UE PALPATION REVIEWER
REFERENCES: Brunnstrom’s Clinical Kinesiology by Peggy A. Houglum & Dolores B. Bertoti, and Physical
Examination of the Spine & Extremities by Stanley Hoppenfield
LANDMARK/
STRUCTURE
Body of Sternum
Manubrium of
Sternum
Xiphoid Process of
Sternum
Lateral End and the
Acromoclavicular
Joint
Medial End and the
Sternoclavicuar Joint
Infraclavicular Fossa
Body of the Clavicle
Coracoid Process
Inferior Angle of the
Scapula
PALPATION PROCEDURES FOR
OPT2101/OPT2101.1 APPLIED ANATOMY AND KINESIOLOGY LEC AND LAB
SHOULDER REGION
PROCEDURE
STERNUM
Located inferior to the sternal angle
Located inferior to the jugular notch, and superior to the sternal angle.
Traverse along the body of the sternum until you feel a depression; that is the
xiphoid process of the sternum.
CLAVICLE
With patient in sitting position, move laterally from the clavicle until the end.
You can feel a protuberance which is the lateral end of the clavicle which
meets with the acromion of the scapula to form the Acromioclavicular joint.
Find the jugular notch at the superior border of the sternum. From there, you
cn feel the junction where the medial end of the clavicle meets the
manubrium to form the Sternoclavicular joint.
From the clavicle, move the palpating fingers distally and slide towards the
inferio-lateral aspect of the clavicle. The depression is the infraclavicular fossa.
Move laterally from the Sternoclavicular joint and palpate in a sliding motion
along the smooth anterior surface of the clavicle. Feel the body or shaft of the
clavicle by moving the palpating fingers medially and laterally to feel its entire
length.
SCAPULA
Located deep to the apex of the delto-pectoral triangle or approximately an
inch below the deepest concavity of the clavicle. The circular bony
prominence is the coracoid process of the scapula.
Ask the patient to place is hand at the small of his or her back such that the
scapula protrudes. The angular aspect in the inferior part of the scapula is the
inferior angle of the scapula.
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Medial Border of the
Scapula Ask the patient to place is hand at the small of his or her back such that the
scapula protrudes. The aspect almost parallel to the midline of the vertebral
column is the medial border of the scapula.

Superior Angle of the

Scapula Ask the patient to place is hand at the small of his or her back such that the
scapula protrudes. From the inferior angle of the scapula, move along the
medial border superiorly until you feel the superior angle.

Spine of the Scapula

Ask the patient to place is hand at the small of his or her back such that the
scapula protrudes. From the acromion process, move your fingers obliquely
along the spine of the scapula.

Ask the patient to place is hand at the small of his or her back such that the
Lateral Border of the scapula protrudes. Lateral to the inferior angle of the scapula is the lateral
Scapula border.

PROXIMAL HUMERUS
Bicipital Groove of
the Humerus Externally rotate the shoulder until you feel a dent which is the bicipital
groove. For easier control, the therapist may flex the patient’s elbow.

Greater Tuberosity of
the Humerus From the jugular notch, move laterally along the clavicle until your reach the
acromion process. Move the palpating fingers postero-inferiorly until you feel
the greater tuberosity.

Lesser Tuborsity of
the Humerus Externally rotate the shoulder. Levelled with the coracoid process, you may
palpate the lesser tuberosity of the humerus.

SOFT TISSUE
Deltoid
Anterior Deltoid: Palpated when the arm is held in a horizontal position. The
anterior deltoid conracts strongly when horizontal adduction is resisted.

Middle Deltoid:Has the best anatomic position for abduction, and is seen
contracting whenever this movement is carried out or the abducted position is
maintained. Located in between the acromion process and deltoid tuberosity.

Posterior Deltoid:Contracts strongly when the shoulder is hyperextended

against resistance, or resistance is given to horizontal abduction.

Pectoralis Major and Pectoralis Major: The muscle is easily observed and palpated along its origin
Minor along the sternum or distal to the clavicle. The entire muscle contracts when
horizontal adduction is resisted.

