Head neck and Face
Mastoid Process
/ -Pneumatic part of the temporal bone-attchmt site of longissimus capitis, splenius capitis, digastric posterior belly and sternocleidomastoid / -directly postrior to the ear lobe
-can follow SCM superiorly to the mastoid process attchmt
Styloid Process
/ -of the temporal bone-fragile
-deep to facial nerve
-fanglike shape
-not directly palpable (it is likely that you’re feeling ligaments and Mm which attch there) / - landmark mastoid process and posterior mandible edge
- lies btw the mastoid and mandible (anterior to the mastoid process)
Zygomatic Arch / -formed by temporal and zygomatic bones
-inferior to temporalis M
-aka the cheekbone
-anteriorly merges with orbit of eye / -place finger anterior to the ear canal
-move anteriorly to follow arch to the orbit
Angle of the Mandible
/ -forms pt of attchmt for masseter M-at posterior end of the base of the mandible / -fingers inferior to the bottom teeth to find edge of the mandible
-follow the edge posteriorly, along the body of the mandible to the angle
-have client open and close mouth to confirm (the angle will move)
Condyle of the Mandible / -superficial
-anterior to the ear canal
-inferior to zygomatic arch / -place finger pads ant. to the ear canal, below arch, ask partner to open mouth fully as the condyle is more palpable during opening and closing
-it slides anteriorly and inferiorly during opening and returns to position as jaw closes
Ramus of the Mandible / -flat ramus is the posterior vertical portion of the mandible
-deep to the masseter M / -slide superiorly off the angle to the ramus
Coronoid process of the Mandible / -lives 1” anterior to the condyle
-attchmt site for the temporalis M
-opening the mouth fully will bring the coronoid process out from underneath the zygomatic arch / -place finger pads on the middle aspect of the zygomatic arch
-drop one half inch inferiorly and ask partner to open mouth fully
-as mouth opens, process will press into your finger
Sternocleidomastoid
SCM / -located on the lateral and anterior neck
-large belly with two heads (flat clavicular head and a slender sternal head
-both heads merge to attach behind the are to the mastoid process
-carotid artery passes deep and medial to the SCM / Locate the mastoid process, the medial clavicle and the top of the sternum
-draw a line btw these landmarks
-ask partner to raise her head slightly off the table and rotate head slightly to the contralateral side to bring out SCM
Middle Scalene
/ -slightly larger than ant. Scalene-lies lateral to ant. Scalene
-fibres begin at the side of the cervical vertebresa / -SCM lateral edge and trapezius
-roll across the belly of ant. Scalene and move laterally to explore the middle scalene
-have client take an apical breath to activate scalenes
Masseter
O- zygomatic archI-angle & ramus of mandible
A-elevates the mandible
FD-vertical / -strongest M in body
-primary chewing M
-used in speech and swallowing
-made of 2 overlapping bellies
-squareshaped
-superficial belly accessed from face
-deep belly accessed from inside the mouth
-masseter is deep to parotid gland / -zygomatic arch and angle of mandible
-place fingers btw the above landmarks and palpate Masseter
-ask partner to clench teeth and relax as you feel the square shaped M
-strum fingers x-fibre (horizontal)
-ask partner to relax and try grasping the bellies
Temporalis
O-temporal fossa & fasciaI-coronoid process of the mandible
A-elevates mandible &
retracts mandible / -located on temporal aspect of cranium
-fibres converge into a thick mass reaching reaching underneath the zygomatic arch
-deep to temporal fascia and temporal artery / -zygomatic arch
-place fingertips 1 inch superior to the arch
-ask partner to clench & relax jaw
-feel M contract
-palpate for coronoid process and you “may be able to locate the temporalis tendon
Digastric
O-mastoid process (deep to SCM and splenius capitis)I-inf. border of mandible
A- depresses & retracts mandible
-elevates hyoid / -long round M bellies
-post belly:
mastoid to hyoid thru a tendinous sling on ant. surface of hyoid
-ant belly:
from tendinous sling to the underside of the chin / -mastoid and hyoid
-draw imaginary line btw these points
-use index finger to palpate for skinny post. belly
-draw a line btw hyoid & under chin & palpate for ant belly
* place finger under chin & ask partner to open mouth against gentle resistance to bring up both bellies
FOREARM & HAND
Head of Radius
/ -distal to humerus’ lat. Condyle-stabilized by annular ligament
-pivot point for supination/pronation
-deep to supinator & extensors / -shake hands
-locate lateral epicondyle
-slide distal across small ditch onto the head of radius
Head of the Ulna
/ -visible along post. med. side of the wrist / -slide fingers distal along ulnar shaft-just proximal to the wrist, shaft will bulge to become the head of ulna
Lunate
Lunate con’d / -most dislocated carpal bone-just distal to Lister’s tubercle
-flexing wrist will slide the lunate to the dorsal surface
-deep to extensor tendons / -Lister’s tubercle and the base of the third MC
-slightly extend wrist, lay thumb btw these pts and notice how it falls into a small cavity
-set your thumb at the prox end of this cavity, then flex wrist and feel the lunate press into your finger
Capitate
/ -the largest of the carpal bones-is located distal to the lunate
-shallow ditch on its dorsal surface that can be easily palpated
-deep to the extensors / -extend the wrist and feel carpal disappear
-shift thumb to the distal end of the cavity and notice how it bumps into the base of the 3rd MC
-passively flex the wrist noting how the capitate rolls into your finger filling it’s own cavity
Scaphoid
/ -the scaphoid tubercle serves as lat attchmt for flexor retinaculum / -radial surface of scaphoid along flexor crease-walk thumb around to the palmer surface side of scaphoid
-using your thumbpad, explore just distal to the flexor crease for a prominent bony knob
-flex wrist slightly to soften tiss.
