Palpation Techniques: Surface Anatomy for Physical Therapists

428 Pages·2021·72.922 MB·English

by  Bernhard Reichert, Wolfgang Stelzenmüller

Palpation Techniques
Surface Anatomy for Physical Therapists
Third Edition
BernhardReichert,MScPT,MT
PracticingMassageTherapist,PhysicalTherapist,andManualTherapist
Fellbach,Germany
Withthecollaborationof
WolfgangStelzenmüllerandOmerMatthijs
877illustrations
Thieme
Stuttgart(cid:129)NewYork(cid:129)Delhi(cid:129)RiodeJaneiro
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Contents
ForewordtotheFirstEnglishEdition.................................................................. xii
Preface ..................................................................................................... xiii
Acknowledgments........................................................................................ xv
1 BasicPrinciples.............................................................................................. 2
1.1 WhyDoCliniciansNeedSurfaceAnatomy?. 2 1.5.2 PalpatingBonyEdges ........................... 5
1.5.3 PalpatingBonyProminences.................... 6
1.2 WhatIsUnderstoodbySurfaceAnatomyin 1.5.4 PalpatingMuscleBellies......................... 6
1.5.5 PalpatingtheEdgeofMuscles................... 8
thisBook?..................................... 2
1.5.6 PalpatingTendons.............................. 8
1.5.7 PalpatingLigaments ............................ 9
1.3 WhenCanSurfaceAnatomyBeUsed?...... 3
1.5.8 PalpatingCapsules............................ 10
1.3.1 PhysicalTherapyAssessment.................... 3 1.5.9 PalpatingBursae.............................. 11
1.3.2 BasicPrinciplesofRegionalorLocalTreatment.. 3 1.5.10 PalpatingPeripheralNerves................... 11
1.5.11 PalpatingBloodVessels(Arteries)............. 12
1.4 WorkflowforPalpation...................... 3
1.6 PalpationAids............................... 13
1.4.1 ObjectiveandLocation.......................... 4
1.4.2 TheReliableResult.............................. 4 1.6.1 GuidingStructures............................ 13
1.4.3 CentralAspectsoftheProcedure................ 4 1.6.2 ConnectingLines.............................. 13
1.4.4 PressureAppliedduringPalpation .............. 5 1.6.3 SupportingMeasuresforConfirminga
Palpation..................................... 14
1.5 PalpatoryTechniques ........................ 5 1.6.4 MarkingStructures........................... 14
1.6.5 StartingPositionsforPractice(PracticeSPs)... 15
1.5.1 PalpatingtheSkin............................... 5
2 ShoulderComplex........................................................................................ 17
2.1 Introduction................................. 17 2.4.2 SummaryofthePalpatoryProcess ............ 29
2.4.3 PalpationofIndividual
2.1.1 SignificanceandFunctionoftheShoulder
Structures .................................... 29
Region........................................ 17
2.1.2 CommonApplicationsforTreatmentinthis 2.5 GeneralOrientation—Anterior............. 35
Region........................................ 17
2.5.1 StartingPosition.............................. 35
2.1.3 RequiredBasicAnatomicalandBiomechanical
Knowledge.................................... 17 2.5.2 SupraclavicularandInfraclavicularFossae..... 35
2.2 GeneralOrientation—Posterior............ 21 2.6 LocalPalpation—Anteromedial............ 36
2.2.1 SummaryofthePalpatoryProcess ............ 21 2.6.1 OverviewoftheStructurestobePalpated..... 36
2.2.2 TopographicalPositionoftheScapula......... 21 2.6.2 SummaryofthePalpatoryProcess ............ 36
2.6.3 PalpationofIndividualStructures............. 36
2.3 LocalPalpation—Posterior ................. 22 2.6.4 TipsforAssessmentandTreatment............ 37
2.3.1 OverviewoftheStructurestobePalpated..... 22 2.7 LocalPalpation—Anterolateral............. 37
2.3.2 SummaryofthePalpatoryProcess ............ 22
2.3.3 PalpationofIndividualStructures............. 23 2.7.1 OverviewoftheStructurestobePalpated..... 37
2.7.2 SummaryofthePalpatoryProcess ............ 37
2.4 LocalPalpation—Lateral.................... 29 2.7.3 PalpationofIndividualStructures............. 38
2.4.1 OverviewoftheStructurestobePalpated..... 29
3 ElbowComplex........................................................................................... 48