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 Pectoralis Minor: The forearm is placed in the small of the back, where the
pectoralis major is relaxed. The examiner places one finger just below the
coracoid process of the scapula, pressing down gently to let the finger sink in
as far as possible. When the subject rasies the forearm off the back, the
pectoralis minor contracts, and its tendons becomes tense under the palpating
fingers. The muscle can also be palpated in its important function of shoulder
depression (trunk elevation). The palpating fingers should be placed distal to
the coracoid process, and the subject should be asked to push down on the
table with the hands as if to elevate the trunk, causing the other muscles to
contract and obscure palpation of the muscle.

Coracobrachialis
The coracobrachialis may be palpated in the distal portion of the axillary region
of the arm is elevated above the horizontal. It emerges from underneath the
inferior border of the pectoralis major where it lies medial, and parallel to the
tendon of the short head of the biceps. The biceps is first identified by
supination of the forearm or asking the patient to make a “ muscle”. The
palpating fingers then follow the short head of the biceps proximally until the
muscles tapers off, this is the height best suited for palpation of the
coracobrachialis.

Biceps Brachii
Palpated with the muscle relaxed, as when the forearm rests on the table or in
the lap. The contour of the biceps is easily identified by resisting elbow
flexion. The tendon of the biceps is best identified in the fold of the elbow
when the forearm is supinated.

Subclavius
Located halfway the medial and lateral ends of the clavicle. Place the
palpating fingers inferior to the said aspect and ask the patient to depress his
or her shoulder. The contracting muscle is the subclavius.

Trapezius
The entire muscle can be observed during shoulder abduction with shoulder
girdle retraction. If the trunk is simultaneously inclined forward or the subject
lies prone, the muscle has to act against the force of gravity to hold the
shoulders back, and the intensity of the contraction increases.

Levator Scapulae
The subject places the forearm in the small back, then shrugs the shoulder. The
levator may be palpated in the neck region, anterior to the trapezius, but
posterior to the sternocleidomastoid. The muscle can only be done if the shrug
is done quickly and within a short range.

Rhomboids Major
and Minor Best palpated when the trapezius is relaxed. The subject’s hand is placed in the
small of the back. If the subject raises the hand just off the back, the rhomboid
major contracts vigorously as a downward rotator of the scapula and pushes
the palpating fingers out from underneath the medial border of the scapula.

Latissimus Dorsi
Easily palpable and observed in near the axillary line where the muscles
converge. Contract when adduction or extension of the shoulder is resisted.

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 You may aslo ask the subject to place his or her forearm at your shoulder and
press down.

Teres Major and Teres Major: The belly of the muscle can be palpated on the inferior aspect of
Minor the axillary border of the scapula when the subject is prone on a table with the
arm hanging over the side. If the relaxed subject inwardly rotates the
glenohumeral joint, the teres major rises under the palpating fingers.

Teres Minor: Ask the patient to bend forward with the arms dangling at the sid.
Have the patient externally rotate his or her shoulder and push the palpating
fingers towards distal aspect of the muscle where you can feel the conracting
teres minor muscle.

Serratus Anterior
The lower digitations may be palpated distal to the axilla, close to the ribs,
posterior to the pectoralis major. Palpation may be possible of these lower
digitations with the arm in about 135°; protraction may also be considered
as a good additional stimulus.

Supraspinatus
With the subject prone and the arm hanging over the edge of the table, the
scapula moves ateriorly around the rib cage by the weight of the arm and is
already partially upwardly rotated. When abduction is carried out in this
position, a contraction of the supraspinatus may be felt in the supraspinatus
fossa with little or no inference by the trapezius.

The supraspinatus may also be palpated when the subjects lifts a heavy object
with the trunkn inclined forward. Muscle becomes tense for the purpose of
preventing separation of the glenohumeral joint.

Infraspinatus
The arm must be away from the body and the posterior deltoid must be
relaxed. Palpation is accomplished if the subject lies prone or stands with the
trunk inclined forward and if the arm hangs vertically. The margin of the
posterior deltoid is first identified. While maintaining this position, the subject
laterally rotates the shoulder by turning the palm forward. The infraspinatus and
teres minor then rise under tha palpating fingers.

Subscapularis The fingers are placed in the axilla anterior to the latissimus dorsi and, with
gentle pressure, are moved in the direction of the costal surface of the scapula.
With the arm hanging vertically, the subject medially rotates the shoulder by
turning the palm posteriorly. The firm, round belly of the subscapularis can then
be felt rising under the palpating fingers.