Hook of Hamate
/ -distal and lat to the pisiform-palpable one the palmar surface of hand
-attchmt site for flexor retinaculum
-hook is often tender
-pisiform and hook of hamate form a small channel called the Tunnel of Guyon- the ulnar nerve and artery pass thru the canal / -pisiform
-draw line from the pisiform to the base of the 1st finger
-using thumb pad, slide off the pisiform, ½” along line feel hook
Pisiform
/ -knobby attchmt for FCU-distal to flexor crease
-pisiform and hook of hamate form a small channel called the Tunnel of Guyon- the ulnar nerve and artery pass thru the canal / -flexor crease then slide medial and distal rolling thumbpad in small circles
Brachialis
O- distal ½ of the ant surface of humerousI-tuberosity and coronoid process of ulna
A-flexes elbow
/ -lies deep to the biceps brachii on the anterior arm-it’s the biceps best friend because it helps to bulge the arm further
-the lateral edge is palpable between biceps and triceps
-the distal aspect is also palpable as it passes on either side of the biceps tendon / Shake hands, flex elbow to 90 degrees.
Ask partner to flex elbow against resistance to isolate the edges of biceps brachii.
Relax arm, slide ½ inch laterally of distal biceps.
Strum across edge of brachialis and feel the pronounced “thump”
Continue strumming distally to where it disappears into the elbow.
Find biceps tendon and palpate either side to find deeper portions of brachialis
Brachiolradialis
O-Lateral supracondylar ridge of humerousI-Styloid process of radius
A-Flex elbow, assists in pronation and supination of forearm / -on the lateral side of the forearm
-long, oval belly which divides flexors and extensors
-it’s the only muscle that runs the length of the forearm but does not cross the wrist / Shake hands, flex elbow to 90 degrees.
With forearm in neutral position (thumb up) have partner flex against resistance.
Palpate the tubular belly, try to pinch it between your fingers and follow it distal as it becomes tendon.
Extensor Pollicis Longus
O-posterior surface of radius and ulnaI-distal phalange of thumb
A-extends thumb /
-lies along the posterior forearm, deep to the wrist extensors
-forms the posterior wall of the snuffbox. / Wrist in neutral position, ask partner to “bring your thumbnail towards your elbow:.Just distal to the styloid process of radius you will see the snuffbox.
Follow the tendon proximally over the posterior side of radius.
Have partner circumduct thumb to feel muscle belly contract.
Spine and Thorax
Longissimus
O-Common tendon, TVPs of upper five thoracic vertebrea (cervicis and capitis)I-lower 9 ribs and TVPs of thoracic vertebrea (thoracis), TVPs of C-spine(cervical), mastoid process (capitis) / A-(Bilateral) Extends vertebral column, (Unilateral) Ipsilateral lateral flexion of vertebral column / Partner Prone. Lay both hand on either side of lumbar vertebrea and have partner raise and lower their feet slightly.
With partner contracting, palpate inferior to sacrum and superior along T-spine.(have partner extend back and neck to palpate along Thoracic region.)
Follow the fibers up between the scapulas and along the back of the neck (lateral to laminar grooves)
Have partner relax and sink into the fibres and feel their verticle fibre direction.
Multifidi
O-Sacrum and TVPs of L, T, C-spinesI-SPs of L, T and C7-C2 -deep lateral rotator (transversospinalis)
A-extend vertebral column, rotate column to the opposite side / -surprisingly thick mm, directly accessible in the lumbar spine
-the only mm with fibres that lie across the posterior surface of the sacrum / Partner prone.
