Palpation of Bony Landmarks UPPER EXTREMITY Scapula: 1. 2. 3. 4.

Spine From AC joint palpate across the upper part of the posterior surface of the scapula. It is a long (3) thin projection, which runs medial to lateral, at T3 level. Acromion process Located on the lateral part of the shoulder, right above the shoulder joint. Coracoid process Palpate under the lateral part of the clavicle (about one inch below the anterior edge of the clavicle). Medial (vertebral) border The edge of the scapula closest to the vertebral column (about 2 inches from the spinous processes). The medial border runs in a superior-inferior direction. Lateral (axillary) border The lateral (or outer) edge of the scapula located between the inferior angle and the shoulder joint. Superior medial angle Located above the vertebral border or medial aspect of scapula, level T2. Inferior angle Located between vertebral and axillary borders. The point at the bottom of scapula, level T7.

5. 6. 7. Clavicle:

Collar bone anterior from sternum to acromion Humerus: 1. Greater tuberosity Located just below acromion when arm is resting by the side. (proximal end of humerus)

2. Lesser tuberosity Easiest to palpate with arm in shoulder external rotation. located medial to greater tuberosity on proximal end of humerus. 3. 4. Intertubercular (Bicipital) Grove Located between greater and lesser tuberosity; easiest to palpate with arm in external rotation. Medial and lateral epicondyles Palpated on medial and lateral sides, respectively, of distal end of humerus (2 bumps on distal end).

5. 6. Radius: 1. 2. 3. 4. Ulna: 1. 2. 3.

Medial and lateral supracondylar ridge above the medial and lateral epicondyles on distal end of humerus. Olecxranon fossa indentation on posterior of elbow

Head From lateral epicondyle of humerus move distally about 1 inch. Head of radius palpated easiest as you pronate and supinate. Anterior border Ridge just above wrist on lateral aspect of lower forearm. Styloid process In the anatomic position, styloid is lateral just above wrist joint. Dorsal tubercle On distal end of radius on posterolateral aspect of wrist. Feels like a small longitudinal bony prominence or module.

Olecranon Funny bone long protuberance on posterior of elbow. Styloid process In the anatomic position, styloid process is on medial aspect of wrist, also slightly posterior. Is more proximal than radial styloid process. Head On distal end of ulna. In supination, it can be palpated on medial-anterior aspect of wrist (just proximal to wrist). In pronation, head is the projection on posterior aspect (ulnar side) of wrist.

Carpals: 1. 2. 3. 4. 5. 6. Pisiform Pea-shaped bone on ulnar side of hand (palmar surface) Scaphoid On radial side of wrist easiest to palpate in floor of anatomical snuffbox (proximal to thumb) as you move hand into ulnar deviation. Trapezium On radial side of wrist where it articulates with 1st metacarpal to form saddle joint. Easiest to palpate as you flex and extend the thumb. Hamate (hook) Located slightly distal and radial to the pisiform. Capitata Proximal to the base of the third metacarpal between the dorsal tubercle of the radius and the third metacarpal. Most easily palpated as you flex the wrist. Triangular Located just distal to the ulnar styloid process. To palpate, radially deviate the hand.

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Base, body, head of metacarpals and phalanges.

LOWER EXTREMITY Femur: 1. 2. 3. Patella: Knee cap anterior aspect of knee (a sesamoid bone located in quadriceps tendon). Tibia: 1. 2. 3. 4. 5. 6. 7. Fibula: 1. 2. 3. 4. Head Move distally and posteriorly from lateral femoral condyle. Lateral malleolus Large protuberance on lateral aspect of ankle. Shaft Styloid process Medial condyle on proximal end of tibia, medial aspect. Tibial tuberosity on proximal end, anterior aspect just below patella. (insertion for quadriceps tendon) Tibial spine Shin bone - anterior ridge along tibia. Medial malleolus large protuberance on medial aspect of ankle. Tibial plateau Lateral condyle Shaft Greater trochanger lateral aspect of thigh just distal to hip joint. Medial and lateral condyles on distal end of femur Medial and lateral epicondyles (Epicondyles)

Tarsals: 1. 2. 3. 4. 5. 6. Calcaneus heel bone. Naviculr tubercle On medial border of foot, large bony prominence. Head of the Talus Just proximal to navicular tubercle, especially palpable in eversion. Sustentaculum tali Located between the head of the Talus and the medial malleolus. Feels like a small ridge. Peroneal tubercle of the calcaneus On lateral aspect of foot just distal to lateral malleolus. Medial tubercle of calcaneus lies on the medial plantar surface of the calcaneus (not usually sharp or distinct unless it is associated with a heel spur.