functional anatomy practical exam

ANKLE: Peroneus (Fibularis) Longus

 I begin on the lateral aspect of the lower leg posterior to the fibula. I ask the participant to perform eversion against resistance. This allows me to palpate the contracting peroneus longus along the lateral compartment of the leg. 

ANKLE: Gastrocnemius

I begin on the  posterior  calf and  palpate  the  muscle  belly. I ask the participant to perform  plantarflexion  or rise onto their toes. This causes the gastrocnemius to contract and become clearly  palpable .

ANKLE: Tibialis Anterior

I begin lateral to the  tibial shaft  on the  anterior  lower leg and  palpate  distally towards the ankle. I ask the participant to perform  dorsiflexion  and  inversion  against resistance. This causes tibialis anterior to contract and become prominent.

ANKLE: Navicular

Beginning at the  medial malleolus , I move  distally  and slightly anteriorly until I locate the navicular tuberosity.

ANKLE: Lateral Malleolus

Beginning on the lateral side of the lower leg, I follow the  fibula  distally until I locate the lateral malleolus.

ANKLE: Medial Malleolus

Beginning on the medial side of the lower leg, I follow the  tibia  distally until I locate the medial malleolus.

KNEE: Semimembranosus

I begin at the  posteromedial  aspect of the knee and move  proximally  along the medial  hamstring  region. During  resisted  knee flexion,  semimembranosus  becomes more prominent beneath my fingers.

KNEE: Biceps Femoris

I begin at the posterolateral aspect of the knee and move proximally along the lateral hamstring. I ask the participant to perform knee flexion against resistance. This allows me to palpate the biceps femoris tendon and muscle belly.

KNEE: Vastus Medialis

I begin at the  medial  aspect of the  distal  thigh  superior  to the  patella . I ask the participant to perform knee extension against resistance. The characteristic teardrop-shaped vastus medialis becomes more prominent.

KNEE: Tibial Tuberosity

Starting at the inferior pole of the  patella , I follow the  patellar tendon  distally until I reach the tibial tuberosity.

KNEE: Patella

I palpate the  anterior  aspect of the knee to identify the patella.

KNEE: Lateral Femoral Condyle

Beginning at the  patella , I move laterally above the joint line to identify the lateral femoral condyle.

KNEE: Medial Femoral Condyle

Beginning at the  patella , I move medially above the  joint line  to identify the medial femoral condyle.

HIP: Semitendinosus

I begin at the  posteromedial  aspect of the thigh and follow the muscle  distally  towards the medial knee. I ask the participant to perform  knee flexion  against resistance. This makes the  semitendinosus  tendon and  muscle belly  more prominent.

HIP: Tensor Fascia Latae

I begin just distal and lateral to the  ASIS . I ask the participant to perform  hip flexion ,  abduction  and  internal rotation  against resistance. This movement makes tensor fascia latae clearly palpable.

HIP: Rectus Femoris

I begin at the anterior thigh inferior to the  ASIS  and palpate the central portion of the  quadriceps . I ask the participant to perform  hip flexion  or  knee extension  against resistance. This causes rectus femoris to contract and become prominent.

HIP: Sacrum

After locating both  PSIS  landmarks, I  palpate   medially  between them to identify the sacrum.

HIP: PSIS

Following the  iliac crest  posteriorly leads me to the  posterior superior iliac spine .

HIP: Greater Trochanter

Beginning at the  lateral pelvis , I move inferiorly onto the lateral aspect of the  proximal femur  and palpate the greater trochanter. Internal and external hip rotation helps confirm the landmark.

HIP: ASIS

Starting on the  iliac crest , I move anteriorly until I reach the prominent  anterior superior iliac spine.

TRUNK: Quadratus Lumborum

I begin between the  iliac crest  and  lower ribs  on the  posterior-lateral trunk . I ask the participant to perform  lateral trunk flexion  against resistance. This causes quadratus lumborum to contract and become palpable.

TRUNK: Longissimus

I begin beside the spinous processes of the  thoracic  and  lumbar   vertebrae . I ask the participant to extend their trunk against resistance. The longissimus muscles become palpable on either side of the  vertebral  column.

TRUNK: Rectus Abdominis

I begin on the anterior abdominal wall adjacent to the midline. I ask the participant to perform a small abdominal crunch by lifting their shoulders from the table. This causes the rectus abdominis to contract beneath my fingers.

TRUNK: PSIS 

I begin on the  iliac crest  and move posteriorly and slightly inferiorly until I locate the  posterior superior iliac spine .

TRUNK :  C7   Spinous Process 

With the participant flexing their cervical spine, I move inferiorly down the posterior neck until I locate the most prominent spinous process, C7.

TRUNK: Sternum

I palpate the  anterior  thorax in the  midline  to identify the sternum.