LM-SPs of lumbar vertebrea, slide fingers laterally sinking between them and the erectors.
Push the erectors laterally out of the way, explore the deep, dense diagonal fibres of the multifidi.
Progress inferiorly to the sacrum, rolling your fingers perpendicular to multifidi.
*ask parnter to extend and rotate back
Splenius Capitis
O-Ligamentum nuchae, SPs C7-T3
I-Mastoid process, lateral nuchal lineA-(Bilat) extends head and neck, (uni) rotates head to same side, laterally flexes head and neck / -deep to the traps and rhomboids
-it’s fibres are angled towards the mastiod
-fibres are superficial between upper traps and SCM / Prone, Locate upper fibres of the traps.
Have partner slightly extend neck to isolate lateral edge of traps.
Have partner relax as you palpate just lateral to traps for the oblique fibres, follow them up to the mastoid and inferior through the traps
OR
Find mastoid process and slide medially and inferiorly onto the superficial capitis fibres
Shoulder and Arm
Bicipital groove`
/ - b/n greater and lesser tubercules- biceps brachii LH tendon lies within / - locate greater tub by shaking hands & locating acromion. Slide inf & lat 1”
- rotate arm lat. As you rotate the gr tub will be replaced by groove
Coracobrachialis
O: coracoid processI: med surf hum
A: flex, add GH jt / - deep to pec major and ant delt
- lat wall of axilla / - supine. Lat rot and abduct shoulder
- locate pec maj fibres
- lay hand on med side of arm and slide into axilla
- have partner adduct against resistance
- find pec maj edge and slide off post to find slender belly of coracob
Latissimus dorsi
O: SP T6-12, iliac crest, inf 4ribs, thoracolumbar fascia
I: floor of bicep groove
A: ext, adduct, med rot shoulder / - broadest mm of back
- post wall of axilla (w teres major) / Prone: arm of side of table, locate lat border of scap
- grasp wad of mm tissue lat to lat border
- ask partner to med rot GH against resistance
- follow fibres into ribs and axilla
Levator scapula
O: TVPs C1-4I: sup med bord scap
A: down rot, elev / - located on lat/post side of neck
- inf portion is deep to UT but it emerges at lat side of neck to b/c superficial / Prone: locate sup angle of scap and up med bord
- place fingers just of sup bord and strum fibres
- follow fibres up lat side of neck
Serratus Anterior
O: lat ext surf of 1st 9 ribs
I: ant med bord of scap
A: abd protract,
Low F: may depress
Upp F: may elevate / - assists in forced respiration
- stab scap to prevent winging / Supine: - abd arm slightly and locate lower edge of pec major, then locate ant border of lats
- place fingers b/n pec and lat
- strum across ribs to feel serratus fibres
isolate location by partner pushing hand towards ceiling
have partner alternate abduct scap and relax
Subscapularis
O: subscap fossa
I: lesser tub
A: med rot / - on ant side sandwiched b/n subscap fossa and serr ant
- only rotator cuff mm that attaches to lesser tub / Sidelying: - flex shoulder and pull arm ant
- hold arm while other thumb locates lat border (slide under lats)
- slowly curl thumb onto subscap fossa
Supine: cradle arm in flexed position and locate lat border
- sink thumb onto subscap fossa
- ask partner to med rotate to activate
Teres major
O: inf ang scap
I: bicp groove med lip
A: add, ext, med rot / -“ lat’s little helper”
- handcuff mm / - prone: arm off table
- locate lat fibres and grasp
- move thumb and finger to lat border
- the mm that lie med to lats and attach to lat bord will be teres maj
- follow towards axilla where they blend with lats
- have partner med rot to distinguish b/n lats
Upper trapezius
O: sup nuch line, lig nuchae, inion, SP C2-7
I: lat 1/3 clav, acromion med side
A: elev, up rot,
LA: lat flex HN, rot chin contralat side
BilatA: ext HN / - superficial
- blankets the shoulders / Prone: - grasp sup tissue on tob of shoulder
- follow sup toward base of head at occiput
- stand at head of table and ask partner to extend head then follow inf to lat clavicle
Lower trapezius
O: SP T6-12I: root of spine of scap
A: up rot, depress / See UT / Prone: draw line from sp of scap to SP T12 to find border
- palpate along
- ask partner to superman
- attempt to lift up the fibres
Pec Major
O: med clav, ant surf sternum, cost cart ribs, apo of abd mm
I: lat lip bicipital groove
A: add, med rot GH, hor add
Clav head: flex hum
Stern head: ext (bring back from flexion)
