Athletic Training & Sports Medicine Center

AH 321 Assessment of Athletic Injuries/Illnesses Laboratory

Bony Palpation Skill Sheet

Hand & Wrist	Arm	Hip, Pelvis & Spine	Foot & Ankle
Forearm	Shoulder Girdle	Knee	Head & Face
back to AH 321

Wrist & Hand

Bony Landmark (include alternative name if applicable)	Related Information such as purpose, function, attachment of ligaments, tendon, soft tissues involved	Preferred Body & Joint Position best for palpation	Anatomical Description of Location relative to other structures	Skeleton Picture or Video	Model Picture or Video
Pisiform	Along with the hamate, it permits passage of the ulnar nerve and artery; the flexor carpi ulnaris and abductor digiti minimi attach here; also attachment site of pisohamate ligament	Arm and hand resting on table in the anatomical position	On the ulnar side of the wrist, just proximal to the base of the 5th metacarpal
Scaphoid (navicular) in snuffbox	The navicular forms the floor of the anatomic snuffbox. The rest of the snuffbox is formed by the abductor pollicis longus and the extensor pollicis longus and brevis tendons	Patient needs to be sitting on the edge of the table with arm relaxed and abducted, with the thumb extended laterally away from the fingers	The anatomic snuffbox is a small depression located immediately distal and slightly dorsal to the radial styloid process
Scaphoid tubercle	Also called the "navicular"	Patient's hand relaxed on the table	It is situated on the radial side of the carpus, longest bone in the proximal carpal row, ulnar deviation causes the navicular to slide out from under the radial styloid process so that it becomes palpable
Triquetrum	Vulnerable to injury, ranking 3rd highest of all the carpal bones in incidence of a fracture	Hand must be radially deviated or abducted so the triquetrum moves from under the styloid process	Lies just distally to the ulnar styloid process, in the proximal carpal row
Trapezoid		Hand relaxed on table, palm side down	Lies between the capitate and trapezium
Capitate	Attachment for capitotriquentral ligament	Patient's wrist in neutral position	Located in the depression just proximal to the base of the 3rd metacarpal and distal to Lister's tubercle		XX
Hamate	Forms the insertion of part of the flexor carpi ulnaris muscle	Patient's hand supported by the examiner with the forearm and wrist in supination	Is located slightly distal and radial to the pisiform; place the interphalangeal joint of your thumb upon the pisiform, pointing the tip of your thumb toward the web space between the patient's thumb and index finger and rest the tip of your thumb in the palm of the patient's hand, the hammate lies directly underneath the tip of your thumb, but is hard to palpate because it is buried deeply under layers of soft tissues
Lunate	Articulates proximally with the radius and distally with the capitate; covered by the extensor carpi radialis brevis tendon; most frequently dislocated and 2nd most fractured bone of the wrist	Wrist in flexion	Follow the 3rd metacarpal to its articulation with the capitate; there will be an indention; have the patient flex the wrist; this will make the lunate palpable
Hamate (hook)	Forms the lateral border of the tunnel of Guyon which transports the ulnar nerve and artery to the hand	Patient sitting on the edge of the table, relaxed	Located slightly distal and radial to the pisiform
Metacarpals 1-5	Insertion point for the flexor carpi radialis, palmaris longus, extensor carpi radialis brevis, extensor carpi radialis longus, and adductor pollicus longus	Hand relaxed and in a neutral position	Located superior to the phalange bones
Metacarpal heads 1-5	Attachment site of flexor digitorum superficialis	Fingers in full extension	Articulates with base of proximal phalanx
Metacarpal bases 1-5	Assist in flexion and extension of the fingers	Patient's wrist in neutral position	Located superiorly to the carpal bones	X	X
Proximal phalanxes 1-5	Classified as ginglymus joint	Hand supinated or in anatomical position	Located between the distal phalanxes and the MCP joint respectively 1-5
Middle phalanxes 2-5	Insertion of flexor digitorum superficialis and extensor indicis muscles	Hand supinated and fingers extended	Lies between proximal phalanx and distal phalanx
Distal phalanxes 1-5	serves as attachments to the DIP joint	Patient sitting on table and relaxed	Located superior to the DIP joint