanical Knowledge
	3.2 General Orientation—Anterio
		3.2.1 Boundaries of the Cubital Fossa
	3.3 Local Palpation—Anterior
		3.3.1 Overview of the Structures to be Palpated
		3.3.2 Summary of the Palpatory Process
		3.3.3 Palpation of Individual Structures
		3.3.4 Neurovascular Bundle
		3.3.5 Proximal Radioulnar Joint (PRUJ)
		3.3.6 Tips for Assessment and Treatment
	3.4 Local Palpation—Medial
		3.4.1 Overview of the Structures to be Palpated
		3.4.2 Summary of the Palpatory Process
		3.4.3 Palpation of Individual Structures
		3.4.4 Differentiation in the Presence of Epicondylitis
		3.4.5 Tips for Assessment and Treatment
	3.5 Local Palpation—Lateral
		3.5.1 Summary of the Palpatory Proces
		3.5.2 Locating the Most Important Osseous Structures
		3.5.3 Locating the Muscles and their Insertions
		3.5.4 Locating the Lateral Insertion Tendinopathies
		3.5.5 Tips for Assessment and Treatment
		3.5.6 Palpation in the Radial Tunnel
	3.6 General Orientation—Posterior Humerus
		3.6.1 Summary of the Palpatory Process
		3.6.2 Palpating Warmth and Swelling
4 Hand
	4.1 Significance and Function of the Hand
		4.1.1 Causes of the Diversity of Functions in the Hand
		4.1.2 Common Applications for Treatment in this Region
		4.1.3 Required Basic Anatomical and Biom echanical Knowledge
		4.1.4 Axial Divisions of the Skeleton of the Hand into Columns and Their Clinical Significance
		4.1.5 The Carpus
		4.1.6 Kinematic and Kinetic Model of the Hand
		4.1.7 Triangular Fibrocartilage Complex (TFC)
		4.1.8 Construction of the Carpal Tunnel
		4.1.9 Extensor Tendons and their Compartments
	4.2 General Orientation—Dorsal
		4.2.1 Summary of the Palpatory Process
		4.2.2 Palpation of Individual Structures
		4.2.3 Tips for Assessment and Treatment
	4.3 Local Palpation of the Dorsal Soft Tissues
		4.3.1 Summary of the Palpatory Process
		4.3.2 Palpation of Individual Structures
		4.3.3 Radial Nerve, Cephalic Vein, and Radial Artery
		4.3.4 Tips for Assessment and Treatment
	4.4 Local Palpation of the Dorsal Aspect of the Carpal Bones
		4.4.1 Summary of the Palpatory Process
		4.4.2 Carpal Bones in the Radial Column
		4.4.3 Carpal Bones in the Central Column
		4.4.4 Tips for Assessment and Treatment
		4.4.5 Carpal Bones in the Ulnar Column
		4.4.6 Tips for Assessment and Treatment
	4.5 General Orientation—Palmar
		4.5.1 Summary of the Palpatory Process
		4.5.2 Edge of the Radius
	4.6 Local Palpation of the Palmar Soft Tissues
		4.6.1 Summary of the Palpatory Process
		4.6.2 Palpation of Individual Structures
		4.6.3 Summary of all Radial Structures
		4.6.4 Summary of all Ulnar Structures
		4.6.5 Tips for Assessment and Treatment
	4.7 Local Palpation of the Palmar Aspect of the Carpal Bones
		4.7.1 Summary of the Palpatory Process
		4.7.2 Palpation of Individual Structures
		4.7.3 Tips for Assessment and Treatment
5 Hip and Groin Region
	5.1 Introduction
		5.1.1 Lumbar-Pelvic-Hip Region
		5.1.2 Functional Significance of the Pelvis and Hip Joint
		5.1.3 Pathology and Common Applications for Treatment in this Region
		5.1.4 Required Basic Anatomical and Biomechanical Knowledge
	5.2 Local Palpation—Lateral
		5.2.1 Overview of the Structures to be Palpated
		5.2.2 Summary of the Palpatory Process
		5.2.3 Palpation of Individual Structures
	5.3 Local Palpation—Dorsal
		5.3.1 Overview of the Structures to be Palpated
		5.3.2 Summary of the Palpatory Process
		5.3.3 Palpation of Individual Structures
	5.4 Local Palpation—Anterior
		5.4.1 Overview of the Structures to be Palpated
		5.4.2 Summary of the Palpatory Process
		5.4.3 Palpation of Individual Structures
6 Knee Joint
	6.1 Introduction
	6.2 Significance and Function of the Knee Joint
	6.3 Pathological Conditions and Common Applications for Treatment
		6.3.1 A Selection of Possible Pathologies
		6.3.2 Common Assessment and Treatment Techniques