LA: acc mm of resp / - acc mm of respiration ( tired athlete props arms on iliac crest)
- 3 sections: sternal , clavicular and costal
- the up and low fibres do opposite actions making this mm it’s own antagonist / Supine: - partners shoulder slightly abd stand facing them
- locate med shaft of clav and move inf onto fibres
- follow fibres lat as they blend with deltoid
- grasp belly by sinking thumb into axilla
- ask partner to medially rotate against resistance
sidelying: - supporting partners arm, flex shoulder and pull ant
- grasping pec major explore it’s mass
- passively ext and flex shoulder
Triceps
O: olecrenon
I: LongH: infranglen tub
MedH: post surf hum inf to rad groove
LatH: post surf hum sup to rad groove
A: ext elbow, ext GH jt / - only mm on post arm
- med head is also deep head b/c most is deep to long head / Prone: - bring arm off side of table
- palpate post aspect
- locate olecrenon to outline distal tendon
- ask partner to exten elbow as you resist at forearm. Slide free hand off olecrenon proximally to find tendon
Leg and Foot
Peroneal tubercule / - helps stabilize the peroneal mm / Supine/seated: dorsiflex & locate lat malleolus- slide and inch inf
- may feel like small ridge
Navicular tuberosity / Attcht site for tib post and spring ligament / Supine/seated: locate base of 1st MT
- slide along med foot
- move prox across med cuneiform and the jt b/n med cun and navicular
- explore tuberosity
- tub will lie 1-2” dist to med malleolus
Sustentaculum tali / - shaped like plank
- supports the talus on the calcaneous
- atchmt site for deltoid ligment
- most of it is deep to flexor tendons / Supine/seated: ankle in neutral position
- locate med malleolus and slide 1’ dist to small tip of susten.
- passively inverting the foot will soften surrounding tissues
Head of fibula / - attmt site for biceps femoris, part of soleus and lat collateral ligament / Seated w knee flexed
- locate tib tuberosity
- slide fingers lat 3-4’
Tibialis posterior
O: tib and fib
I: navic tub and surr bones on plantar surf
A: TC: plantarflex, ST: inversion / - Tom, Dick and Harry: most ant: tib post; flexor digitorum longus, tib artery, flexor hallucis longus
- deepest mm of ant compartment
- prime function is to slow pronation after heel contacts ground during gait / Supine, prone: locate med mall
- slide of pos and prox into space b/n post shaft fo tib and calcaneal tendon
- explore tendons and follow around back of med malleolus
-hard to isolate but tib post will be most ant
- have partner invert as you follow T to underside of foot
Peroneus Longus & Brevis
PL:
O: lat prox fib incl head
I: 1st MT, 1st cuneiform lat surf
PB:
O: fib lat dis
I: 5th MT styloid
Both A: TC: planterflex
SC: eversion / - peroneus longus aka fibularis
- located on lat side of fib b/n ext dig long and soleus / Supine/prone: finger on head of fib and lat malleolus
- ask partner to alt evert and relax
- follow peroneus long to head of fib
- now follow both dist to where the T’s wrap around back of lat mall
- follow per brev T to base of 5th MT
Tibialis Anterior
O: prox lat surf tib
I: 1st MT base, 1st cuneiform & plant surf
A: TC: dorsiflex, ST: invert / - ant compartment
- lies directly lat to tib shaft
- large and sup / Supine:- locate shaft of tib and slide lat onto tib ant
- ask partner to dorsiflex
- w ft dorsiflexed follow mm distally as it b/c thick tendon until it disappears at the med cuneiform
Gastrocnemius
O: fem condyles
I: calcaneous
A: TC: plantarflex, flex knee / - triceps surae composed of 2 heads of gastrox and soleus and reaches the calcaneous via the Achilles aka tendocalcaneous T
- it crosses 2 jts (knee and ankle) / Standing: - supported by chair stand on toes
- palpate post leg sculpting gastrox oval heads
- follow both heads to back of knee and distal noting that med head goes farther dist
Prone: - bend knee to 90 and ‘investigate’
Soleus
O: prox fib, tib soleal line
I: calcaneous
A: TC: plantarflex / - deep to gastrox
- “2nd heart” b/c of impt role it’s strong contractions play in returning blood from leg to the heart / See Gastrox:
Standing: - move dist to gastrox and palpate dist portion of soleus
- also plapate med and lat sides that bulge from under gastrox
Prone: - w knee flexed gastrox is ineffectual as plantar flexor. Ask partner to gently plantar flex against resistance
- notice soleus contracted while gastrox stays FLACCID
HIP AND THIGH