{"id":1192,"date":"2010-12-04T14:43:28","date_gmt":"2010-12-04T14:43:28","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/palpation-8\/"},"modified":"2024-01-10T17:10:10","modified_gmt":"2024-01-10T17:10:10","slug":"palpation-8","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-lower-extremities\/the-pelvic-girdle\/palpation-8\/","title":{"rendered":"Palpation"},"content":{"rendered":"<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/124602470?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">The patient lies in supine position on the examination table. <\/span><\/li>\n<li><span style=\"color: #003366;\">During palpation of the <span style=\"color: #33cccc;\"><strong>dorsal muscles<\/strong><\/span>, the patient should be lying on their abdomen.<\/span><\/li>\n<li><span style=\"color: #003366;\">Stand next to the patient and palpate with the fingertips.<\/span><\/li>\n<li><span style=\"color: #003366;\">Ask the patient to indicate exactly where and when they experience pain. <\/span><\/li>\n<li><span style=\"color: #003366;\">In the case of abnormal findings, compare left and right.<\/span><\/li>\n<li><span style=\"color: #003366;\">Note:<\/span>\n<ul>\n<li><span style=\"color: #003366;\">Any swelling and its characteristics.<\/span><\/li>\n<li><span style=\"color: #003366;\">Muscle tone (<em>fingers transverse to the direction of the fibres<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Abnormal mobility.<\/span><\/li>\n<li><span style=\"color: #003366;\">Abnormal structures.<\/span><\/li>\n<li><span style=\"color: #003366;\">Discontinuity.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #003366;\">The following bone parts are accessible for palpation:<\/span>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Greater trochanter<\/strong><\/span> (<em>palpate preferably during passive endorotation of a slightly flexed hip<\/em>) <em><strong>[Figure 33]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">To detect right\/left asymmetry (<em>collum fracture, coxa vara, abduction contracture<\/em>), determine the position of both greater trochanters with respect to both anterior superior iliac spines. <\/span><\/li>\n<li><span style=\"color: #003366;\">For the aforementioned abnormalities, this distance will be smaller on the affected side. <\/span><\/li>\n<li><span style=\"color: #003366;\">Estimate this distance by placing the thumbs on both anterior superior iliac spines and the index fingers on both greater trochanters (<em>if necessary, mark both these structures with a pencil<\/em>) <em><strong>[Figure 34]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1182\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-33.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-33.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-33-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 33<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1183\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-34.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-34.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-34-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 34<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Symphysis<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>superior pubic ramus<\/strong><\/span><em><strong> [Figure 35]<\/strong><\/em> (<em>symphysiolysis and tendonitis of the pectineus muscle<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1184\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-35.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-35.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-35-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 35<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Ischial tuberosity<\/strong><\/span> (<em>palpate at 90\u00b0 flexion of the hip in prone position<\/em>) (<em>hamstrings tendonitis<\/em>) <em><strong>[Figure 36]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1185\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-36.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-36.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-36-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 36<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">The following soft tissues are accessible for palpation:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Skin<\/strong><\/span>: Palpate mainly with the back of the hand.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Muscles<\/strong><\/span>: Most of the muscles stated in the previous section are accessible for palpation (<em>palpation of the tone of the rectus femoris muscle<\/em>)<em><strong> [Figure 37]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1186\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-37.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-37.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-37-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 37<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Bursitis<\/strong><\/span>: The trochanteric bursa (<em>between the greater trochanter and the iliotibial band<\/em>) can only be palpated in the case of swelling. The overlying iliotibial band hinders palpation. Any tenderness should be noted.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Nerves<\/strong><\/span>: Femoral nerve (<em>in the groin<\/em>) (<em>neuritis<\/em>); Valleix points (<em>palpate in prone position<\/em>) <em><strong>[Figures 38, 39]<\/strong><\/em> (<em>sciatic-like symptoms<\/em>).<\/span><\/li>\n<li><span style=\"color: #33cccc;\"><strong>Valleix Points<\/strong><\/span><span style=\"color: #003366;\">: Palpate the points at L5 (<em>paravertebral<\/em>) and the middle of the maximum curvature of the gluteus maximus muscle and the middle of the gluteal fold.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1187\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-38.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-38.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-38-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 38<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1188\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-39.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-39.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-39-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 39<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Blood Vessels<\/strong><\/span>: Femoral artery (<em>in the groin<\/em>): claudication, aneurysms.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Lymph Glands<\/strong><\/span>:<\/span>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"text-decoration: underline;\">Horizontal groin glands<\/span> (<em>in the groin around the inguinal ligament<\/em>) (<em>Poupart<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"text-decoration: underline;\">Vertical groin glands<\/span> (<em>in the groin region perpendicular to, and under, the inguinal ligament<\/em>).<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #003366;\">When indicated, determine whether there is:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Pain upon <span style=\"color: #33cccc;\"><strong>axial compression<\/strong><\/span>. With the ulnar side of a clenched fist, apply force against the heel in the axial direction with extended hip and knee <em><strong>[Figure 40]<\/strong> <\/em>(<em>collum fracture<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1189\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-40.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-40.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-40-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 40<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Tenderness<\/strong> <strong>In The Groin<\/strong><\/span>: With the palm of the hand, apply considerable compression in the <span style=\"text-decoration: underline;\">ventro-dorsal direction<\/span> <em><strong>[Figure 41]<\/strong><\/em> (<em>coxarthrosis, collum fracture<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1190\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-41.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-41.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-41-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 41<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Trochanter Tenderness<\/strong><\/span>: Exert simultaneously from the lateral sides at the height of both greater trochanters considerable compression with the palms of the hands in the direction of the symphysis <em><strong>[Figure 42]<\/strong><\/em> (<em>collum fracture, pelvic fracture, symphysiolysis<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1191\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-42.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-42.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-42-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 42<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Procedure The patient lies in supine position on the examination table. During palpation of the dorsal muscles, the patient should be lying on their abdomen. Stand next to the patient and palpate with the fingertips. Ask the patient to indicate exactly where and when they experience pain. In the case of abnormal findings, compare left [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[69],"tags":[144],"class_list":["post-1192","post","type-post","status-publish","format-standard","hentry","category-the-pelvic-girdle","tag-the-examination-of-the-lower-extremities"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Palpation - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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