	6.4 Required Basic Anatomical and Biomechanical Knowledge
		6.4.1 Construction of the Femorotibial Joint
		6.4.2 Construction of the Patellofemoral Joint
		6.4.3 Proximal Tibiofibular Joint
		6.4.4 Muscles of the Knee Joint
		6.4.5 Neural Structures
	6.5 Palpation for Warmth and Swelling
		6.5.1 Palpating an Increase in Temperature
		6.5.2 Palpating Edema
	6.6 Local Palpation—Anterior
		6.6.1 Summary of the Palpatory Process
		6.6.2 Palpation of Individual Structures
		6.6.3 Tips for Assessment and Treatment
	6.7 Local Palpation—Medial
		6.7.1 Summary of the Palpatory Process
		6.7.2 Boundaries of the Joint Space
		6.7.3 Medial Epicondyle of the Femur
		6.7.4 Medial Gastrocnemius Tubercle
		6.7.5 Anteromedial and Medial Soft Tissues
		6.7.6 Tips for Treatment
	6.8 Local Palpation—Lateral
		6.8.1 Summary of the Palpatory Process
		6.8.2 Palpation of Individual Structures
		6.8.3 Tips for Assessment and Treatment
	6.9 Local Palpation—Posterior
		6.9.1 Summary of the Palpatory Process
		6.9.2 Palpation of Individual Structures
		6.9.3 Tips for Assessment and Treatment
7 Foot
	7.1 Introduction
		7.1.1 Significance and Function of the Foot
		7.1.2 Special Characteristics of the Bony Construction
		7.1.3 Features of the Nomenclature
		7.1.4 Special Biomechanical Characteristics
		7.1.5 Common Symptoms in the Foot
		7.1.6 Required Basic Anatomical and Biomechanical Knowledge
	7.2 Local Palpation of the Medial Border of the Foot
		7.2.1 Summary of the Palpatory Process
		7.2.2 Overview of the Structures to be Palpated
		7.2.3 Position of the Medial Ligaments
		7.2.4 Tips for Treatment
	7.3 Palpation of the Lateral Border of the Foot
		7.3.1 Summary of the Palpatory Process
		7.3.2 Overview of the Structures to be Palpated
		7.3.3 Tips for Assessment and Treatment
	7.4 Local Palpation of the Dorsum of the Foot
		7.4.1 Summary of the Palpatory Process
		7.4.2 Overview of the Structures to be Palpated
		7.4.3 Tips for Assessment and Treatment
	7.5 Local Palpation of the Distal Posterior Leg
		7.5.1 Summary of the Palpatory Process
		7.5.2 Overview of the Structures to be Palpated
		7.5.3 Borders of the Achilles Tendon
		7.5.4 Insertion of the Triceps Surae
		7.5.5 Palpation of the Tendon
8 Soft Tissues
	8.1 Significance and Function of Soft Tissues
	8.2 Common Applications for Treatment in this Region
	8.3 Required Basic Anatomical and Biomechanical Knowledge
	8.4 Summary of the Palpatory Process
		8.4.1 Extent of the Palpation
		8.4.2 Criteria for Palpation
	8.5 Method and Techniques of the Palpatory Process
	8.6 Starting Position
		8.6.1 Difficult and Alternative Starting Positions
	8.7 Palpation Techniques
		8.7.1 Palpating the Surface of the Skin
		8.7.2 Palpating the Quality of the Skin (Turgor
		8.7.3 Palpating the Consistency of Muscle (Assessment of Muscle Tension)
	8.8 Tips for Assessment and Treatment
		8.8.1 Differentiating between Tissues
		8.8.2 Interpreting the Findings of Skin Surface Palpation
		8.8.3 Interpreting the Skin Consistency (Turgor) Palpation Findings
		8.8.4 Interpreting the Muscle Consistency (Tension) Palpation Findings
	8.9 Examples of Treatment
		8.9.1 Lumbar Functional Massage in Side-lying
		8.9.2 Functional Massage of the Trapezius in Side-lying
9 Posterior Pelvis
	9.1 Significance and Function of the Pelvic Region
	9.2 Common Applications for Treatment in this Region
	9.3 Required Basic Anatomical and Biomechanical Knowledge
		9.3.1 Gender-based Differences
		9.3.2 Coxal Bone
		9.3.3 Sacrum
		9.3.4 The Pelvic Ligaments
		9.3.5 The Sacroiliac Joint
		9.3.6 Sacroiliac Joint Biomechanics
		9.3.7 Ligament Dynamization in the Sacroiliac Joint
	9.4 Summary of the Palpatory Process
	9.5 Palpatory Techniques for Quick Orientation on the Bones
		9.5.1 Starting Position
	9.6 Palpatory Procedures for Quick Orientation on the Muscles
