Week 1 Palpation Landmarks and Techniques (All Pictures from your required book (Reichert,

2015, Palpation Techniques, Publisher Thieme).

We will walk you through how to palpate these landmarks in class.

Posterior bone landmarks

- Occiput (Thieme Palpation Techniques, pp 354-357)
Standing position, the finger pads of the second and third fingers are placed flatly over the
occiput. With circular motion, the therapist looks for the external occipital protuberance,
posterior/inferior and in the center of the skull. The examiner palpates the posterior skull in
midline and moves caudally until coming to a point where the fingers dip inward: the external
occipital protuberance. From the external occipital protuberance, slide down the fingers to find
the edge of the occiput, palpate the edge of the occiput bilaterally and note the difference
between bone and soft tissue below the edge of the occiput. Slide the fingers laterally following
the edge of the occiput until the tip of the fingers reach close to the earlobes. Near the
earlobes, the edge of the occiput has an inferior protuberance: the mastoid process. With
circular motion of the second and third fingers, search for the origen of the
sternocleidomastoid muscle tendon inferior and anterior to the mastoid process. Have the
person move the head from side to side (lateral flexion) and feel the muscle insertion tense and
relax.

- C2 Spinous process (Thieme Palpation techniques, pp. 355-357)

Return to the external occipital protuberance, slide the finger straight down until the edge of
the occiput and the soft tissue interface below the edge can be felt. The pads of the fingers are
pressed against the bone firmly but gently during the process. When the last bony point of
contact is felt, if the therapist presses over the soft tissue in a posterior to anterior direction
and feels for an elastic form of resistance: suboccipital fosse. The elastic soft tissue is made up
of the trapezius and posterior deep suboccipital muscles. As the examiner moves the finger
pads inferiorly, the first bony bump will be the spinous process of C2 (axis). The index finger and
thumb may be used to move the spinous process of C2 from side to side with a pinch grip.

- Transverse process of C1 (Thieme pp 380)

Return to the mastoid process near the earlobes, the examiner first palpates the mastoid
process and then moves inferiorly and slightly anteriorly until a hard bump is felt. If the
examiner applies slight pressure to the bump, the person should say it feels uncomfortable.
These bumps are the transverse processes of C1. If the person nods (flex the cervical spine), the
examiner will feel that the space between the mastoid and the transverse processes will
increase.

- C7 spinous process
Standing position, slide fingers down from C2 spinous process until the next two major spinous
processes of the spine (C6 and C7) can be felt near the trapezius (upper fibers origin). Ask the
patient to flex and extend the cervical spine while palpating the spinous processes of C6 and C7.
With this movement, the C6 spinous process moves in and out, and the C7 spinous process
remains stationary. The movements between the spinous processes of C2 through C7 or T1 may
be palpated by feeling between each set of spinous processes. If the examiner palpates
inferiorly 3 more spinous processes, the T3 spinous process will be at the same level with the
spine of the scapula.

Anterior Bone Landmarks

-Hyoid bone (Thieme, pp. 382)
Standing position, locate the mandible anteriorly. From the midline of the mandible, slide the
pads of the second and third finger inferior to the mandible and palpate the floor of the mouth,
this will feel like soft tissue similar to the soft tissue of the suboccipital fossa. Keep following the
soft tissue posterior and inferiorly until a bony prominence is noted: the hyoid bone. The
superior edge of the hyoid bone is level with the lamina of the C3 vertebral body. To confirm
the location of the hyoid bone, the therapist pinches the bone laterally with the thumb and
index finger and moves it from side to side. The firm lateral edges confirm the location of the
bone. When the patient swallows, the bone moves up and down.
The cricoid cartilage may be palpated inferior to the hyoid bone. The therapist slides the pads
of the fingers anterior and inferior to the hyoid bone, the thyroid cartilage will be palpated first
and just before the soft traquea can be felt anteriorly, the cricoid cartilage will be fell (Thieme,
pp. 383).
- Upper edge of the sternum and clavicles (Thieme, pp. 376)
The clavicles can be visualized anteriorly and their superior and inferior edges followed and
palpated with the pad of the fingers. If the therapists move the fingers medially, they will reach
the superior border of the sternum and touch the Sterno-Clavicular joint. If the therapist move
the fingers laterally, they will reach the Acromion-Clavicular joint. The insertion of the
sternocleidomastoid muscle may be felt on the most medial superior border of the clavicle and
most lateral and superior border of the sternum. When the patient extends and side-flex the
head away from the clavicle, the muscle insertion of the sternocleidomastoid may tension and
relax.
Soft tissue
- Sternocleidomastoid (374).
Standing or sitting position. This muscle can be easily found in the lateral and anterior part of
the neck. The origin (mastoid process of the occiput) and insertion (superior and medial part of
clavicle as well as lateral superior border of the sternum) of this muscle were previously
described. The muscle belly can be palpated initially from the mastoid process with the pads of
the 3rd and 2nd fingers. The mid-belly section of the muscle can be palpated gently with a pinch
grip of the thumb and index fingers. The distal end of the muscle can be palpated with the pads
of the 2nd and 3rd fingers on the clavicle and sternum.

- Trapezius, upper/lower
Standing or sitting position, posterior approach (Thieme pp. 363), from the C7 spinous process
to the occiput, and from the occiput to the acromial end of the clavicle, deep to only the skin
the upper trapezius is palpated. The lower trapezius extend medially from a line starting at T12
spinous process and ending at the root of the spine of the scapula (see power point for lower
fibers).
Anterior approach, the upper trapezius is the only one palpable. The lateral border of the
muscle lay on a line drawn from the acromial end of the clavicle to the middle of the posterior
border of the sternocleidomastoid (Thieme, pp. 376). The muscle is in the same superficial
layer than the sternocleidomastoid and from the anterior approach it disappears behind the
sternocleidomastoid muscle. Isolation of the upper trapezius is done by manually resisting
shoulder shrug with upward rotation of the scapula.
Blood vessels
- Carotid artery (Thieme, pp. 384).
The common carotid artery can be easily palpated lateral to the cricoid cartilage. The artery lies
posterior to the cricoid and anterior to the mid-belly of the sternocleidomastoid muscle. Return
to the hyoid bone, palpate inferiorly to feel where the cricoid cartilage and trachea are located.
Move fingers posteriorly lateral to the cricoid cartilage until you reach the anterior margin of
the sternocleidomastoid. Press gently with the pad of the fingers medially and feel for the pulse
of the carotid artery. Do NOT rub the finger pads for too long (over 2 or 3 min) in this area as
you can cause a induce blood pressure drop and hypotension causing the patient to faint.
Stimulation of the carotid baroreceptors (located on the carotid sinus where the common
carotid split into deep and external carotid arteries) may cause vasodilation and cause
hypotension.