Triceps Brachii
Long Head: Identified proximally as it emerges from underneath the lowest
fibers of the posterior deltoid; it may be followed distally halfway.

Lateral Head: Strongest of the three heads; is palpated distal to the posterior
deltoid. Joins the common tendon of insertion from opposite sides.

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 Medial Head: Suggested that the dorsum of the wrist be placed on the edge
of a table and pressure be applied in a downward direction, the table supplying
resistance to elbow extension. The medial head may then be felt contracting.

ELBOW AND FOREARM

LANDMARK/ PROCEDURE
STRUCTURE
BONY PALPATION
Medial Epicondyle
The medial epicondyle is located on the medial side of the distal end of the
humerus. It is rather larger and subcutaneous, and its bony countours stand
out conspicuously from the surrounding tissue.

Lateral Epicondyle
Located lateral to the olecranon process; it is prominent, but somewhat
smaller and less defined than the medial epicondyle.

Medial
Supracondylar Ridge Move upward in linear fashion from the epicondyle and palpate this short
of Humerus bony ridge, even though it is covered by the thick origin of the wrist flexor
muscles and is not very distinct.

Lateral
Supracondylar Ridge This is better defined and longer than the medial supracondylar line,
of Humerus extending almost to the deltoid tuberosity. From the lateral epicondyle,
palpate up the lateral supracondylar line and then back down to the lateral
epicondyle.

Olecranon Process Flexion moves the olecranon out of the depth of its fossa, making it available
for palpation. Although it is subcutaneous to the touch, the olecranon is
actually covered by the olecranon bursa and the triceps tendon and
aponeurosis.

Olecranon Fossa
Partial extension, likewise flexion of the elbow slackens the triceps brachii, its
origin and insertion closer together and exposing a portion of the fossa for
palpation.

Ulnar Border
Hold the patient’s arm in abduction and palpate from the olecranon down the
subcutaneous posterior ulnar border which runs in a relatively straight line to
the ulnar styloid process at the wrist.

Radial Head
To orient yourself, relocate the lateral epicondyle, and move your fingers
about one inch distally until you find a visible depression in the skin just
medial and posterior to the wrist extensor muscle group. The radial head lies
deep within this depression and is palpable through this thick mass of wrist
extensors. Ask the patient to turn his/her forearm slowly, first in supination,
then in pronation; the radial head will rotate under your thumb. If the patient
can perform both motions fully, approximately three-quarters of the radial
head is palpable.
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 SOFT TISSUE
Ulnar Nerve
Elbow slightly flexed; cord-like structure in between olecranon process and
medial epicondyle.

Biceps Brachii
Palpated with the muscle relaxed, as when the forearm rests on the table or in
the lap. The contour of the biceps is easily identified by resisting elbow flexion.
The tendon of the biceps is best identified in the fold of the elbow when the
forearm is supinated.

Brachialis
The palpating fingers are placed laterally and medially to the biceps, and inch
or two higher than the grasp. The forearm is pronated, which ensures relaxation
of the biceps. The elbow is flexed with as little effort as possible, so that the
contraction may be felt.

Brachioradialis
Best observed and palpated when resistance is given to flexion of the elbow
while the elbow angle is about 90 degrees and the forearm is in midposition
between pronation and supination.

Triceps Brachii
Long Head: Identified proximally as it emerges from underneath the lowest
fibers of the posterior deltoid; it may be followed distally halfway.

Lateral Head: Strongest of the three heads; is palpated distal to the posterior
deltoid. Joins the common tendon of insertion from opposite sides.

Medial Head: Suggested that the dorsum of the wrist be placed on the edge
of a table and pressure be applied in a downward direction, the table supplying
resistance to elbow extension. The medial head may then be felt contracting.

Anconeus
If one fingertip is placed on the lateral epicondyle and one on the olecranon
process, the muscular portion of the anconeus is palpated distally at a point
that forms a triangle with two other points.

Supinator
The fingertips are pushing the muscles of the radial group in a radial direction
so that there is no interference The best position for palpation is to sit with the
pronated forearm resting in the lap and to grasp the rasial side, pulling it out as
much as possible.

Pronator Teres
Its fibers are best easily identifeid when the forearm is pronated while the elbow
is flexed or semiflexed during resistance to elbow flexion.

