Palpation of Bony Landmarks

UPPER EXTREMITY Scapula:

1. Spine – From AC joint palpate across the upper part of the posterior surface of the scapula. It is a long (3”) thin projection, which runs medial to lateral, at T3 level.

2. Acromion process – Located on the lateral part of the shoulder, right above the shoulder

joint.

3. Coracoid process – Palpate under the lateral part of the clavicle (about one inch below the anterior edge of the clavicle).

4. Medial (vertebral) border – The edge of the scapula closest to the vertebral column (about

2 inches from the spinous processes). The medial border runs in a superior-inferior direction.

5. Lateral (axillary) border – The lateral (or outer) edge of the scapula located between the

inferior angle and the shoulder joint.

6. Superior medial angle – Located above the vertebral border or medial aspect of scapula, level T2.

7. Inferior angle – Located between vertebral and axillary borders. The “point” at the

bottom of scapula, level T7. Clavicle: “Collar bone” – anterior from sternum to acromion Humerus:

1. Greater tuberosity – Located just below acromion when arm is resting by the side. (proximal end of humerus)

2. Lesser tuberosity – Easiest to palpate with arm in shoulder external rotation. located medial to greater tuberosity on proximal end of humerus. 3. Intertubercular (Bicipital) Grove – Located between greater and lesser tuberosity; easiest to palpate with arm in external rotation. 4. Medial and lateral epicondyles – Palpated on medial and lateral sides, respectively, of distal end of humerus (2 “bumps” on distal end).

5. Medial and lateral supracondylar ridge – above the medial and lateral epicondyles on distal end of humerus. 6. Olecxranon fossa – indentation on posterior of elbow Radius: 1. Head – From lateral epicondyle of humerus move distally about 1 inch. Head of radius palpated easiest as you pronate and supinate. 2. Anterior border – Ridge just above wrist on lateral aspect of lower forearm.

3. Styloid process – In the anatomic position, styloid is lateral just above wrist joint.

4. Dorsal tubercle – On distal end of radius on posterolateral aspect of wrist. Feels like a small longitudinal bony prominence or module.

Ulna: 1. Olecranon – “Funny bone” – long protuberance on posterior of elbow.

2. Styloid process – In the anatomic position, styloid process is on medial aspect of wrist, also slightly posterior. Is more proximal than radial styloid process.

3. Head – On distal end of ulna. In supination, it can be palpated on medial-anterior aspect

of wrist (just proximal to wrist). In pronation, head is the projection on posterior aspect (ulnar side) of wrist.

Carpals: 1. Pisiform – “Pea-shaped” bone on ulnar side of hand (palmar surface)

2. Scaphoid – On radial side of wrist – easiest to palpate in “floor” of anatomical snuffbox (proximal to thumb) as you move hand into ulnar deviation.

3. Trapezium – On radial side of wrist where it articulates with 1st metacarpal to form saddle

joint. Easiest to palpate as you flex and extend the thumb. 4. Hamate (hook) – Located slightly distal and radial to the pisiform.

5. Capitata – Proximal to the base of the third metacarpal between the dorsal tubercle of the radius and the third metacarpal. Most easily palpated as you flex the wrist.

6. Triangular – Located just distal to the ulnar styloid process. To palpate, radially deviate

the hand.

7. Base, body, head of metacarpals and phalanges. LOWER EXTREMITY Femur: 1. Greater trochanger – lateral aspect of thigh just distal to hip joint. 2. Medial and lateral condyles – on distal end of femur 3. Medial and lateral epicondyles (Epicondyles) Patella: “Knee cap” – anterior aspect of knee (a sesamoid bone located in quadriceps tendon). Tibia: 1. Medial condyle – on proximal end of tibia, medial aspect.

2. Tibial tuberosity – on proximal end, anterior aspect just below patella. (insertion for quadriceps tendon)

3. Tibial spine – “Shin bone” - anterior ridge along tibia. 4. Medial malleolus – large protuberance on medial aspect of ankle. 5. Tibial plateau 6. Lateral condyle 7. Shaft Fibula: 1. Head – Move distally and posteriorly from lateral femoral condyle. 2. Lateral malleolus – Large protuberance on lateral aspect of ankle. 3. Shaft 4. Styloid process

Tarsals: 1. Calcaneus – heel bone. 2. Naviculr tubercle – On medial border of foot, large bony prominence. 3. Head of the Talus – Just proximal to navicular tubercle, especially palpable in eversion.

4. Sustentaculum tali – Located between the head of the Talus and the medial malleolus. Feels like a small ridge.

5. Peroneal tubercle of the calcaneus – On lateral aspect of foot just distal to lateral

malleolus.

6. Medial tubercle of calcaneus – lies on the medial plantar surface of the calcaneus (not usually sharp or distinct unless it is associated with a heel spur.