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Palpation. Dr. Michael P. Gillespie. Palpation Hints. Palpation 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 structure Becoming aware of its characteristics

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Dr. Michael P. Gillespie

palpation hints
Palpation Hints
  • Palpation 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 structure
      • Becoming aware of its characteristics
      • Assessing its quality or condition so you can determine how to treat it
palpation hints3
Palpation Hints
  • In 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 experience
A Full Sensory Experience
  • Palpation requires receptive hands and fingers, open eyes, listening ears, calm breath, and quiet mind.
making contact
Making Contact
  • Your 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 contact6
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 contact7
Making Contact
  • Smaller structures can be located by using one or two fingertips.
making contact8
Making Contact
  • Larger structures are best palpated with the whole hand.
making contact9
Making Contact
  • By 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
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 more
Less Is More
  • Often, 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 more12
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
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 receptors
Sensory Receptors
  • An 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.
rolling and strumming
Rolling And Strumming
  • When 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.
movement and stillness
Movement And Stillness
  • If 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 stillness20
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, Practice, Practice
  • Practice on yourself.
  • Practice on others.
active movement
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
  • Passive movement is the opposite of active movement.
  • Your partner relaxes while you move her body.
resisted movement
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 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
Three Principles Of Palpation
  • 1. Move slowly.
  • 2. Avoid using excessive pressure.
  • 3. Focus your awareness on what you are feeling. Be present.
textural differences
Textural Differences
  • Different 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.
  • The 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 skin
Palpating Skin
  • Palpate 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.
  • Bones 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.
  • Skeletal 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.
  • A 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.
palpating muscle
Palpating Muscle
  • Muscle 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 deeper muscles
Palpating Deeper Muscles
  • Sometimes 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.
  • Tendon 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.
  • Some 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.
  • Ligaments 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.
tendon vs ligament
Tendon Vs. Ligament
  • A 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.
  • Fascia 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.
superficial and deep 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 fascia48
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.
  • A 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.
  • Most 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.
artery and vein
Artery And Vein
  • The 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 vein53
Artery And Vein
  • Some 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.
  • A 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.
  • Bursitis 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.
  • Nerve 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.
lymph node
Lymph Node
  • Lymph 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 node60
Lymph Node
  • Palpable 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.
adipose tissue
Adipose Tissue
  • Adipose (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.