Athletic Training & Sports Medicine Center

AH 321 Assessment of Athletic Injuries/Illnesses Laboratory

Joint & Soft Tissue Palpation

Hand & Wrist	Arm	Spine & Trunk	Foot & Ankle
Forearm	Shoulder Girdle	Hip, Knee & Lower Leg	Head & Face
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FOOT & ANKLE

Joint or Soft Tissue Structure (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
1st Interphalangeal joint		Patient sitting or standing with the foot in neutral.	It is located on the great toe and it is the joint just proximal to the toe nail.
5th Metatarsocuboid		Foot in neutral position	Located on the lateral side of the ball of the foot; the joint is located inferior to the 5th metatarsal and superior to the cuboid.
Anterior Inferior Tibiofibular	Amphiarthrodial; The anterior inferior tibiofibular ligament lies just superior to the joint.	Clear palpation is impossible because the anterior inferior tibiofibular ligament overlies the joint; You can only feel a slight depression over it.	Located immediately proximal to the talus.
4th DIP	The attachment of flexor digitorum longus, extensor digitorum longus, and it is formed by the 4th distal phalanx and the 4th middle phalanx.	The patient's foot needs to be in neutral and relaxed.	It is the distal joint on the fourth metatarsal.
Talocrural (anterior)
Talocrural (posteromedial)	Allows foot to dorsiflex and plantarflex; flexor hallucis longus crosses this joint	Short-sitting, foot in neutral	Immediately posterior to the medial malleolus
1st Metatarsophalangeal	Joint most involved in gout, bunions, and "turf toe"; extensor hallucis longus crosses this joint	Short-sitting, foot in neutral	Located on the anteromedial side of the foot; where the head of the 1st metatarsal articulates with the proximal head of the 1st proximal phalanx
Talonavicular	Articulation point of the talus and navicular; it is a midtarsal joint	Short-sitting position, foot relaxed	Located medially and proximal to the navicular tubercle
Posterior Inferior Tibiofibular	Posterior inferior tibiofibular ligament crosses this joint and serves to keep the mortise from widening	Short-sitting, foot in neurtal	Posterior and distal articulation of the tibia and fibula
5th MP
Calcaneocuboid	Serves as an attachment for the peroneus brevis muscle	Patient in short-sitting position, foot in neutral	It is lateral to the talus and cuneiforms
Talocrural (posterolateral)	Ginglymus joint	Patient in short sitting position with foot in neutral	The talocrural controls dorsiflexion and plantarflexion
3rd PIP	Sliding joints	Patient in short-sitting position, foot in neutral	It is located distally to the third proximal phalanx
Subtalar	Subtalar joint controls the movements of inversion, eversion, pronation, and supination	Patient in short-sitting position with foot in neutral	Subtalar joint is located inferior to the lateral malleolus

LOWER LEG

Joint or Soft Tissue Structure (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
Posterior Superior Tibiofibular		Knee in slight flexion.	Palpate the back of the knee where the lateral condyle of the tibia and the head of the fibula articulate.		XXX
Anterolateral Tibiofemoral	Palpate sharp edge of the lateral tibial plateau to the junction of the tibia and femur	Knee flexed at 90 degrees	Located distal to the lateral femoral condyle and proximal to the lateral tibial plateau
Medial Patellofemoral	Arthrodial joint	Knee extended	Located on the anteriomedial aspect of the knee, just proximal to the joint line
Anteromedial Tibiofemoral	Where flexion and extension of the knee occurs; medial meniscus lies within this joint	Short-sitting	Where the medial tibial plateau articulates with the medial femoral condyle		XX
Posterolateral Tibiofemoral	Where flexion and extension of the knee occurs; lateral meniscus lies within this joint	Not palpable; covered by the lateral head of the gastrocnemius	Where the posterior portion of the lateral tibial plateau articulates with the posterolateral femoral condyle
Lateral Patellofemoral		Short-sitting position, knee flexed to 90°	Where the patella articulates with the lateral femoral condyle
Anterior Superior Tibiofibular	Arthrodial joint	Patient in short-sitting position	Located on the anterolateral aspect of knee just superior to the Gerdy's Tubercle
Posteromedial Tibiofemoral	Ginglymus joint	Patient lying prone on table with knee flexed	Located inferior to the medial collateral ligament
Posterior Tibiofemoral	Ginglymus joint	Patient lying prone on table with knee flexed	Located inferior to the posterior cruciate ligament

