PalpationDr. Michael P. Gillespie

Palpation HintsPalpation 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 structureBecoming aware of its characteristicsAssessing its quality or condition so you can

determine how to treat it

Palpation HintsIn 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 ExperiencePalpation requires receptive hands and fingers,

open eyes, listening ears, calm breath, and quiet mind.

Making ContactYour 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 ContactBy 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 MoreOften, 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 ReceptorsAn 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 StrummingWhen 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 StillnessIf 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 DifferencesDifferent 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.

SkinThe 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 SkinPalpate 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

BoneBones 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.

MuscleSkeletal 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.

MuscleA 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 MuscleMuscle 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 MusclesSometimes 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

TendonTendon 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.

TendonSome 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

LigamentLigaments 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. LigamentA 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.

FasciaFascia 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.

RetinaculumA 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.

RetinaculumMost 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 VeinThe 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 VeinSome 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.

BursaA 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

BursitisBursitis 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.

NerveNerve 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 NodeLymph 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 NodePalpable 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 TissueAdipose (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.