Palpation of different structures

Skin
extremely superficial
only gentle pressure is needed

Temperature
The dorsum of the hand contains many free nerve endings and is sensitive to changes in the
skin temperature
Used to detect when inflammation is present due changes in temperature

Oedema
Several types of oedema exist e.g. swelling due to joint effusion
Fluid into the tissues may indicate the presence of oedema
Stoke test – used to assess knee joint effusion; the clinician begins below the joint line on
the medial aspect of the knee and applies a gentle upward stroke to the level of the
suprapatellar pouch 2-3x. with the other hand, the clinicians applies a gentle downward
force along the lateral aspect of the patella as the fluid is moved there. The clinician then
looks for a wave of fluid along the medial aspect of the patella.

Tissue mobility
There are 4 main tissue types in the body
 Epithelial tissue
 Connective tissue – bone, ligaments, tendons
 Muscle tissue
 Nervous tissue

General tissue mobility is assessed to determine if adhesions are present between the skin
and underlying subcutaneous tissues
 Normal tissue
o Soft and mobile
o Moves equally in all directions
 Injured tissue
o Hard and tender to touch
o Ropey or crunchy

General tissue mobility can be assessed by a combination of

 skin gliding test
o Performed to assess the skins ability to slide on the underlying soft tissues
o Clinicians place a hand on the skin and gently attempts to slide the skin
 finger sliding test
o Used to assess the ability of the fingers to slide across the skin
o In the absence of pathology, the fingers should be able to slide across the
skin
o In the absence of pathology, the fingers should be able to slide across the
skin with little resistance to movement.
o During injury, pathology or dehydration, the clinician feels resistance
  skin rolling test
o Pinching the skin using the thumb and second or third digit
o This test evaluated the skins ability to be lifted from underlying soft tissue
structures

Hydration
Clinicians assess the presence of symptoms of hypo- and hyperhidrosis
Scaly, cracking skin is potentially a sign of dehydration or hyperhidrosis

Tendons
These are among the soft tissue structures that most frequently present with local
pathology, such as tendinitis or tendinosis
Composed of connective tissue, specifically type 1 collagen and are found at the ends of
muscles attaching to bony landmarks
As tendons have a smaller SA than most muscles bellies – the no. of fingers used to palpate
tendons should be kept to a minimum.
For more;
Superficial tendon – use tip of finger along tendon border (e.g. Achilles tendon)
Deep tendon – use the pads of the fingers directly over where the tendon is expected to be
(e.g. the subscapularis tendon)

Ligaments
They connect bone to bone and prevent excessive motion at a particular joint
Noncontractile tissue and increase passive stability of the joint

Nerves
Non-palpate
Inferior & superior gluteal nerve

Palpate
Ulnar nerve
Common fibular nerve

When palpating, add a moderate amount of pressure and add a gentle tension placed on
the nerve may improve the ability to accurately identify the structure

In the case of nerve injury e.g. axonotmesis, pacing tension on the nerve to improve
accuracy of palpation may be contraindicated
 Skull and Face
Functions of the skull and face
The skull can be divided into two distinct regions known as the neurocranium and facial
skeleton.
The neurocranium is composed of 8 bones and is responsible for protecting the underlying
brain and cranial meninges
The facial skeleton is composed of 14 bones and is responsible for giving architectural
structure to the region and provides a base for muscle and ligament attachments.

Bony anatomy
The neurocranium – the roof is referred to as calvaria, which has 3 sutures that connect
bones of the skull into ab single complex
Frontal
Parietal
Temporal
Occipital
Sphenoid
Ethmoid
Physiotherapy notes

Body part Picture Palpation