Palpation
Dr. Michael P. Gillespie
Palpation Hints
 Palpation means “to examine or explore by touching
(an organ or area of the body), usually as a diagnostic
aid.”
 Palpation is both an art and a skill.
 Palpation involves:
 Locating a structure
 Becoming aware of its characteristics
 Assessing its quality or condition so you can determine how
to treat it
Palpation Hints
 In order to locate and feel the characteristics of body
structures it is necessary to have a thorough
knowledge of functional anatomy and experience this
anatomy through mindful, hands-on practice.
A Full Sensory Experience
 Palpation requires receptive hands and fingers, open
eyes, listening ears, calm breath, and quiet mind.
Making Contact
 Your hands and fingers must be responsive and
sensitive.
 Relaxed hands allow the body’s contours,
temperatures, and structures to come more easily into
your awareness.
 When palpating, you may want to close your eyes
periodically to enhance your awareness.
Making Contact
 For greater sensitivity and
stability, try laying one hand
upon the other, using the top
hand to create the necessary
pressure, while the bottom
hand remains relaxed.
 The bottom hand will stay
receptive as the top hand
directs movement and depth.
Making Contact
 Smaller structures can be
located by using one or two
fingertips.
Making Contact
 Larger structures are best
palpated with the whole
hand.
Making Contact
 By sculpting out all of the sides and edges, full hand
contact helps to define the complete shape of a region
or structure and also allows for a greater understanding
of the interrelationships between structures.
Working Smart Vs. Working Hard
 Take your time. Rushing will decrease your focus and
awareness.
 Visualize what you are trying to access and verbalize
this to your partner.
 Locate the structure on your own body first before
trying to palpate it on your partner.
 Be patient.
Less Is More
 Often, if we cannot feel the structure we are trying to
access, a common reaction is to press harder and
deeper.
 Instead of pushing into the muscles and other tissues,
try to invite the tissues into your hands.
Less Is More
 Gentle contact allows your
hands to be sensitive.
 Excessive pushing numbs
the fingers and is unpleasant
for your partner.
Palpating Deeper Structures
 Even deep structures need to be accessed with mild
palpation.
 The deeper you move into the body, the slower and
softer your touch needs to be.
 Palpation at different levels of the body is not a
question of pressure, but of intention.
Sensory Receptors
 An adult has over 600,000 sensory receptors in the
skin – more nerve endings than in any other part of the
body.
 The fingertips are one of the most sensitive areas, with
up to 50,000 nerve endings every square inch.
 A single touch receptor can respond to a pressure of
less than 1/1400 of an ounce – the weight of an
average house fly.
Somatosensory Mapping
Homunculus
Rolling And Strumming
 When outlining the shape or edge of a bone, try rolling
your fingers or thumb across, rather than along, its
surface.
 Use the same procedure with the ropy fibers of muscle
tissue.
 Like strumming the strings of a guitar, this method will
help you ascertain the muscle’s fiber direction and
tensile state.
Rolling And Strumming
Movement And Stillness
 If the structure you are palpating is stationary, move
your hands across it. If it is moving, stay still.
 When palpating an expectant mother’s abdomen,
hoping to feel the fetus move, you keep your hand still.
Movement And Stillness
 When you want to determine
the fiber direction of a
muscle or the shape of a
bone, move your hands
along its surface.
Practice, Practice, Practice
 Practice on yourself.
 Practice on others.
Active Movement
 Active movement is
performed by your partner.
 She actively moves her body
while you palpate or observe
the movement.
 All active movements should
be slow and smooth.
Passive Movement
 Passive movement is the
opposite of active movement.
 Your partner relaxes while
you move her body.
Resisted Movement
 Resisted movement requires
both of you to act.
 Your partner attempts to
perform an action against
your gentle resistance.
 No movement should occur
at the joint being assessed.
When In Doubt, Ask The Body
 When palpating, you may be confused about various
body structures and there whereabouts.
 If you want to know what a particular muscle or tendon
is, palpate it and follow it in both directions to see
where it leads you.
Three Principles Of Palpation
 1. Move slowly.
 2. Avoid using excessive pressure.
 3. Focus your awareness on what you are feeling. Be
present.
Textural Differences
 Different structures and tissues of the body will all have
unique textures.
 Understanding these textural differences will help you
determine which techniques to apply on a particular
body part in your hands-on practice.
Skin
 The skin is the largest organ of the body.
 The skin averages about 1/20 of an inch in thickness,
with the eyelids having the thinnest skin – less than
1/500 of an inch.
 The skin is intimately connected with the superficial
fascia and deeper tissues.
 Its texture, thickness and flexibility vary throughout the
body.
Palpating Skin
 Palpate the skin on the back of your hand. Note the
thin, delicate, and pliable quality.
 Turn your hand over and palpate the palmar surface.
Here the skin has a tougher, thicker layering.
Skin
Bone
 Bones and bony landmarks (the hills, valleys, and
bumps on the surface of bones) are easy to distinguish
from other tissues because they have a solid feel.
 The bones shift along with the surrounding structures
during movement.
 Muscles and tendons can feel very hard when a
muscle contracts against resistance.
 The shape and rigidity of bones are constant, unlike
muscles which transform from soft to hard.
Muscle
 Skeletal muscle is the voluntary contractile tissue that
moves the skeleton.
 It is composed of muscle cells (fibers), layers of
connective tissue (fascia), numerous nerves and blood
vessels.