3.1 Introduction................................. 48 3.1.2 CommonApplicationsforTreatmentinthis
Region........................................ 48
3.1.1 SignificanceandFunctionoftheElbow
3.1.3 RequiredBasicAnatomicalandBiomechanical
Complex...................................... 48 Knowledge.................................... 48
v
Contents
3.2 GeneralOrientation—Anterior............. 52 3.4.4 DifferentiationinthePresenceofEpicondylitis 60
3.4.5 TipsforAssessmentandTreatment............ 62
3.2.1 BoundariesoftheCubitalFossa ............... 52
3.5 LocalPalpation—Lateral.................... 63
3.3 LocalPalpation—Anterior.................. 52
3.5.1 SummaryofthePalpatoryProcess ............ 63
3.3.1 OverviewoftheStructurestobePalpated..... 52
3.5.2 LocatingtheMostImportantOsseous
3.3.2 SummaryofthePalpatoryProcess ............ 52 Structures .................................... 63
3.3.3 PalpationofIndividualStructures............. 53 3.5.3 LocatingtheMusclesandtheirInsertions..... 66
3.3.4 NeurovascularBundle......................... 54 3.5.4 LocatingtheLateralInsertionTendinopathies 66
3.3.5 ProximalRadioulnarJoint(PRUJ).............. 56 3.5.5 TipsforAssessmentandTreatment............ 68
3.3.6 TipsforAssessmentandTreatment............ 56 3.5.6 PalpationintheRadialTunnel................. 69
3.4 LocalPalpation—Medial.................... 57 3.6 GeneralOrientation—PosteriorHumerus 71
3.4.1 OverviewoftheStructurestobePalpated..... 57 3.6.1 SummaryofthePalpatoryProcess ............ 71
3.4.2 SummaryofthePalpatoryProcess ............ 57 3.6.2 PalpatingWarmthandSwelling............... 71
3.4.3 PalpationofIndividualStructures............. 57
4 Hand........................................................................................................ 75
4.1 SignificanceandFunctionoftheHand.... 75 4.4.1 SummaryofthePalpatoryProcess ............ 91
4.4.2 CarpalBonesintheRadialColumn............ 91
4.1.1 CausesoftheDiversityofFunctionsinthe
4.4.3 CarpalBonesintheCentralColumn........... 93
Hand ......................................... 75
4.4.4 TipsforAssessmentandTreatment............ 94
4.1.2 CommonApplicationsforTreatmentinthis
4.4.5 CarpalBonesintheUlnarColumn............. 94
Region........................................ 76
4.4.6 TipsforAssessmentandTreatment............ 95
4.1.3 RequiredBasicAnatomicalandBiomechanical
Knowledge.................................... 77 4.5 GeneralOrientation—Palmar .............. 96
4.1.4 AxialDivisionsoftheSkeletonoftheHandinto
ColumnsandTheirClinicalSignificance....... 77 4.5.1 SummaryofthePalpatoryProcess ............ 96
4.1.5 TheCarpus.................................... 78 4.5.2 EdgeoftheRadius............................ 97
4.1.6 KinematicandKineticModeloftheHand..... 78
4.6 LocalPalpationofthePalmarSoft
4.1.7 TriangularFibrocartilageComplex(TFC)....... 79
Tissues....................................... 98
4.1.8 ConstructionoftheCarpalTunnel............. 80
4.1.9 ExtensorTendonsandtheirCompartments... 80 4.6.1 SummaryofthePalpatoryProcess ............ 98
4.2 GeneralOrientation—Dorsal............... 82 4.6.2 PalpationofIndividualStructures............. 98
4.6.3 SummaryofallRadialStructures.............. 99
4.2.1 SummaryofthePalpatoryProcess ............ 82 4.6.4 SummaryofallUlnarStructures ............. 101
4.2.2 PalpationofIndividualStructures............. 83 4.6.5 TipsforAssessmentandTreatment........... 101
4.2.3 TipsforAssessmentandTreatment............ 86
4.7 LocalPalpationofthePalmar
4.3 LocalPalpationoftheDorsalSoftTissues 86 AspectoftheCarpalBones ............... 101
4.3.1 SummaryofthePalpatoryProcess............... 86 4.7.1 SummaryofthePalpatoryProcess ........... 101
4.3.2 PalpationofIndividualStructures............. 86 4.7.2 PalpationofIndividualStructures............ 101
4.3.3 RadialNerve,CephalicVein,andRadialArtery 89 4.7.3 TipsforAssessmentandTreatment........... 106
4.3.4 TipsforAssessmentandTreatment............ 90
4.4 LocalPalpationoftheDorsal
AspectoftheCarpalBones ................ 91
5 HipandGroinRegion................................................................................... 109
5.1 Introduction................................ 109 5.2 LocalPalpation—Lateral................... 114
5.1.1 Lumbar-Pelvic-HipRegion................... 109 5.2.1 OverviewoftheStructurestobePalpated.... 114
5.1.2 FunctionalSignificanceofthePelvisandHip 5.2.2 SummaryofthePalpatoryProcess ........... 114
