{"id":1231,"date":"2010-12-04T14:51:17","date_gmt":"2010-12-04T14:51:17","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/palpation-9\/"},"modified":"2023-12-04T10:20:13","modified_gmt":"2023-12-04T10:20:13","slug":"palpation-9","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-lower-extremities\/the-knee\/palpation-9\/","title":{"rendered":"Palpation"},"content":{"rendered":"<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/124602282?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, unless otherwise stated.<\/span><\/li>\n<li><span style=\"color: #003366;\">Stand next to the patient and palpate with the tips of the fingers.<\/span><\/li>\n<li><span style=\"color: #003366;\">Palpate the skin, <span style=\"color: #33cccc;\"><strong>Hoffa\u2019s fat pad<\/strong><\/span>, the majority of muscles and the patella with the knee in 0\u00b0 flexion. <\/span><\/li>\n<li><span style=\"color: #003366;\">The other structures should preferably be palpated at 90\u00b0 flexion of the knee<em><strong> [Figure 69]<\/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-1225\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-69.jpg\" alt=\"\" width=\"400\" height=\"382\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-69.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-69-300x287.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\"><strong>Figure 69: Anatomy Of The Knee At 90 Degrees<\/strong><br \/>\n<\/span><\/span><\/p>\n<hr \/>\n<ol>\n<li><span style=\"color: #003366;\"><em>Lateral collateral ligament<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><em>Medial collateral ligament<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><em>Contour of the vastus medialis muscle<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><em>Head of the fibula<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><em>Contour of the pes anserinus<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><em>Patellar ligament<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><em>Contour of the iliotibial band<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><em>Lateral femoral condyle<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><em>Patella<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><em>Medial femoral condyle<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><em>Lateral tibial condyle<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><em>Tibial tuberosity<\/em><\/span><\/li>\n<\/ol>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Ask the patient to indicate exactly when and where they feel pain. <\/span><\/li>\n<li><span style=\"color: #003366;\">In the case of an <span style=\"color: #33cccc;\"><strong>abnormal finding<\/strong><\/span>, 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 characteristics.<\/span><\/li>\n<li><span style=\"color: #003366;\">The muscle tone (<em>fingers perpendicular to the course of the fibres<\/em>).<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #003366;\">The following bones and joints are accessible for palpation:<\/span>\n<ul>\n<li><span style=\"color: #003366;\">Femoral condyles and epicondyles (<em>osteophytic ridges, exostoses, Pellegrini-Stieda syndrome<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Tibial condyles (<em>osteophytic ridges, exostoses<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Head of the fibula (<em>fracture, luxation<\/em>) <em><strong>[Figure 73]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1226\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-73.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-73.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-73-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 73<\/span><\/strong><\/span><\/span><\/p>\n<hr \/>\n<p><strong><span style=\"color: #003366;\">Patella:<\/span><\/strong><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Inferior pole<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>superior pole<\/strong><\/span> (<em>tendonitis, Sinding-Larsen and Johansson disease<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Surface (<em>in particular patella bipartita<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Movement (<em>laterally and medially, proximally and distally<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Inferior side of the medial and lateral patella for pain (<em>patellar chondropathy<\/em>)<em><strong> [Figure 70]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Medial side of the patella (<em>medial retinaculum due to traumatic patellar luxation, presence of a medial plica<\/em>). The latter can usually be assessed if the patella is slid laterally during palpation.<\/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-1227\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-70.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-70.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-70-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 70<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><em>Palpation of the base of the patella (right knee). With one hand the patella is slid in a lateral to medial direction during which the medial base of the patella is palpated for pain.<\/em>\u00a0<\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Medial joint space (<em>meniscus damage<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Lateral joint space (<em>tenderness in the case of meniscus damage, meniscal cyst<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">The following soft tissues are accessible for palpation:<\/span>\n<ul>\n<li><span style=\"color: #003366;\">Skin (<em>knee region<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Muscles: In principle, most of the muscles stated in the previous section are accessible for palpation.<\/span><\/li>\n<li><span style=\"color: #003366;\">Tendons:<\/span>\n<ul>\n<li><span style=\"color: #003366;\">Superficial pes anserinus <em><strong>[Figure 71]<\/strong><\/em> (<em>tendons of the sartorius muscle, gracilis muscle, semitendinosus muscle<\/em>) and deep pes anserinus (<em>tendon of the semimembranosus muscle<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Tendon of the biceps femoris muscle; attachment of the iliotibial band to the lateral condyle of the tibia.<\/span><\/li>\n<\/ul>\n<\/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-1228\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-71.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-71.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-71-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 71<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Ligaments:<\/span>\n<ul>\n<li><span style=\"color: #003366;\">Patellar ligament (<em>jumper\u2019s knee<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Medial collateral ligament (<em>preferred position: hip in flexion and endorotation, knee in flexion, with the foot flat on the examination table<\/em>) <em><strong>[Figure 72]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Lateral collateral ligament (<em>preferred position: hip in flexion and exorotation, knee in flexion<\/em>)<em><strong> [Figure 73]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><em>Palpation of the lateral collateral ligament. With the right index finger the examiner should palpate the lateral collateral ligament.<\/em><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><em><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1229\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-72.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-72.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-72-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/span><\/em><span class=\"jce_caption\" style=\"display: inline-block;\"><strong><span style=\"width: 400px; display: block;\">Figure 72<\/span><\/strong><\/span><\/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-1226\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-73.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-73.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-73-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 73<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Joint capsule (<em>on both sides of the patella<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Hoffa\u2019s fat pad<\/strong><\/span><em><strong> [Figure 74]<\/strong><\/em> (<em>while the knee is extended palpate on both sides of the patellar ligament<\/em>) (<em>Hoffitis<\/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-1230\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-74.jpg\" alt=\"\" width=\"400\" height=\"293\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-74.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-74-300x220.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 74<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Bursa (<em>only palpable in the case of pathology<\/em>):<\/span>\n<ul>\n<li><span style=\"color: #003366;\">Suprapatellar bursa (<em>suprapatellar recess; fluid accumulation; synovial swelling in the case of rheumatoid arthritis, for example; in this case a negative fluid accumulation test is found<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Prepatellar bursa (<em>housemaid\u2019s knee<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Infrapatellar bursa (<em>clergyman\u2019s knee<\/em>).<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #003366;\">Baker\u2019s cyst (<em>medially in the popliteal fossa<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Nerves: Common peroneal nerve (<em>behind the fibular head<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Blood vessels: Popliteal artery (<em>in the popliteal fossa<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Procedure The patient lies in supine position on the examination table, unless otherwise stated. Stand next to the patient and palpate with the tips of the fingers. Palpate the skin, Hoffa\u2019s fat pad, the majority of muscles and the patella with the knee in 0\u00b0 flexion. The other structures should preferably be palpated at 90\u00b0 [&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":[70],"tags":[144],"class_list":["post-1231","post","type-post","status-publish","format-standard","hentry","category-the-knee","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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