Knowledge base

Palpation landmarks

The bony landmarks you look for under your fingers, with the route towards them and what you use them for in your examination.

Shoulder

• AcromionReference point for the subacromial space: the greater tubercle disappears underneath it during abduction.…Acromion
• Lateral end of the claviclePalpation of the AC joint after a fall onto the shoulder; tenderness here plus pain on horizontal adduction…Extremitas acromialis claviculae
• Coracoid processAttachment of the pectoralis minor, the short head of the biceps brachii and the coracobrachialis; landmark…Processus coracoideus
• Inferior angle of the scapulaAssessing scapular position and upward rotation during the scapulohumeral rhythm; it normally lies at the…Angulus inferior scapulae
• Greater tubercleAttachment of the supraspinatus, infraspinatus and teres minor; the site of tenderness in cuff tendinopathy.Tuberculum majus humeri
• Jugular notchStarting point for following the clavicle and the sternoclavicular joint, and a fixed landmark when assessing…Incisura jugularis sterni
• Lesser tubercleInsertion of subscapularis, the only internal rotator of the cuff. Tenderness here points to subscapularis…Tuberculum minus humeri
• Bicipital grooveThe long head of biceps runs here, held by the transverse humeral ligament. Tenderness exactly in the groove…Sulcus intertubercularis
• Spine of the scapulaThe divide between the supraspinous and infraspinous fossae, and so between supraspinatus and infraspinatus.…Spina scapulae
• Triangle of the scapular spineA fixed landmark for counting vertebral levels and for comparing left with right when judging scapular…Trigonum spinae scapulae
• Medial border of the scapulaAttachment of the rhomboids and serratus anterior. If the border lifts away from the chest wall you have a…Margo medialis scapulae
• Superior angle of the scapulaAttachment of levator scapulae, and a classic site of neck complaints with prolonged screen work.Angulus superior scapulae
• Sternal end of the clavicleThe only true joint between arm and trunk. Swelling here after a fall may be a dislocation; a posterior…Extremitas sternalis claviculae

Elbow

• Lateral epicondyle of the humerusAttachment of the wrist extensors, so the tender point in lateral epicondylitis. With the medial epicondyle…Epicondylus lateralis humeri
• Medial epicondyle of the humerusAttachment of the wrist flexors (medial epicondylitis) and the wall of the cubital tunnel.Epicondylus medialis humeri
• OlecranonOlecranon bursitis is directly visible and palpable here; the triangle with both epicondyles changes in a…Olecranon
• Head of the radiusTenderness in a radial head fracture after a fall onto the outstretched hand; also the site of restriction in…Caput radii
• Posterior border of the ulnaThe divide between the flexor and extensor compartments of the forearm, and the reference for judging the…Margo posterior ulnae

Wrist and hand

• Radial styloid processReference for radial inclination after a distal radius fracture; the Finkelstein test hurts right across it…Processus styloideus radii
• Ulnar styloid processTogether with the radial styloid the measure of ulnar variance; the fovea just distal to it is the tender…Processus styloideus ulnae
• PisiformEntrance to Guyon's canal, through which the ulnar nerve runs; and the attachment you look for to follow the…Os pisiforme
• Tubercle of the scaphoidTenderness in the snuffbox after a fall onto the outstretched hand is a scaphoid fracture until proven…Tuberculum ossis scaphoidei
• Lister's tubercleThe fixed landmark of the wrist. The extensor pollicis longus tendon turns around it as around a pulley, and…Tuberculum dorsale radii
• Head of the ulnaThe articular disc of the TFCC lies beneath the head. Tenderness in the hollow between head and styloid…Caput ulnae
• LunateThe middle bone of the proximal carpal row and the one that most often dislocates. Avascular necrosis of it…Os lunatum
• TriquetrumWith the pisiform it forms the ulnar cornerstone of the wrist. Tenderness here belongs to the examination of…Os triquetrum
• Hook of the hamateWith the pisiform it forms Guyon's canal, through which the ulnar nerve passes. A hook fracture occurs in…Hamulus ossis hamati
• CapitateThe largest carpal bone and the axis about which the whole wrist moves. It sits centrally, so injury to it…Os capitatum
• TrapeziumWith the base of the first metacarpal it forms the saddle joint of the thumb. Osteoarthritis of it, thumb…Os trapezium
• TrapezoidThe smallest bone of the distal carpal row and the most stable: it sits like a keystone between trapezium and…Os trapezoideum