Joint......................................... 109 5.2.3 PalpationofIndividualStructures............ 115
5.1.3 PathologyandCommonApplicationsfor
TreatmentinthisRegion..................... 109 5.3 LocalPalpation—Dorsal ................... 117
5.1.4 RequiredBasicAnatomicaland
5.3.1 OverviewoftheStructurestobePalpated.... 117
BiomechanicalKnowledge................... 110
5.3.2 SummaryofthePalpatoryProcess ........... 117
vi
Contents
5.3.3 PalpationofIndividualStructures............ 118 5.4.2 SummaryofthePalpatoryProcess ........... 120
5.4.3 PalpationofIndividualStructures............ 121
5.4 LocalPalpation—Anterior................. 120
5.4.1 OverviewoftheStructurestobePalpated.... 120
6 KneeJoint................................................................................................. 131
6.1 Introduction................................ 131 6.6 LocalPalpation—Anterior................. 138
6.6.1 SummaryofthePalpatoryProcess ........... 138
6.2 SignificanceandFunctionoftheKnee
6.6.2 PalpationofIndividualStructures............ 139
Joint......................................... 131 6.6.3 TipsforAssessmentandTreatment........... 142
6.3 PathologicalConditionsandCommon 6.7 LocalPalpation—Medial................... 143
ApplicationsforTreatment ............... 132 6.7.1 SummaryofthePalpatoryProcess ........... 143
6.7.2 BoundariesoftheJointSpace ................ 143
6.3.1 ASelectionofPossiblePathologies........... 132
6.7.3 MedialEpicondyleoftheFemur.............. 146
6.3.2 CommonAssessmentandTreatment
Techniques .................................. 132 6.7.4 MedialGastrocnemiusTubercle.............. 146
6.7.5 AnteromedialandMedialSoftTissues........ 146
6.4 RequiredBasicAnatomicaland 6.7.6 TipsforTreatment........................... 150
BiomechanicalKnowledge................ 132
6.8 LocalPalpation—Lateral................... 153
6.4.1 ConstructionoftheFemorotibialJoint........ 132
6.8.1 SummaryofthePalpatoryProcess ........... 153
6.4.2 ConstructionofthePatellofemoralJoint...... 134
6.8.2 PalpationofIndividualStructures............ 154
6.4.3 ProximalTibiofibularJoint................... 134
6.8.3 TipsforAssessmentandTreatment........... 158
6.4.4 MusclesoftheKneeJoint .................... 134
6.4.5 NeuralStructures............................ 136 6.9 LocalPalpation—Posterior ................ 160
6.5 PalpationforWarmthandSwelling...... 136 6.9.1 SummaryofthePalpatoryProcess ........... 160
6.9.2 PalpationofIndividualStructures............ 160
6.5.1 PalpatinganIncreaseinTemperature........ 136
6.9.3 TipsforAssessmentandTreatment........... 163
6.5.2 PalpatingEdema............................. 137
7 Foot........................................................................................................ 165
7.1 Introduction................................ 165 7.3.1 SummaryofthePalpatoryProcess ........... 180
7.3.2 OverviewoftheStructurestobePalpated.... 180
7.1.1 SignificanceandFunctionoftheFoot......... 165
7.3.3 TipsforAssessmentandTreatment.......... 187
7.1.2 SpecialCharacteristicsoftheBony
Construction................................. 165 7.4 LocalPalpationoftheDorsumofthe
7.1.3 FeaturesoftheNomenclature................ 166 Foot......................................... 189
7.1.4 SpecialBiomechanicalCharacteristics........ 166
7.1.5 CommonSymptomsintheFoot.............. 167 7.4.1 SummaryofthePalpatoryProcess ........... 189
7.1.6 RequiredBasicAnatomicaland 7.4.2 OverviewoftheStructurestobePalpated.... 189
BiomechanicalKnowledge................... 168 7.4.3 TipsforAssessmentandTreatment........... 192
7.2 LocalPalpationoftheMedialBorder 7.5 LocalPalpationoftheDistalPosterior
oftheFoot ................................. 170 Leg.......................................... 193
7.2.1 SummaryofthePalpatoryProcess ........... 170 7.5.1 SummaryofthePalpatoryProcess ........... 193
7.2.2 OverviewoftheStructurestobePalpated.... 170 7.5.2 OverviewoftheStructurestobePalpated.... 194
7.2.3 PositionoftheMedialLigaments............. 173 7.5.3 BordersoftheAchillesTendon............... 194
7.2.4 TipsforTreatment........................... 178 7.5.4 InsertionoftheTricepsSurae................ 194
7.5.5 PalpationoftheTendon...................... 195
7.3 PalpationoftheLateralBorderofthe
Foot......................................... 180