TRUNK: Xiphoid Process

Beginning at the body of the  sternum , I move  inferiorly  along the midline until I reach the xiphoid process.

SHOULDER: Serratus Anterior

I begin along the  lateral  ribs beneath the  axilla . I ask the participant to perform a punching motion or push against a wall. This protracts the  scapula  and makes the serratus anterior visible and  palpable  along the rib cage.

SHOULDER: Latissimus Dorsi

I begin along the  posterior axillary fold  and  lateral trunk . I ask the participant to extend and adduct the shoulder against resistance. This causes latissimus dorsi to  contract , making the posterior axillary fold more prominent.

SHOULDER: Lower Trapezius

I begin near the  inferior angle  of the  scapula  and palpate superiorly towards the  thoracic spine . I ask the participant to retract and depress the scapula against resistance. The lower trapezius becomes more palpable during this movement.

SHOULDER: Upper Trapezius

I begin at the  superior  aspect of the shoulder between the neck and  acromion . I ask the  participant  to elevate or shrug their shoulders against resistance. This makes the upper trapezius contract and become prominent beneath my fingers.

SHOULDER: Inferior Angle

Starting at the  medial border  of the  scapula , I move  inferiorly  until I locate the lowest  palpable  point, the inferior angle.

SHOULDER: Lateral Border of Scapula

I begin at the inferior angle of the scapula and trace superiorly along the lateral border towards the  glenoid  region.

SHOULDER: Medial Border of Scapula

Starting at the spine of the scapula, I move medially towards the  vertebral column  and identify the medial border.

SHOULDER: AC Joint

I begin at the  clavicle  and follow it laterally until I feel a small gap between the clavicle and  acromion . This is the  acromioclavicular  joint.

ELBOW: Triceps Brachii

I begin at the  posterior  aspect of the upper arm and  palpate  towards the  olecranon process. To identify the triceps, I ask the participant to perform elbow extension against resistance . This causes the muscle belly to contract and become more prominent.

ELBOW: Brachioradialis

I begin at the  lateral supracondylar ridge  and palpate distally along the  lateral forearm . I ask the participant to perform  elbow flexion  with the forearm in neutral, or a  thumbs-up  position, against resistance. This makes the brachioradialis prominent.

ELBOW: Biceps Brachii

I begin at the  anterior  aspect of the arm between the  shoulder  and  elbow  and palpate the muscle belly. To make the muscle more prominent, I ask the participant to perform elbow flexion and  forearm   supination  against resistance. The  biceps  contracts and becomes easily palpable on the anterior arm.

ELBOW: Radial Head

Beginning at the  lateral epicondyle , I move slightly  distal  onto the  proximal  radius. As I ask the participant to  pronate  and  supinate  their forearm, I can feel the radial head rotating beneath my finger.

ELBOW: Medial Epicondyle

Starting at the  olecranon process , I move medially across the  distal humerus  to locate the medial epicondyle.

ELBOW: Lateral Epicondyle

Starting at the  olecranon process , I move laterally across the  distal humerus  until I reach a prominent bony landmark. This is the lateral epicondyle.

ELBOW: Olecranon Process

With the elbow flexed to approximately 90 degrees, I start at the posterior aspect of the elbow and palpate the large bony prominence. This is the olecranon process of the  ulna .

WRIST: Extensor Digitorum

I begin on the  posterior  forearm distal to the  lateral epicondyle  and palpate along the  central  forearm. I ask the participant to extend their fingers against resistance. This allows me to feel the contraction of extensor digitorum and observe its tendons on the  dorsum  of the hand.

WRIST: Extensor Carpi Ulnaris

I begin at the  lateral epicondyle  and move  distally  along the  posterior  aspect of the forearm towards the fifth  metacarpal . I ask the participant to perform wrist extension and  ulnar deviation  against resistance. This causes the extensor carpi ulnaris to contract and become more prominent

WRIST: Flexor Carpi Ulnaris

I begin at the  medial epicondyle  of the  humerus  and move  distally  along the medial aspect of the forearm towards the  pisiform . To make the muscle prominent, I ask the participant to perform  wrist flexion  and  ulnar deviation  against resistance. I can  palpate  the  contracting   muscle belly  along the ulnar side of the forearm.

WRIST: Phalanges

Beginning at the  MCP  joint, I move  distally  along the finger to  palpate  the proximal, middle and distal phalanges

WRIST: Metacarpals

Beginning at the MCP joints, I move proximally along the shaft of the metacarpal to palpate the bone.

WRIST: Radial Styloid Process

Starting on the lateral aspect of the forearm, I follow the radius distally towards the wrist. The  prominent  bony projection on the  thumb  side is the radial styloid process

WRIST: Ulnar Styloid Process

Starting on the medial side of the forearm, I palpate distally along the shaft of the ulna towards the wrist. The prominent bony projection at the distal end of the ulna is the ulnar styloid process.