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Causes of Right Side Chest Pain. How Synovial Sarcoma Is Diagnosed. How Lymphoma Is Diagnosed. Even more important than performing palpation exercises with textbooks, applying palpation directly to the client is imperative. When your hands are on your fellow students in school or on your clients if you are in professional practice, constantly try to feel for the structures about which you have learned in your anatomy, physiology, and kinesiology classes.
The better you can picture an underlying structure, the better you will be able to feel it with your palpating hands and with your mind. Once felt, you can focus on locating its precise location and assessing its tissue quality. Perfecting our palpatory literacy is a work in progress—an endless journey. The more we polish and perfect this skill, the greater our therapeutic potential becomes, bringing greater benefit to our clients.
However, written chapters can only provide guidelines and a framework for how to palpate. Ultimately, palpation is a kinesthetic skill and, as such, can only be learned by kinesthetic means. The following 20 guidelines are provided for successful muscle palpation.
The first two guidelines make up the science of muscle palpation. The remaining guidelines begin and perfect the art of muscle palpation. When a target muscle is superficial, it is usually not difficult to palpate. If we know where it is located, we can simply place our hands there and feel for it.
Therefore the first step of muscle palpation is to know the attachments of the target muscle. For example, if we know that the deltoid is attached to the lateral clavicle, acromion process, spine of the scapula, and deltoid tuberosity of the humerus, then we need simply to place our palpating hand there to feel it Figure Sometimes, even if a target muscle is superficial, it can be difficult to discern the borders of the muscle.
If the target muscle is deep to another muscle, it can be that much harder to palpate and discern from more superficial and other nearby muscles. To better discern the target muscle from all adjacent musculature and other soft tissues, asking the client to contract the target muscle by performing one or more of its actions is helpful.
If the target muscle contracts, it will become palpably harder. Assuming that all the adjacent muscles stay relaxed and therefore palpably soft, the difference in tissue texture between the hard target muscle and the soft adjacent muscles will be clear. This difference will allow an accurate determination of the location of the target muscle. Therefore the second step of muscle palpation is to know the actions of the target muscle Figure Armed with this knowledge, the majority of muscle palpations can be reasoned out instead of memorized.
Using the attachments and actions to palpate a target muscle can be thought of as the science of muscle palpation. Applying knowledge of the attachments and actions of a target muscle to palpate it is a solid foundation for palpatory literacy. However, effective palpation requires not only that the target muscle contracts, but it also requires that an isolated contraction of the target muscle occurs.
This means that the target muscle needs to be the only muscle that contracts, and all muscles near the target muscle must remain relaxed.
If the action chosen is shared with an adjacent muscle, then the adjacent muscle will also contract, making it very difficult to discern the target muscle from it. For this reason, knowing which joint action to ask the client to perform requires the therapist to be creative and to think critically. Palpation is the most important assessment skill that exists in the world of manual therapy. Learning to palpate the muscles of the body is not a matter of having muscle palpations presented and then memorizing them.
Rather, there is a science and an art to muscle palpation. With this workshop, you will sharpen and master how to do muscle palpation so that you are empowered to locate and assess the skeletal muscles of the human body.
Learn to locate the exact attachment points for each and every target muscle that you are palpating; learn how to feel and assess baseline tone for each and every target muscle.
During the workshop, we will practice and perfect muscle palpation protocols for the musculature of the entire body. Specifically, we will palpate the most clinically important muscles of the body, including some of the more challenging muscle palpations, such as the psoas major, quadratus lumborum, piriformis, rotator cuff group, hip flexor group, pterygoids, and the scalenes and longus muscles of the anterior neck, as well as many others.
This workshop will build mastery and confidence in your palpation assessment skill. This means that we need to find an action that engages the target muscle but does not engage the adjacent muscles. In effect, we want an isolated contraction of the target muscle.
Although this is not always perfectly possible, most of the time it can be achieved quite well. Here, guideline No. In a sense, this guideline is a refinement of guideline No. Choosing the best action to create an isolated contraction of the target muscle requires knowledge of not just the actions of the target muscle, but also the actions of all the adjacent muscles.
This is where our foundation of science knowledge and critical thinking skills truly become important. What we need to do is think through all of the actions of the target muscle to find the action that is most different from the actions of the adjacent muscles.
For example, continuing with the deltoid as our example, glenohumeral abduction will engage anterior, middle and posterior fibers of the deltoid.
However, if we want to palpate and discern only the anterior deltoid, flexion of the arm at the glenohumeral joint is a better joint action because it engages the anterior deltoid without also engaging the middle deltoid. In fact, an even better action for palpation of the anterior deltoid is horizontal flexion of the arm at the glenohumeral joint because it creates a more powerful contraction, and engages fewer adjacent muscles.
Similarly, if we want to palpate the posterior deltoid, glenohumeral joint extension is better than abduction because it engages the posterior deltoid without engaging the middle deltoid. And horizontal extension of the arm at the glenohumeral joint is the very best joint action to have the client perform because it creates the most powerful and isolated contraction of the posterior deltoid.
Another example is palpation of the fl exor carpi radialis FCR of the wrist flexor group. If we ask the client to flex the hand at the wrist joint, the FCR engages, but so will many other muscles of the anterior forearm, including the adjacent palmaris longus PL. In this case, a better action is to have the client radially deviate abduct the hand at the wrist joint. So, when palpating the FCR, guideline No. Flexion of the hand accomplishes this goal, but is also a common action of other adjacent muscles.
Guideline No. In this instance, the best action is radial deviation of the hand at the wrist joint. In these cases, choosing the best action depends upon which aspect of the target muscle we are palpating.
An excellent example is the fibularis longus FL please note, the FL was formerly called the peroneus longus of the leg. The FL everts and plantarflexes the foot. What action would be the best one to use? The answer depends upon whether we are palpating the anterior or posterior aspect of the muscle. If we had chosen eversion, both the FL and EDL would engage, making discerning the border between them difficult. Eversion engages the FL, but not the soleus the soleus plantarfl exes and inverts the foot.
If we had asked the client to plantarfl ex in this case, both the FL and the soleus would have contracted, making it difficult to discern the border between them.
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