		9.6.1 Starting Position
	9.7 Local Palpation Techniques
		9.7.1 Summary of the Palpatory Procedure
		9.7.2 Ilium—Iliac Crest
		9.7.3 Ilium—Posterior Superior Iliac Spine (PSIS)
		9.7.4 Sacrum—S2 Spinous Process
		9.7.5 Sacrum—Median Sacral Crest
		9.7.6 Sacrum—Insertion of the Multifidus
		9.7.7 Sacrum—Sacral Hiatus
		9.7.8 Sacrum—Sacrococcygeal Transition
		9.7.9 Sacrum—Inferolateral Angles of the Sacrum
		9.7.10 Sacrotuberous Ligament
		9.7.11 Long Posterior Sacroiliac Ligament
	9.8 Orienting Projections
		9.8.1 Posterior Inferior Iliac Spine (PIIS)
		9.8.2 Sacroiliac Joint Projection
		9.8.3 Piriformis
		9.8.4 Sciatic Nerve and the Gluteals
	9.9 Tips for Treatment
10 Lumbar Spine
	10.1 Significance and Function of the Lumbar Spine
		10.1.1 Supporting the Weight of the Body
		10.1.2 Spatial Alignment of the Upper Body
		10.1.3 The Importance of Stability for Standing and Lifting
		10.1.4 Movement in the Trunk
		10.1.5 Development of Energy Needed for Locomotion
		10.1.6 Junction between the Rigid and Mobile Vertebral Column
	10.2 Common Applications for Treatment in this Region
	10.3 Required Basic Anatomical and Biomechanical Knowledge
		10.3.1 Anatomical Definitions
		10.3.2 Shape of the Inferior Lumbar Vertebrae and Intervertebral Disks
		10.3.3 Detailed Anatomy of Bony Structures
		10.3.4 Detailed Anatomy of the Ligaments
		10.3.5 Detailed Anatomy of the Muscles
		10.3.6 Basic Biomechanical Principles
	10.4 Overview of the Structures to be Palpated
	10.5 Summary of the Palpatory Process
	10.6 Starting Position
		10.6.1 Positioning in the Frontal Plane
		10.6.2 Positioning in the Transverse Plane
		10.6.3 Difficult and Alternative Starting Positions
	10.7 Palpation Techniques
		10.7.1 Orienting Projections
		10.7.2 Local Bony Palpation
	10.8 Tips for Treatment
		10.8.1 Research Findings on Reliable Lumbar Palpation
		10.8.2 Test for Rotation (Transverse Vertebral Pressure)
		10.8.3 Posteroanterior Segmental Joint Play
		10.8.4 Palpation during Flexion and Extension Movements
		10.8.5 Anteroposterior Segmental Joint Play
		10.8.6 Local Segmental Mobility Using Coupled Movements
		10.8.7 Training the Multifidus
11 Abdominal Region
	11.1 Significance of the Region
	11.2 Common Applications for Treatment in this Region
	11.3 Required Knowledge (Topographic and Morphologic)
		11.3.1 Boundaries of the Abdominal Wall
		11.3.2 Regions of the Abdominal Wall
		11.3.3 Deep and Superficial Abdominal Muscles
		11.3.4 Organs of the Abdominopelvic Cavity
		11.3.5 Anatomy of the Groin
	11.4 Summary of the Palpatory Process
	11.5 Overview of the Structures to be Palpated
		11.5.1 Bony Structures
		11.5.2 Orienting Projections
		11.5.3 Muscles
		11.5.4 Palpation of the Colon
		11.5.5 Palpation of the Groin Region
	11.6 Starting Position
		11.6.1 Difficult and Supplementary SPs
	11.7 Palpation of the Bony Structures
		11.7.1 Preparation
		11.7.2 Xiphoid Process
		11.7.3 Costal Arch
		11.7.4 Anterior Superior Iliac Spine (ASIS) and Inguinal Ligament
		11.7.5 Pubic Symphysis
	11.8 Orienting Projections
		11.8.1 Epigastric Region
		11.8.2 Lower Abdomen
		11.8.3 Anterior Median Line
	11.9 Muscles
		11.9.1 Rectus Abdominis
		11.9.2 Linea Semilunaris
		11.9.3 Regional Subdivision of the Central Abdomen
	11.10 Palpation of the Colon
		11.10.1 Locating the Cecal Point
		11.10.2 Locating the Ascending Point
		11.10.3 Locating the Linear Point
		11.10.4 Locating the Descending Point
		11.10.5 Locating the Sigmoid Point
	11.11 Palpation of the Groin Region
		11.11.1 Technique and Expectations
		11.11.2 Palpation of Inguinal Hernias
12 Thoracic Spine and Thoracic Cage
	12.1 Significance and Function of the Thoracic Region
		12.1.1 Protective Function
		12.1.2 Supportive Function
		12.1.3 Junction between the Cervical and Lumbar Spines
