Exam 3 Rec/Eval: Palpation

Shoulder (bony landmarks)

Palpate: Clavicle

How to Palpate:

• Begin at the sternoclavicular (SC) joint medially

• Follow the clavicle laterally to the acromioclavicular (AC) joint.

Confirm:

• Feel for the S-shaped curve and firmness of cortical bone.

• Identify widening or step-offs near AC joint.

Shoulder (bony landmarks)

Palpate: Sternoclavicular (SC) joint

How to Palpate:

• Find the medial end of the clavicle where it meets the sternum.

Confirm: Ask patient to shrug; feel for joint motions

Shoulder (bony landmarks)

Palpate: Acromioclavicular (AC) joint

How to Palpate:

• Move to lateral clavicle until a small “dip” is felt before the acromion.

Confirm: Horizontally adduct the patient’s arm; joint separates slightly.

Shoulder (bony landmarks)

Palpate: Acromion Process

How to Palpate:

• Broad, flat bone superior/lateral shoulder.

Confirm: Follow anteriorly to the acromial angle; follow posteriorly into scapular spine.

Shoulder (bony landmarks)

Palpate: Spine of the Scapula

How to Palpate:

• Posterior shoulder: prominent ridge running horizontally.

Confirm: Trace medially to vertebral border; laterally to acromion.

Shoulder (bony landmarks)

Palpate: Medial (vertebral) Border of Scapula

How to Palpate:

• Slide fingers along inside edge of scapula.

Confirm: Have patient place hand behind back—border becomes more prominent.

Shoulder (bony landmarks)

Palpate: Inferior Angle of Scapula

How to Palpate:

• Move down medial border to tip of scapula.

Confirm: Ask patient to actively abduct the arm—angle moves laterally.

Shoulder (bony landmarks)

Palpate: Lateral (axillary) Border of Scapula

How to Palpate:

• From inferior angle, palpate upward toward axilla.

Shoulder (bony landmarks)

Palpate: Coracoid Process

How to Palpate:

• Drop inferior and slightly medial to the AC joint.

Confirm: Small, tender, bony "knob" deep to soft tissue.

Shoulder (bony landmarks)

Palpate: Greater Tubercle of Humerus

How to Palpate:

• With arm at side, rotate humerus internally and externally.

Confirm: The greater tubercle becomes prominent during slight external rotation.

Shoulder (bony landmarks)

Palpate: Lesser Tubercle of Humerus and Bicipital Groove

How to Palpate:

• Continue rotating the humerus:

  • Lesser tubercle felt during internal rotation.

  • Bicipital groove lies between lesser and greater tubercles.

Confirm: Patient flexes elbow and supinates → biceps tendon tightens in the groove.

Shoulder (soft tissue)

Palpate: superspinatous tendon

Location: Greater tubercle, anterior to acromion.

How to Palpate:

• Extend patient’s arm behind back or slight extension.

Confirm: Patient abducts arm lightly—tendon firms under finger.

Shoulder (soft tissue)

Palpate: Infraspinatus Muscle and Tendon

Location: Below scapular spine, posterior shoulder.

How to Palpate:

• Press into infraspinous fossa.

Confirm: Ask for external rotation against resistance

Shoulder (soft tissue)

Palpate: Tres Minor

Location: Lateral scapular border, superior to teres major.

Confirm: External rotation at 45° abduction activates it.

Shoulder (soft tissue)

Palpate: Subscapularis

Location: Anterior surface of scapula (harder to access).

How to Palpate:

• Palpate inside axilla on anterior scapular wall.

Confirm: Internal rotation against resistance.

Shoulder (soft tissue)

Palpate: Deltoid (Anterior, Middle, Posterior)

How to Palpate:

• Follow muscle fibers from clavicle, acromion, and spine of scapula.

Confirm: Resist flexion (anterior), abduction (middle), extension (posterior).

Shoulder (soft tissue)

Palpate: Biceps Brachii (Long Head Tendon)

Location: Bicipital groove.

Confirm: Supination against resistance tightens the tendon.

Shoulder (soft tissue)

Palpate: Pectoralis Major

Location: Anterior chest to humerus.

Confirm: Resist horizontal adduction.

Shoulder (soft tissue)

Palpate: Pectoralis Minor

Location: Deep to pec major, attaches to coracoid.

How to Palpate:

• Sink fingers inferior/medial to coracoid process. (Be gentle—often tender.)

Shoulder (soft tissue)

Palpate: Upper Trapezius

How to Palpate:

• From nuchal line to acromion.

Confirm: Resisted shoulder elevation.

Shoulder (soft tissue)

Palpate: Middle & Lower Trapezius

Location: Across upper back.

Confirm:

• Middle: resist scapular retraction

• Lower: resist scapular depression / upward rotation

Shoulder (soft tissue)

Palpate: Rhomboids

Location: Under trapezius, between scapula and spine.

Confirm: Resisted scapular retraction with hand behind back.

Shoulder (soft tissue)

Palpate: Latissimus Dorsi

How to Palpate:

• Posterior axilla fold.

Confirm: Resist shoulder extension or internal rotation