RIB & SPINE

Joint or Soft Tissue Structure (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
Posterior Intervertebral Joints C2-S1	Spaces for spinal nerves to pass through to supply the body.	The patient must be lying prone.	Located from the base of the skull to the posterior superior iliac spine.
Posterior Rib #8 & T8
Anterior Rib #4 & sternum			You can locate these bones by moving up from the xiphoid process approximately three finger widths; this is where the two bones connect.
Posterior Rib #1 & T1	A true rib; connected to the manubrium by costal cartilage; lies directly inferior to the clavicle.	The patient must be lying prone with some capital and cervical flexion	The first rib-thoracic vertebrae articulation located inferior to the prominent spinous process of C7
Posterior Rib #12 & T12	Attachment site of erector spinae muscle	Prone	Where the posterior head of rib 12 articulates with the transverse process of T12
Anterior Rib #7 & Sternum	Where the serratus anterior attaches	Patient in supine	Located on the ventral side of the abdomen between the 6th and 7th ribs
Posterior Rib #4 & T4	Arthrodial joints	Patient standing relaxed or lying prone	Where the posterior aspect of rib 4 articulates with the transverse process of T4
Anterior Rib #2 & Sternum	Where the pectoralis major attaches	Patient standing relaxed or lying supine	Where the anterior aspect of rib 2 articulates with the sternum

HIP

Joint or Soft Tissue Structure (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
Posterior Sacroiliac	Posterior sacroiliac ligaments attach here	Prone	Where the posterior sacrum articulates with the posterior iliac spine

SHOULDER

Joint or Soft Tissue Structure (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
Posterior Glenohumeral	Apex of the pyramid that is formed by the axilla	Patient sitting with arm adducted and elevated at 45 degrees	Located posteriorly to the glenohumeral joint, resting on the superior scapula border
Acromioclavicular	Movement can be felt when the patient actively flexes and extends; Arthrodial joint	Palpation is easier if the patient rotates the arm, push in a medial direction against the thickness at the end of the clavicle	Find the clavicle and palpate laterally to the distal most point.
Anterior Glenohumeral	Site where the glenoid labrum encapsulates the humeral head	Patient supine; externally rotate the shoulder, palpate the acromion and move slightly distal	Anterior surface of the shoulder where the head of the humerus articulates with glenoid fossa
Inferior Glenohumeral	Attachment site of inferior glenohumeral ligament	Patient supine, arm abducted to at least 90°	Where the inferior portion of the humeral head articulates with the inferior rim of the glenoid fossa
Sternoclavicular	Enarthrodial joint supported by the anterior sternoclavicular ligament	Either standing in the anatomical position or in short sitting position	Located lateral to the suprasternal notch
Superior Glenohumeral	Enarthrodial joint that is supported by the joint capsule, glenoid labrum, and the coracohumeral ligament	Patient in the short-sitting position with shoulder relaxed	Where the superior aspect of the humeral head articulates with the glenoid fossa

ELBOW & FOREARM

Joint or Soft Tissue Structure (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
Anterior Distal Radioulnar
Medial Humeroulnar	A hinge joint formed by the humerus and ulnar	To palpate; have the patient sitting with their arm on the table.	Stabilize humerus and palpate medially until you come to the elbow joint.
Medial Olecranon & Fossa	Filled with fat and covered by a portion of the triceps and aponeurosis; precise palpation is difficult	Standing or short-sitting with the elbow flexed to 10°	Medial side of the distal end of the posterior humerus
Posterior Distal Radioulnar	Attachment site of the extensor indices muscle and extensor retinaclum	Arm resting on table, hand in full pronation	Lies just proximal to the lunate bone
Radiocapitellar	Attaches to the lateral epicondyle of the elbow	Patient in short sitting position with arm internally rotated	Controls the movements of supination and pronation
Lateral Olecranon & Fossa	The lateral olecranon process inserts into the lateral olecranon fossa on elbow extension	Patient in short sitting position with elbow flexed 30 degrees	The olecranon fossa lies at the distal end of the posterior humerus, the olecranon process is located on the proximal end of ulna

