Procedure
- The patient sits down on with both arms placed loosely on the upper legs.
- The examiner stands behind or beside the patient.
- Preferably, palpate using the fingertips.
- Ask the patient to indicate precisely where and when it is painful.
- In the case of abnormal findings, compare left and right.
Note:
- Any swelling and its characteristics.
- The muscle tone (fingers transverse to the direction of the muscle fibres).
- Abnormal mobility.
- Abnormal structures.
- Discontinuity.
The following bones and joints are accessible for palpation:
- Sternum and chondrocostal transition (ankylosing spondylitis, Bechterew’s disease, Tietze’s syndrome).
- Sternoclavicular joint (rheumatoid arthritis).
- Clavicle (fracture) [Figure 51].
Figure 51
- Acromioclavicular joint (dislocation, osteoarthritis).
- Scapula:
- Coracoid process (fracture).
- Acromion.
- Scapular spine.
- Medial border.
- Inferior angle.
- Humerus:
- Greater tubercle of humerus (tendonitis).
- Lesser tubercle (tendonitis).
- Intertubercular groove.
Place the palpating fingers at the level of the ventral subacromial space and rotate the shoulder inwards and outwards with the elbow in 90° flexion.
The following soft tissues are accessible for palpation:
- Skin [Figure 53].
- Muscles: Most of the muscles mentioned in the previous paragraph are accessible for palpation (palpation of the deltoid muscle tone) [Figure 54].
Figure 53
Figure 54
The other soft tissues are:
- Suprasternal notch (goitre).
- Supraclavicular fossa (lymphomas).
- Intraclavicular fossa (lymphomas).
- Axillae (lymphomas, disorders of the humeral joint).