bony landmark
bony landmark
Any place on the skin surface where the underlying bone is normally close to the surface and easily palpable.Palpation of Bony Landmarks—Upper extremity
Scapula:
1. Spine—From AC joint palpate across the upper part of the posterior surface of the scapula. It is a long (3”) thin projection, which runs medial to lateral, at T3 level.
2. Acromion process—Located on the lateral part of the shoulder, right above the shoulder joint.
3. Coracoid process—Palpate under the lateral part of the clavicle (about one inch below the anterior edge of the clavicle).
4. Medial (vertebral) border—The edge of the scapula closest to the vertebral column (about 2 inches from the spinous processes). The medial border runs in a superior-inferior direction.
5. Lateral (axillary) border—The lateral (or outer) edge of the scapula located between the inferior angle and the shoulder joint.
6. Superior medial angle—Located above the vertebral border or medial aspect of scapula, level T2.
7. Inferior angle—Located between vertebral and axillary borders. The “point” at the bottom of scapula, level T7.
Clavicle:
“Collar bone” — anterior from sternum to acromion.
Humerus:
1. Greater tuberosity—Located just below acromion when arm is resting by the side (proximal end of humerus).
2. Lesser tuberosity—Easiest to palpate with arm in shoulder external rotation, located medial to greater tuberosity on proximal end of humerus.
3. Intertubercular (Bicipital) Grove—Located between greater and lesser tuberosity; easiest to palpate with arm in external rotation.
4. Medial and lateral epicondyles—Palpated on medial and lateral sides, respectively, of distal end of humerus (2 “bumps” on distal end).
5. Medial and lateral supracondylar ridge—Above the medial and lateral epicondyles on distal end of humerus.
6. Olecxranon fossa Indentation on posterior of elbow.
Radius:
1. Head—From lateral epicondyle of humerus move distally about 1 inch; palpated easiest as you pronate and supinate.
2. Anterior border—Ridge just above wrist on lateral aspect of lower forearm.
3. Styloid process—In the anatomic position, styloid is lateral just above wrist joint.
4. Dorsal tubercle—On distal end of radius on posterolateral aspect of wrist. Feels like a small longitudinal bony prominence or module.
Ulna:
1. Olecranon (“Funny bone”)—Long protuberance on posterior of elbow.
2. Styloid process—In the anatomic position, styloid process is on medial aspect of wrist, also slightly posterior; more proximal than radial styloid process.
3. Head—On distal end of ulna. In supination, it can be palpated on medial-anterior aspect of wrist (just proximal to wrist); in pronation, head is the projection on posterior aspect (ulnar side) of wrist.
Carpals:
1. Pisiform—“Pea-shaped” bone on ulnar side of hand (palmar surface).
2. Scaphoid—On radial side of wrist, easiest to palpate in “floor” of anatomical snuffbox (proximal to thumb) as hand moves into ulnar deviation.
3. Trapezium—On radial side of wrist where it articulates with 1st metacarpal to form saddle joint; easiest to palpate as thumb is flexed and extended.
4. Hamate (hook)—Located slightly distal and radial to the pisiform.
5. Capitata—Proximal to the base of the third metacarpal between the dorsal tubercle of the radius and the third metacarpal; most easily palpated as wrist is flexed.
6. Triangular—Located just distal to the ulnar styloid process; to palpate, radially deviate the hand.
7. Base, body, head of metacarpals and phalanges.
LOWER EXTREMITY
Femur:
1. Greater trochanger—Lateral aspect of thigh just distal to hip joint.
2. Medial and lateral condyles—on distal end of femur.
3. Medial and lateral epicondyles (Epicondyles).
Patella:
“Knee cap”—anterior aspect of knee (a sesamoid bone located in quadriceps tendon).
Tibia:
1. Medial condyle—On proximal end of tibia, medial aspect.
2. Tibial tuberosity—On proximal end, anterior aspect just below patella (insertion for quadriceps tendon).
3. Tibial spine (“Shin bone”)—Anterior ridge along tibia.
4. Medial malleolus—Large protuberance on medial aspect of ankle.
5. Tibial plateau.
6. Lateral condyle.
7. Shaft.
Fibula:
1. Head—Move distally and posteriorly from lateral femoral condyle.
2. Lateral malleolus—Large protuberance on lateral aspect of ankle.
3. Shaft.
4. Styloid process.
Tarsals:
1. Calcaneus—Heel bone.
2. Naviculr tubercle—On medial border of foot, large bony prominence.
3. Head of the Talus—Just proximal to navicular tubercle, especially palpable in eversion.
4. Sustentaculum tali—Located between the head of the Talus and the medial malleolus; feels like a small ridge.
5. Peroneal tubercle of the calcaneus—On lateral aspect of foot just distal to lateral malleolus.
6. Medial tubercle of calcaneus—lies on the medial plantar surface of the calcaneus (not usually sharp or distinct unless it is associated with a heel spur).