Pronator Quadratus
Impossible to palpate because the muscle is covered by the tendons of the
wrist and fingers. The approximate length and direction of the muscle fibers are
diagonally along the radius and ulna.
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 WRIST AND HAND
LANDMARK/ PROCEDURE
STRUCTURE
BONY PALPATION
Head of Ulna
Palpate along the shaft of the ulna until you feel a circular bony prominence.
The circular bony surface on the postero-medial aspect of the distal forearm is
the head of the ulna.

Styloid Process of
Ulna In the anatomic position, the ulnar styloid process does not lie directly along
the side of the wrist but rather is both medially and posteriorly located.

Styloid Process of
Radius The radial styloid process is truly lateral when the hand is in the anatomic
position. As you palpate its distal tip, note the small but distinct groove than
can be felt along the lateral edge. From there, palpate up the length of styloid
process, and continue up the radial shaft until it becomes obscured by
overlying soft tissues about halfway up the forearm. Then return to the most
prominent point of the radial styloid process, just proximal to the carpal joint.

Tubercle of Radius
Lister’s tubercle lies about one-third of the way across the dorsum of the wrist
from the radial styloid process. It feels like a small, longitudinal bony
prominence or nodule.

Anatomic Snuff Box

-Lateral: APL, EPB The anatomic snuffbox is sa small depression located immediatelt distal and
-Medial: EPL slightly dorsal to the radial styloid process. It becomes outlined and is
-Floor: Styloid palpable when the patient extends his thumb laterally away from his fingers.
Process of radius,
base of first
metacarpal bone,
scaphoid, trapezium

Scaphoid, Lunate,
Triquetrum, Pisiform Scaphoid: Situated on the radial side of the carpus. It represents the floor of
the snuffbox.

Lunate: Palpable just distal to the radial tubercle. As you palpate, ask the
patient to flex and extemd the wrist his wrist so that the motion at the
lunate/capitate articulation can be felt.

Triquetrum: To facilitate its palpation, the hand must be radially deviated so

that the triquetrum moves from under the ulnar styloid process.

Pisiform: As you probe the anterolateral region of the triquetrum, you will
feel a small sesamoid bone, the pisiform, which is formed within the FCU
tendon.

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Trapezium,
Trapezoid, Capitate, Trapezium: Located on the radial side of the carpus where it articulates with
Hamate the first metacarpal. Move distal to the snuffbox to palpate the trapezium/first
metacarpal artciulation. It is more easily palpable if you instruct the patient to
flex and extend the thumb.

Capitate: As you move distally from the Lister’s tubercle, you will encounter the
base of the third metacarpal bone, the largest and most prominent of the
metacarpal bases. When the wrist is in a neutral position, you will find a small
depression in the area of the capitate, a depression which is actually a curve in
the capitate itself.

Hook of Hamate: To locate it, place the interphalangeal joint of your thumb
upon the pisiform, pointing the tip of your thumb toward the web space
between the patient’s thumb, index fingers, and the rest of the tip of your
thumb upon his palm. The hook of hamate lies directly under your thumb.

Metacarpals,
phalanges, and Metacarpals: Keep your thumb on the patient’s palm and locate the base of
metacarpophalengea the second metacarpal with you index and middle fingers and palpate its full
l joints length.

First Metacarpal: The first metacarpal should be palpated for continuity in

bone structure from the anatomic snuffbox to the MCP joint.

Metacarpophalangeal Joints: Move distally from the metacarpals and

palpate the fusiform joints (knuckles) while they are flexed so that their
articulations are exposed, the condyles at the end of the MC bones
accessible, and the joint lines more evident.

Phalanges: There are fourteen phalanges on each hand, since the thumb has
two and the other fingers three each.

MUSCLE PALPATION
Extensor Carpi
Radialis Longus The tendon lies on the radial side of the capitate bone but on the ulnar side of
(ECRL) the tubercle of the radius and courses toward the base of the metacarpal
bone of the index finger, to which it is attached.

Extensor Carpi
Radialis Brevis (ECRB) Its tendons can be usually felt rising if the thumb is moved in a palmar
direction, perpendicular to the palm of the hand.

Extensor Pollicis
Longus (EPL) This tendon forms the ulnar border of the anatomical snuff box and may be
palpated when the thumb is actively extended.