		12.1.4 Respiration
		12.1.5 How Does this Affect Palpation?
	12.2 Common Applications for Treatment in this Region
	12.3 Required Basic Anatomical and Biomechanical Knowledge
		12.3.1 Functional Divisions in the Thoracic Spine
		12.3.2 Anatomical Characteristics of the Thoracic Spine
		12.3.3 Thorax
		12.3.4 Thoracic Back Muscles
	12.4 Overview of the Structures to be Palpated
	12.5 Summary of the Palpatory Process
	12.6 Starting Position
		12.6.1 Difficult and Alternative Starting Positions
	12.7 Posterior Palpation Techniques
		12.7.1 Cervicothoracic Junction in the Sitting Starting Position
		12.7.2 Cervicothoracic Junction in the Prone Starting Position
		12.7.3 Tips for Assessment and Treatment
	12.8 Anterior Palpation Techniques
		12.8.1 Anterior Palpation in the Sitting Starting Position
		12.8.2 Anterior Palpation in the Supine Starting Position
		12.8.3 Thoracic Palpation in the Sidelying Starting Position
		12.8.4 Tips for Assessment and Treatment
13 Cervical Spine
	13.1 Significance and Function of the Cervical Spine
	13.2 Common Applications for Treatment in this Region
	13.3 Required Basic Anatomical and Biomechanical Knowledge
		13.3.1 Sections of the Cervical Spine
		13.3.2 Anatomy of the Lower CervicalSpine
		13.3.3 Lower Cervical Spine Biomechanics
		13.3.4 Anatomy of the Occiput and the Upper Cervical Spine
		13.3.5 Ligaments of the Cervical Spine
		13.3.6 Biomechanics of the Upper Cervical Spine
		13.3.7 Posterior Muscles
		13.3.8 Anterior and Lateral Muscles
		13.3.9 Nerves and Blood Vessels
	13.4 Overview of the Structures to be Palpated
	13.5 Summary of the Palpatory Process
	13.6 Starting Position
		13.6.1 Difficult and Alternative Starting Positions
	13.7 Posterior Palpation Techniques
		13.7.1 Occiput
		13.7.2 Suboccipital Fossa and Ligamentum Nuchae
		13.7.3 C2 Spinous Process
		13.7.4 Spinous Processes of the Lower Cervical Spine
		13.7.5 Facet Joints
		13.7.6 Muscles, Suboccipital Nerves, and Blood Vessels
	13.8 Tips for Assessment and Treatment
		13.8.1 Functional Massage of the Trapezius in Supine Position
		13.8.2 Test for the Alar Ligaments
		13.8.3 Identifying the Level of Chronically Irritated Intervertebral Disks
		13.8.4 Functional Massage
	13.9 Lateral Palpation Techniques
		13.9.1 Angle of the Mandible
		13.9.2 C1 Transverse Process
		13.9.3 C2 and C3 Transverse Processes
		13.9.4 Boundaries of the Posterior Triangle of the Neck
		13.9.5 Occipital Triangle of the Neck
		13.9.6 Supraclavicular Triangle of the Neck
	13.10 Anterior Palpation Techniques
		13.10.1 Anatomy
14 Head and Jaw
	14.1 Introduction
		14.1.1 Significance and Function of the Temporomandibular Joint
		14.1.2 Common Applications for Treatment in this Region
		14.1.3 Required Basic Anatomical and Biomechanical Knowledge
	14.2 Anatomy of the Bony Skull
		14.2.1 Dividing the Head into Regions
		14.2.2 Overview of the Frontal Aspect of the Viscerocranium
	14.3 Palpation of the Bony Skull
		14.3.1 Frontal Aspect of the Viscerocranium
		14.3.2 Lateral Aspect of the Skull
	14.4 The Jaw—Temporomandibular Joints
		14.4.1 Required Basic Knowledge of Topography and Morphology
		14.4.2 Biomechanics of the Temporomandibular Joint
		14.4.3 Assessing Deviations from the Mid-line during Mouth Opening
	14.5 Palpating the Temporomandibular Joints
		14.5.1 Overview of the Structures to be Palpated
		14.5.2 Summary of the Palpatory Process
		14.5.3 Assessment of the Clicking Phenomenon during Active Mouth Opening
	14.6 Palpatory Examination of the Jaw Muscles
		14.6.1 Overview of the Structures to be Palpated
		14.6.2 Summary of the Palpatory Process
		14.6.3 Masseter
		14.6.4 Tips for Assessment and Treatment
		14.6.5 Medial Pterygoid Muscle
		14.6.6 Lateral Pterygoid Muscle
		14.6.7 Temporalis
		14.6.8 Anterior and Posterior Bellies of the Digastric
Index