Spine

• Spinous process of C7The counting point from which you count the thoracic levels, and the reference for measuring cervical range…Processus spinosus vertebrae cervicalis VII
• Spinous process of L4The counting point for the lumbar levels, and the reference for a lumbar puncture or for locating a radicular…Processus spinosus vertebrae lumbalis IV
• Mastoid processAttachment of sternocleidomastoid, splenius capitis and longissimus capitis. The fixed starting point for…Processus mastoideus
• External occipital protuberanceAttachment of trapezius and the nuchal ligament. Tenderness along the nuchal line belongs to cervicogenic…Protuberantia occipitalis externa
• Sternal angle (angle of Louis)The counting landmark of the chest: the second rib attaches here. From it you count all the ribs. Internally…Angulus sterni
• Xiphoid processAttachment of the diaphragm and rectus abdominis. In resuscitation it is the lower limit: the hands belong…Processus xiphoideus
• Median sacral crestThe crest is the fused row of spinous processes of S1 to S4. The upper tubercles, at S1 and S2, are the…Crista sacralis mediana
• Tenth rib in the midaxillary lineA fixed landmark for organ projection: the lower pole of the left kidney and the spleen lie at this level.…Costa X
• Superior nuchal lineAttachment of trapezius, sternocleidomastoid and splenius capitis. The whole line is tender in cervicogenic…Linea nuchae superior

Pelvis

• Anterior superior iliac spine (ASIS)Fixed reference for pelvic position and leg length; attachment of the sartorius and the inguinal ligament.…Spina iliaca anterior superior
• Posterior superior iliac spine (PSIS)Reference for the SI joints and for pelvic position; the joint itself lies directly medial and deep to it.Spina iliaca posterior superior
• Iliac crestIts highest point normally lies at the level of the spinous process of L4: the classic reference for counting…Crista iliaca
• Ischial tuberosityAttachment of the hamstrings (proximal hamstring tendinopathy) and of the sacrotuberous ligament; also the…Tuber ischiadicum
• Pubic tubercleAttachment of the inguinal ligament and of the adductors; tenderness here fits osteitis pubis or an adductor…Tuberculum pubicum

Hip

• Greater trochanterAttachment of the gluteus medius and minimus; tenderness fits gluteal tendinopathy or trochanteric bursitis.…Trochanter major

Knee

• Lateral femoral epicondyleAttachment of the fibular collateral ligament; the iliotibial tract slides over it at about 30 degrees of…Epicondylus lateralis femoris
• Medial femoral epicondyleAttachment of the medial collateral ligament complex, the tender point after a valgus trauma.Epicondylus medialis femoris
• PatellaAssessment of tracking and of patellofemoral pain; the apex is the tender point in patellar tendinopathy…Patella
• Tibial tuberosityInsertion of the patellar tendon; tenderness and swelling in a growing athlete fits Osgood-Schlatter disease.Tuberositas tibiae
• Head of the fibulaAttachment of the fibular collateral ligament and of the biceps femoris; a risk site for peroneal palsy from…Caput fibulae
• Lateral femoral condyleIn a normally aligned leg it carries about forty per cent of the load. In a valgus knee that rises, and that…Condylus lateralis femoris
• Medial femoral condyleThe most heavily loaded part of the knee and the usual site of osteoarthritis, certainly with a varus…Condylus medialis femoris
• Adductor tubercleThe landmark that separates adductor magnus from the other adductors, and the reference from which to find…Tuberculum adductorium femoris
• Tibial plateauThe rim of the plateau is the joint line. Tenderness over part of its course belongs to meniscal injury; a…Facies articularis superior tibiae

Ankle and foot

• Lateral malleolusIts anterior border is the starting point of the anterior talofibular ligament; its posterior border and the…Malleolus lateralis
• Medial malleolusAttachment of the deltoid ligament; behind it run the tendons of the tibialis posterior, the flexors and the…Malleolus medialis
• Calcaneal tuberosityInsertion of the Achilles tendon (tenderness in insertional tendinopathy or Haglund deformity) and origin of…Tuber calcanei
• Sustentaculum taliCarries the talus and the plantar calcaneonavicular (spring) ligament; a reference point when assessing a…Sustentaculum tali
• Base of the fifth metatarsalInsertion of the fibularis brevis; tenderness here after an inversion trauma belongs to the Ottawa ankle…Basis ossis metatarsi V
• Tuberosity of the navicularInsertion of the tibialis posterior and the top of the medial arch; the navicular drop test measures how far…Tuberositas ossis navicularis
• Trochlea of the talusOnly accessible in plantar flexion. An osteochondral defect of the trochlea is a common reason an ankle stays…Trochlea tali
• Neck of the talusThe neck is the weak point of the talus: it breaks here in a fall from height with forced dorsiflexion. The…Collum tali
• Head of the talusThe classic way to determine hindfoot position: subtalar neutral is where the head protrudes equally on the…Caput tali
• Medial cuneiformAttachment of tibialis anterior and of part of fibularis longus, which pulls on it from the plantar side.…Os cuneiforme mediale
• Intermediate cuneiformThat recess makes the second metatarsal the keystone of the transverse arch. It is exactly there that the…Os cuneiforme intermedium
• Lateral cuneiformThe boundary between the medial and lateral columns of the foot. Tenderness across the whole row of…Os cuneiforme laterale
• CuboidOn the plantar side the fibularis longus tendon runs through a groove in this bone. Cuboid subluxation is a…Os cuboideum