WRIST

Joint or Soft Tissue Structure (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
Triquetrum-Ulnar		Patient can support their arm and hand on the table palm up or they can stand in the anatomical position with the hand relaxed.	Palpate slightly proximal and medial from the styloid process of the ulna.
Posterior Scaphoradial	Posterior to the anatomical snuffbox	Hand in pronation, thumb extended laterally away from fingers	Located distal to the radius along the lateral border, posterior to the scaphoid
Scapholunate	Arthroidal joint; extensor pollicis longus tendon crosses this joint	Hand in pronation, resting on table	Where the scaphoid articulates with the lunate
Anterior Scaphoradial	Condyloid joint	Hand in pronation, resting on table	Where the scaphoid articulates with the head of the radius
Hamate-4th & 5th Metacarpal	Ellipsoid joint	Hand in pronation, resting on table	Where the hamate articulates with the 3rd and 4th metacarpal of hand

HAND

Joint or Soft Tissue Structure (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
1st Metacarpophalangeal	Condyloid type joint	MCP joint flexed	Located immediately distal to the 1st metacarpal bone
2nd PIP	Extensor indicis, extensor digitorum, flexor digitorum superficialis, and is composed of the 2nd middle phalanx and the 2nd proximal phalanx	Neutral	Located just inferior to the 2nd metacarpal joint.
3rd DIP	Hinge joint	To palpate find the third finger on the hand, and make sure the model's hand is relaxed on the table.	Palpate until the last joint of the finger just proximal to the nail.
1st Carpometacarpal	Extensor pollicis longus and brevis cross this joint	Hand in full pronation, resting on table; ask the model to oppose the thumb and palpate the joint line	Where the trapezium articulates with the 1st metacarpal
3rd Metacarpophalangeal	Where flexion, extension, abduction, and adduction occurs in the 3rd phalange	Han in full pronation, resting on table	Where the head of the 3rd metacarpal articulates with the proximal head of 3rd proximal phalanx
2nd DIP	Joint has only flexion and extension; has reinforcing collateral ligaments on medial and lateral joint lines	Hand and forearm resting on table with the fingers hanging over the edge	Where the distal head of the intermediate phalanx of the index finger articulates with the proximal head of the distal phalanx
3rd Metacarpal-Capitate	Condyloid joint	Hand in pronation, resting on table	This joint performs the movements of flexion,extension, abduction, adduction, and circumduction
5th Metacarpophalangeal	Site of finger abduction, adduction, and MCP flexion and extension	Palm and forearm resting on flat surface	Where the head of the 5th metacarpal articulates with the proximal end of the proximal phalanx
4th PIP	Condyloid joint	Hand in pronation, resting on table	This joint is located distal to the MCP joint

FACE

Joint or Soft Tissue Structure (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
Anterior Temporomandibular	Attachment site of the auricularis muscle	Patient in supine; instruct patient to open and close the mouth while the examiner palpates the joint line	Posterior and lateral to the zygomatic arch and anterior to the external ear canal
Posterior Temporomandibular	Serves as an attachment for the Stylomandibular ligament	Patient is short sitting and relaxed	The joint is inferior to the external auditory meatus

SOFT TISSUE

KNEE

Joint or Soft Tissue Structure (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
Patella Tendon		The patient can be seated or lying supine with the knee flexed to 30 degrees and relaxed.	Palpate slightly superior to the tibial tuberosity; you will feel a thick band and this is the patella tendon.
Tibial Collateral Ligament	Also known as the Medial Collateral Ligament (MCL); It joins the medial femoral epicondyle and the tibia	Patient sitting on table with legs at 90 degrees off the edge of the table	Located superior medial aspect of the medial femoral condyle to the inferior medial aspect of the medial tibial plateau
Rectus Femoris Tendon	Connects the quadriceps muscle group to the patella	Patient in short-sitting or supine	Located on the anterior portion of the thigh and attaches to the superior pole of the patella
Biceps Femoris Tendon	Aids in knee flexion	Knee flexed to 90°, becomes prominent where it crosses the knee joint	Originates at the greater tuberosity of the ilium and inserts at the fibular head
Semimembranosus Tendon	It is the most medial of the three hamstring tendons	Lying in the prone position with lower leg internally rotated	Originates from the lateral aspect of the ischial tuberosity and attaches into the medial femoral condyle
Semitendinosus Tendon	Assists in knee flexion	Lying in the prone position with the lower leg internally rotated	Originates from the medial aspect of the ischial tuberosity and attaches into the medial aspect of the proximal tibia
Fibula Collateral Ligament	Attaches to the lateral epicondyle of the femur and the head of the fibula	Have patient sit on the end of table with the leg in figure 4 position	Located lateral to the lateral mensicus