8 SoftTissues............................................................................................... 199
8.1 SignificanceandFunctionofSoftTissues... 199 8.2 CommonApplicationsforTreatment
inthisRegion .............................. 199
vii
Contents
8.3 RequiredBasicAnatomicaland 8.7.3 PalpatingtheConsistencyofMuscle
BiomechanicalKnowledge................ 199 (AssessmentofMuscleTension).............. 204
8.8 TipsforAssessmentandTreatment...... 206
8.4 SummaryofthePalpatoryProcess....... 199
8.8.1 DifferentiatingbetweenTissues.............. 206
8.4.1 ExtentofthePalpation....................... 199 8.8.2 InterpretingtheFindingsofSkinSurface
8.4.2 CriteriaforPalpation......................... 199 Palpation.................................... 207
8.8.3 InterpretingtheSkinConsistency(Turgor)
8.5 MethodandTechniquesofthe
PalpationFindings........................... 207
PalpatoryProcess.......................... 201
8.8.4 InterpretingtheMuscleConsistency
(Tension)PalpationFindings................. 207
8.6 StartingPosition........................... 201
8.9 ExamplesofTreatment.................... 208
8.6.1 DifficultandAlternativeStartingPositions... 202
8.9.1 LumbarFunctionalMassageinSide-lying..... 208
8.7 PalpationTechniques...................... 203 8.9.2 FunctionalMassageoftheTrapeziusin
Side-lying.................................... 210
8.7.1 PalpatingtheSurfaceoftheSkin............. 203
8.7.2 PalpatingtheQualityoftheSkin(Turgor)..... 203
9 PosteriorPelvis.......................................................................................... 213
9.1 SignificanceandFunctionofthe 9.6.1 StartingPosition............................. 227
PelvicRegion............................... 213
9.7 LocalPalpationTechniques ............... 230
9.2 CommonApplicationsforTreatmentin 9.7.1 SummaryofthePalpatoryProcedure......... 230
thisRegion................................. 213 9.7.2 Ilium—IliacCrest............................. 231
9.7.3 Ilium—PosteriorSuperiorIliacSpine(PSIS)... 231
9.7.4 Sacrum—S2SpinousProcess ................. 233
9.3 RequiredBasicAnatomicaland
9.7.5 Sacrum—MedianSacralCrest................. 233
BiomechanicalKnowledge................ 215
9.7.6 Sacrum—InsertionoftheMultifidus.......... 235
9.3.1 Gender-basedDifferences.................... 216 9.7.7 Sacrum—SacralHiatus ....................... 235
9.3.2 CoxalBone................................... 216 9.7.8 Sacrum—SacrococcygealTransition........... 236
9.3.3 Sacrum...................................... 217 9.7.9 Sacrum—InferolateralAnglesoftheSacrum.. 236
9.3.4 ThePelvicLigaments......................... 219 9.7.10 SacrotuberousLigament ..................... 237
9.3.5 TheSacroiliacJoint........................... 220 9.7.11 LongPosteriorSacroiliacLigament........... 237
9.3.6 SacroiliacJointBiomechanics................. 221
9.8 OrientingProjections...................... 238
9.3.7 LigamentDynamizationintheSacroiliacJoint .. 222
9.8.1 PosteriorInferiorIliacSpine(PIIS)............ 238
9.4 SummaryofthePalpatoryProcess....... 223
9.8.2 SacroiliacJointProjection.................... 239
9.8.3 Piriformis.................................... 239
9.5 PalpatoryTechniquesforQuick
9.8.4 SciaticNerveandtheGluteals................ 240
OrientationontheBones ................. 223
9.9 TipsforTreatment......................... 242
9.5.1 StartingPosition............................. 224
9.6 PalpatoryProceduresforQuick
OrientationontheMuscles............... 226
10 LumbarSpine............................................................................................. 245
10.1 SignificanceandFunctionoftheLumbar 10.1.6 JunctionbetweentheRigidandMobile
Spine........................................ 245 VertebralColumn............................ 246
10.1.1 SupportingtheWeightoftheBody........... 245 10.2 CommonApplicationsforTreatment
10.1.2 SpatialAlignmentoftheUpperBody......... 245 inthisRegion .............................. 246
10.1.3 TheImportanceofStabilityforStandingand
Lifting....................................... 245 10.3 RequiredBasicAnatomicaland
10.1.4 MovementintheTrunk...................... 245 BiomechanicalKnowledge................ 247
10.1.5 DevelopmentofEnergyNeededfor
Locomotion.................................. 246 10.3.1 AnatomicalDefinitions....................... 247
viii