Palpation Techniques: Surface Anatomy for Physical Therapists

Description

This completely updated third edition of the award-winning Palpation Techniques is a beautifully illustrated guide with clear step-by-step descriptions that teach readers how to identify and distinguish between a multitude of underlying body structures, based mainly on palpation alone. A unique graphic technique using detailed drawings of muscles, bones, and tendons directly on the skin, which come alive in almost 900 full-color photographs along with complementary color illustrations, provides a solid understanding of the functional significance of each anatomic region. The previous edition introduced palpation techniques for the shoulder and included new photos and illustrations for the hand, hip, and foot. This third edition is upgraded with a chapter on the abdominal area and additional subchapters on further starting positions and palpation techniques of the shoulder, elbow, and hip/groin. Many new illustrations accompany these new sections. Readers will learn how to use: Palpation during physical examination to localize painful, injured structures (provocative palpation) Joints as critical landmarks in carrying out tests and guiding manual therapy techniques Palpation of peripheral nerves to localize and assess sources of dysfunction and pain Deep soft-tissue palpation to relieve musculoskeletal pain This outstanding book will enable physical therapy and osteopathy practitioners and students to refine their knowledge of practical anatomy further and thus optimize patient care. This book includes complimentary access to a digital copy on https://medone.thieme.com. 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