Muscle
 A layer of fascia (epimysium) encases the muscle
“belly”, a deeper layer (perimysium) wraps along
muscle fibers into bundles and, finally, each
microscopic muscle fiber is bound in fascia
(endomysium).
 The muscle’s layers of connective tissue merge at
either end to form a strong tendon that attaches the
muscle to a bone.
Muscle
Palpating Muscle
 Muscle has three specific physical characteristics
which help to distinguish it from other tissues.
 Muscle tissue has a striated texture (similar to a plank of
unsanded wood), whereas tendons have a smoother feel.
 The direction of the muscle fibers can be used to
determine which muscle you are palpating.
 Muscle tissue can be in either a contracted or relaxed
state.
 Relaxed muscle is soft and malleable.
 Contracted muscle has a firm, solid quality.
Palpating Muscle
Palpating Deeper Muscles
 Sometimes the overlying muscle can be shifted to the
side to palpate the deeper one.
 You can slowly compress your fingerpads beyond the
superficial muscle into the deeper tissues (similar to
palpating through your sweater, shirt, and skin to
palpate the muscles in your arm.
Shapes of Muscle Bellies
Tendon
 Tendon attaches muscle to the periosteum (connective
tissue) surrounding the bone.
 Tendons are dense connective tissue shaped into
bundles of parallel collagen fibers.
 Each muscle has one or more tendons.
 Tendons come in many different shapes and sizes.
Tendon
 Some are long and thin while others are short and fat.
 A broad flat tendon is called an aponeurosis.
 Tendons have a smooth resilient feel.
 Palpate from the belly of the muscle into the tendon. It
may feel like a taut strand of cable.
Tendon
Ligament
 Ligaments connect bones together at a joint.
 Their function is to strengthen and stabilize a joint.
 Ligaments are also made of dense connective tissue
like tendons.
 The fibers in a ligament have a more uneven
configuration than in tendons.
 Ligaments have a dense, taut feel.
Ligament
Tendon Vs. Ligament
 A tendon will become taut or slack depending upon
whether it is shortened or lengthened if its muscle belly
is contracted.
 Ligaments remain taut throughout all movements or
states of contraction.
Fascia
 Fascia is a form of dense connective tissue.
 It is a continuous sheet of fibrous membrane located
beneath the skin and around the muscles and organs.
 It forms a three-dimensional matrix of connective tissue
extending throughout the body from head to toe.
Fascia
Superficial and Deep Fascia
 Superficial fascia is located deep to the skin and covers
the entire body.
 It is a layering filled with adipose tissue, nerves, blood
vessels, lymph vessels, and connective tissue.
 It can be very thin (back of the hand) or very thick (sole of
the foot)
Superficial and Deep Fascia
 Deep fascia surrounds muscle bellies, holding them
together and separating them into functional groups.
 It also carries blood vessels and nerves.
 Portions penetrate the muscle belly and surround each
muscle fiber.
Retinaculum
 A retinaculum is a structure that holds an organ or
tissue in place.
 In relation to muscle tissue, it is a transverse thickening
of the deep fascia which straps tendons down in a
particular location or position.
Retinaculum
 Most retinacula are superficial and accessible.
 It can be distinguished from its deeper tendons by its
fiber direction.
 It will have transverse fibers than run perpendicular to
the deeper tendons.
Retinaculum
Artery And Vein
 The pulse of the heart can be felt in an artery, but not
on a vein.
 Arteries are often situated on the protected side of an
appendage and buried deep to the musculature.
Artery And Vein
 Some veins can be palpated superficially.
 We must be able to palpate arteries to obtain a pulse.
 We should avoid pressing on them when palpating
muscles.
Bursa
 A bursa is a small, fluid filled sack that reduces friction
between two structures.
 The bursa are primarily situated around joints.
 The body has approximately 600 bursae that cushion
skin, tendons, ligaments, muscle, or organs from the
hard surfaces of bones.
 They can be found between two muscles, two tendons,
a tendon and a ligament, or a muscle and a ligament.
Bursa
Bursitis
 Bursitis is an inflammation of the bursa.
 It causes tenderness in the area and crepitation
(cracking and clicking sounds) of the joint.
 When inflamed, superficial bursa are easily palpable
and sometimes visible.
 In their normal state, bursa are generally not palpable.
Nerve
 Nerve vessels are tube-shaped, mobile and tender
when compressed.
 Although some sections of nerves and plexuses
(bundles of nerves) can be accessed, they are best
avoided.
 Compression or impingement of a nerve may create a
sharp, shooting sensation locally or down the
corresponding appendage.
Nerve
Lymph Node
 Lymph nodes collect lymphatic fluid from the lymphatic
vessels.
 They are bean-shaped and may range in size from a
tiny pea to an almond.
 They are located throughout the body.
Lymph Node
 Palpable groups of nodes are found in the body’s
creases such as the groin, axilla, and neck.
 Healthy lymph nodes are roundish, slightly moveable,
and non-tender.
 Glandular tissue is usually larger and has an irregular
surface.
Lymph Node
Adipose Tissue
 Adipose (fatty) tissue is a form of loose connective
tissue.
 The most palpable location of adipose tissue is in the
subcutaneous layer of tissue between the skin and
superficial fascia.
 This layer of adipose tissue varies in thickness
throughout the body and may have different
consistencies.
 Adipose tissue usually has a gelatinous consistency.