PALPATION OF MUSCLES
See Hoppenfeld for more information
Trapezius: superficial, can palpate upper, middle and lower
Upper is frequently involved in neck injuries
Hold the sloping superior lateral portion between fingers and thumb and palpate from
origin (O) toward the clavicle/acromion and its insertion (I)
With patient (pt.) standing: abduct shoulders to 90 degrees and retract shoulder girdle.
Slightly bend the trunk forward so antigravity.
Upper can also be seen with elevation and lower with depression
Serratus Anterior: superficial at (O), middle and upper covered by pectoralis under
axilla
Standing: flex shoulder to 90 degrees, flex elbow fully. Have pt. force arm fwd as if
trying to touch wall. Avoid trunk rotation.
Rhomboids: Palpated together. Covered by trapezius so need to relax trap by placing
hand in small of back. Palpate along vertebral border by placing fingers under it. Have pt.
lift hand off back (with resistance if needed) and the rhomboids push fingers out. AKA
"typing muscle".
Deltoid: superficial from (O) to (I). Lateral 1/3 of clavicle, across the AC jt., follows
anterior/lateral and posterior borders of acromion and sweeps down the spine of scapula.
Flex elbow to 90 degrees and have pt. abd shoulder against resistance.
Anterior fibers: deltoid palpated with elbow extended, shoulder 90 degrees abd and then
resist horizontal add.
Posterior fibers: position same as above and then resist horizontal abd.
Pectoralis Major: Abduct the shoulder to palpate easier. The anterior wall of the axilla
is this muscle. The posterior wall is the latissimus dorsi. This ms. is the most frequently
absent congenitally. It has a wide (O) and narrow tapered (I) that covers from the middle
clavicle and whole sternum.
Whole ms. does horizontal adduction and can be palpated when you press palms together
in front of your chest.
Upper portion palpated by raising arm 1/2 way between flexion and abduction to over
100 degrees; then adduct obliquely toward head.
Lower portion palpated with upper extremity in only 30-40 degrees of flex/abd while
adducting
Latissimus Dorsi: With arm abducted can palpate from under axilla toward iliac crests as
far as possible. Have pt. place extended arm on your shoulder and push downward.
Palpate lateral and inferior to axilla
Teres Major: Belly can be palpated but tendon cannot. Place fingers lateral to the
inferior angle of the scapula with shoulder adducted and extended. Flex elbow 90 degrees
and resist extension and adduction
Biceps Brachii: Close fist and supinate, then place forearm under a table surface and
pull up into elbow flexion. Can palpate tendon close to (I) at elbow and then follow it
upward to the ms. belly. You can palpate the tendon in the bicipital groove easier if the
shoulder is externally rotated. With the ms. relaxed, it can be lifted upward away from the
surrounding muscles.
Triceps: Lean on a table supporting your weight as you would during crutch walking
OR resist elbow extension.
Long head felt proximal as emerges from under posterior deltoid. Abduct shoulder 90 +
degrees and resist elbow extension. Can follow 1/2 way down arm
Lateral head is the strongest of the three and can be palpated distal to the posterior
deltoid
Medial head is covered partly by the long head but the distal part can be palpated near
the medial epicondyle
LOWER EXTREMITIES
Psoas Major: Deep ms. and difficult to palpate. Suggest you find psoas on self before
trying others. Have pt. sit and lean trunk fwd to relax abdominal muscles. Place fingers at
the waist between the lower ribs and crest of ilium. With gentle pressure sink fingers in
as deeply as possible toward the posterior wall of the abdominal cavity near vertebral
column. Next, have the pt. flex the hip slightly and you will feel the belly of the psoas
against your fingers as it contracts. NOTE: best done with bowels fairly empty and
should not cause pain.
Tensor Fascia Latae
Sartorius
Rectus Femoris: palpated near hip on anterior surface in supine. Externally rotate hip
and then resist flexion. At the hip there is a "V" formed by the contraction of the TFL
laterally and the sartorius medially. The "V" points toward the foot. In the space
between is the rectus femoris
Gluteus Maximus: palpate standing or prone. Externally rotate and extend hip with knee
flexed. Can also "set" ms. by squeezing the buttocks together
Gluteus Medius: palpated sidelying on opposite side or standing.
Middle portion palpated below the crest of the ilium as the pt. abducts the hip or when in
single leg stance.
Anterior portion palpated posterior to the TFL when hip is internally rotated
Posterior portion palpated during external rotation and hip extension but cannot be
isolated
Quads
Rectus Femoris: see TFL for palpation of proximal portion. Ms. belly palpated
superficially down middle of thigh. Quads are wrapped in a common fascial covering and
cannot always be identified individually
Vastus Medialis: forms visible bulge on the medial side of knee with isometric
contraction
Vastus Lateralis: forms visible bulge on the lateral side of knee with isometric
contraction
Vastus Intermedius: under the rectus. Lift rectus and palpate from the medial or lateral
side
Hamstrings
Biceps Femoris: palpate from common origin on ischium to insertion on lateral side.
Have pt. prone and resist knee flexion
Semimembranosus: most prominent tendon in the back of the knee on the medial side.
Have pt. prone or seated and resist knee flexion
Gastrocnemius: the calf muscle that provides shape to the lower leg. Palpate while pt.
raises up on their toes
Tibialis Anterior: tendon crosses ankle jt. Can be palpated (O) to (I). Have pt. dorsiflex
the ankle and invert the foot. Palpate the belly on the lateral side of the tibial shaft.
Palpate distally to insertion at the base of the first metatarsal and first cuneiform. NOTE:
flex great toe to eliminate confusion with its tendon