FOOT & ANKLE

Joint or Soft Tissue Structure (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
Achilles Tendon	It is the thickest and strongest tendon in the body.	Foot in a dorsiflexed position	Can be palpated from the lower 1/3 of the calf to it's insertion point at the calcaneus.
Extensor Hallucis Longus Tendon	Attaches at the 1st DIP joint.	The patient's foot needs to be slightly dorsiflexed, and the great toe can be actively extended.	Should be located and be visible and palpable to the 1st metatarsal.
Tibialis Anterior Tendon	Dorsiflexor and invertor of the foot. Loss of this tendon alone can result in drop foot.	Have the patient dorsiflex and invert the foot.	The tendon should be located very easily. It should be very palpable where it crosses the ankle joint. As the foot is dorsiflexed the tendon becomes prominent just anterior to the ankle joint and ties into the medial aspect of the base of the first metatarsal and the first cuneiform bones.
Extensor Digitorum Longus Tendon	Attaches to the 2nd-5th phalanges of the foot and acts in extension	Short-sitting, foot in neutral; instruct patient to extend toes against resistance	Lateral to the extensor hallucis longus tendon where it crosses the talocrural joint
Peroneus Brevis Tendon	Primary foot everters; assist in plantarflexion	Short-sitting, foot in neurtal; instruct patient to evert against resistance	Passes through a groove immediately behind the lateral malleolus
Calcaneofibular Ligament	Limits foot inversion	Short-sitting, foot in inversion	Originates at the lateral malleolus and runs in a posterior and inferior direction
Anterior Talofibular Ligament	Attaches the talus to the fibula to prevent anterior displacement of talus	Patient in short sitting position with ankle in neutal position	Located on the lateral side of foot in the sinus tarsi area
Deltoid Ligament	Attaches to the talus medially, and to the posterior margin of the navicular	Patient in short sitting position with ankle in neutral position	Located on the medial aspect of the foot under the medial malleolus

THORAX

Joint or Soft Tissue Structure (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
Linea Alba		The patient can be seated or lying supine on a table and relaxed.	With the abdominal muscles contracted, this is the verticle line that runs between the left and right rectus abdominis muscles.

NECK

Joint or Soft Tissue Structure (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
Sternocleidomastoid Muscle	Located lateral to the thyroid cartilage	Turn head to the opposite side of the side that is being palpated	Extends from the sternoclavicular joint to the mastoid processes

ELBOW

Joint or Soft Tissue Structure (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
Distal Biceps Brachii Tendon	Located in the cubital fossa	Arm flexed to 90 degrees	Located distally from the belly of the bicep muscle. It attaches proximally along the radial tuberosity. When the arm is flexed the tendon becomes prominent at the bend of the elbow. It is bordered laterally by the brachioradialis and medially by the pronator teres
Distal Triceps Brachii Tendon	Connects the triceps muscle to the proximal end of the olecranon process	Have patient standing with the arm internally rotated, elbow flexed, with the hand supported; palpate on the proximal end of the olecranon process	Located on the posterior side of the arm and attaches to the olecranon process
Ulnar Collateral Ligament	Stabilizes the elbow to prevent valgus instability	Patient in short sitting position with arm externally rotated	Located on the medial side of the arm and attaches into the medial epicondyle

HAND

Joint or Soft Tissue Structure (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
Extensor Pollicis Longus Tendon	It is the ulnar border of the anatomical snuffbox	Hand in neutral position	Tunnell III on the ulnar side of the radial tubercle.
Extensor Digitorum Tendon

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