Extensor Indicis (EI)

With the fingers in extension, palpate the index finger’s extensor digitorum
tendon. Immediately adjacent to this tendon, the extensor indicis is palpated
as the second digit is actively flexed and extended

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Extensor Digitorum
The four tendons are palpated between the carpals and MCP joints when the
MCP and IP joints are actively moved into extension.

Extensor Carpi
Ulnaris (ECU) Palpated about 2 inches (5cm) distal to the lateral epicondyle of the humerus
where the muscle lies between the anconeus and extensor digitorum. It may
be followed distally to its insertion and abducted.

Palmaris Longus
The tendon is easily identified by touching the tips of thumb of the and little
finger together and flexing the wrist. The middle prominent tendon at the
wrist is the palmaris longus.

Flexor Digitorum
Superficialis (FDS) If the fist is tightly closed and wrist flexion is simultaneously resisted, one or
more tendons of the flexor digitorum superficialis become prominent in the
space between the palmaris longus and the flexor carpi ulnaris.

Flexor Carpi Radialis

(FCR) With the wrist flexed and the tips of the first and fifth digits touching, the
tendon is laterally to the palmaris longus tendon at the wrist. It cannot be
followed to its distal attachment on the base of the second metacarpal bone.

Flexor Carpi Ulnaris

(FCU) This tendon lies medial to the palmaris longus and may be palpated between
the styloid process of the ulna and the pisiform bone, to which it is attached.

Flexor Digitorum
Profundus (FDP) It is difficult to palpate. If the PIP is stabilized with a palpated finger on the
distal aspect of the middle phalanx, the FDP may be palpated as the distal
phalanx is actively flexed.

Flexor Pollicis Longus

(FPL) The tendon may be palpated in the anterior mid-section of the proximal
phalanx as the thumb is actively flexed.

Extensor Pollicis This tendon along with the abductor pollicis longus tendon form the radial
Brevis (EPB) border of the anatomical snuff box. If the thumb is extended without
abduction, the tendon may be differentiated from the adbuctor pollicis
longus.

Extensor Digiti
Minimi (EDM) With the hand very gently pushing down on a table top so as to prevent
extensor digitorum facilitation, rasie only the little finger into extension. The
tendon is palpated just lateral and distal to the ulnar styloid process.

Thenar Muscles and Abductor Pollicis Brevis: Place a palpating finger over the anterolateral #1
Adductor Pollicis metacarpal and instruct the individual to actively abduct the thumb allows the
muscle to be readily palpated.

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 Opponens Pollicis: Lies deep to the abductor pollicis brevis and flexor
pollicis brevis. Difficult to palpate because all three thenar muscles activate
during opposition

Flexor Pollicis Brevis: Lies over the opponens pollicis and may be palpated
during the very light flexion of the #1 MCP

Adductor Pollicis: Palpated in the #1-2 web space during #1 adduction

against light resistance.

Hypothenar Muscles
Abductor Digiti Minimi: With light palpation of medial #5 metacarpak, the
muscle is palpated with active adbduction.

Flexor Digiti Minimi: Is palpated in the hypothenar eminence just lateral to

the abdcutor digiti minimi against light resistance to the #5 flexion.

Opponens Digiti Minimi: Lies deep to the flexor digiti minimi, just ulnar to
the abductor pollicis brevis. Once the abductor pollicis brevis is located,
move the palpating finger just medial to it and have the individual move the
thumb into opposition.

Lumbricals
Muscle bellies are located on the radial side of the tendons of the long finger
flexors. Identification of the lumbricals is difficult because these muscles are
small and covered with fascia and skin.

Interossei
The muscular portion of #1 is palpated in the #1-2 web sapce with resistance
to adbuction to #2 digit; #2-4 dorsal interossei are difficult to palpate between
MC bones. Resistance with a rubber band around the fingers in various
combinations in finger abudction allows palpation. It may be easier to palpate
the interossei with the digits in MCP and IP extension: palpate between the
metacarpal bones while the fingers are actively abducted and adducted.

ARTERIES
Radial Artery
Ask the patient to supinate the forearm. Place the palpating fingers on the
radial styloid and move medially until you feel a cord-like structure that
produces a pulse, which is your radial artery.

The pulse of the ulnar artery is palpable proximal to the pisifrom bone just
Ulnar Artery before the artery crosses the wrist on the anterior aspect of the ulna. The
pulse can be felt if you press the artery against the ulna.

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