Download Mastoid Process

Structure/Muscle
Head neck and Face
Mastoid Process
Styloid Process
Zygomatic Arch
Angle of the Mandible
Information
Landmarks
-Pneumatic part of the temporal bone
-attchmt site of longissimus capitis, splenius
capitis, digastric posterior belly and
sternocleidomastoid
-of the temporal bone
-fragile
-deep to facial nerve
-fanglike shape
-not directly palpable (it is likely that you’re
feeling ligaments and Mm which attch there)
-formed by temporal and zygomatic bones
-inferior to temporalis M
-aka the cheekbone
-anteriorly merges with orbit of eye
-forms pt of attchmt for masseter M
-at posterior end of the base of the mandible
-directly postrior to the ear lobe
-can follow SCM superiorly to the
mastoid process attchmt
Condyle of the Mandible
-superficial
-anterior to the ear canal
-inferior to zygomatic arch
Ramus of the Mandible
-flat ramus is the posterior vertical portion of
the mandible
-deep to the masseter M
-lives 1” anterior to the condyle
-attchmt site for the temporalis M
-opening the mouth fully will bring the
coronoid process out from underneath the
zygomatic arch
Coronoid process of the
Mandible
Sternocleidomastoid
SCM
-located on the lateral and anterior neck
-large belly with two heads (flat clavicular
head and a slender sternal head
-both heads merge to attach behind the are to
the mastoid process
-carotid artery passes deep and medial to the
SCM
- landmark mastoid process and posterior
mandible edge
- lies btw the mastoid and mandible
(anterior to the mastoid process)
-place finger anterior to the ear canal
-move anteriorly to follow arch to the
orbit
-fingers inferior to the bottom teeth to
find edge of the mandible
-follow the edge posteriorly, along the
body of the mandible to the angle
-have client open and close mouth to
confirm (the angle will move)
-place finger pads ant. to the ear canal,
below arch, ask partner to open mouth
fully as the condyle is more palpable
during opening and closing
-it slides anteriorly and inferiorly during
opening and returns to position as jaw
closes
-slide superiorly off the angle to the
ramus
-place finger pads on the middle aspect
of the zygomatic arch
-drop one half inch inferiorly and ask
partner to open mouth fully
-as mouth opens, process will press into
your finger
Locate the mastoid process, the medial
clavicle and the top of the sternum
-draw a line btw these landmarks
-ask partner to raise her head slightly off
the table and rotate head slightly to the
contralateral side to bring out SCM
Middle Scalene
-slightly larger than ant. Scalene
-lies lateral to ant. Scalene
-fibres begin at the side of the cervical
vertebresa
Masseter
-strongest M in body
-primary chewing M
-used in speech and swallowing
-made of 2 overlapping bellies
-squareshaped
-superficial belly accessed from face
-deep belly accessed from inside the mouth
-masseter is deep to parotid gland
O- zygomatic arch
I-angle & ramus of
mandible
A-elevates the mandible
-SCM lateral edge and trapezius
-roll across the belly of ant. Scalene and
move laterally to explore the middle
scalene
-have client take an apical breath to
activate scalenes
-zygomatic arch and angle of mandible
-place fingers btw the above landmarks
and palpate Masseter
-ask partner to clench teeth and relax as
you feel the square shaped M
-strum fingers x-fibre (horizontal)
-ask partner to relax and try grasping the
bellies
FD-vertical
Temporalis
O-temporal fossa & fascia
I-coronoid process of
mandible
the
A-elevates mandible &
retracts mandible
Digastric
O-mastoid process (deep to
SCM and splenius capitis)
I-inf. border of mandible
A- depresses & retracts
mandible
-elevates hyoid
FOREARM & HAND
Head of Radius
Head of the Ulna
Lunate
Lunate con’d
-located on temporal aspect of cranium
-fibres converge into a thick mass reaching
reaching underneath the zygomatic arch
-deep to temporal fascia and temporal artery
-long round M bellies
-post belly:
mastoid to hyoid thru a tendinous sling on ant.
surface of hyoid
-ant belly:
from tendinous sling to the underside of the
chin
-distal to humerus’ lat. Condyle
-stabilized by annular ligament
-pivot point for supination/pronation
-deep to supinator & extensors
-visible along post. med. side of the wrist
-most dislocated carpal bone
-just distal to Lister’s tubercle
-flexing wrist will slide the lunate to the dorsal
surface
-deep to extensor tendons
-zygomatic arch
-place fingertips 1 inch superior to the
arch
-ask partner to clench & relax jaw
-feel M contract
-palpate for coronoid process and you
“may be able to locate the temporalis
tendon
-mastoid and hyoid
-draw imaginary line btw these points
-use index finger to palpate for skinny
post. belly
-draw a line btw hyoid & under chin &
palpate for ant belly
* place finger under chin & ask partner to
open mouth against gentle resistance to
bring up both bellies
-shake hands
-locate lateral epicondyle
-slide distal across small ditch onto the
head of radius
-slide fingers distal along ulnar shaft
-just proximal to the wrist, shaft will
bulge to become the head of ulna
-Lister’s tubercle and the base of the
third MC
-slightly extend wrist, lay thumb btw
these pts and notice how it falls into a
small cavity
-set your thumb at the prox end of this
cavity, then flex wrist and feel the lunate
press into your finger
Capitate
-the largest of the carpal bones
-is located distal to the lunate
-shallow ditch on its dorsal surface that can be
easily palpated
-deep to the extensors
Scaphoid
-the scaphoid tubercle serves as lat attchmt for
flexor retinaculum
Hook of Hamate
-distal and lat to the pisiform
-palpable one the palmar surface of hand
-attchmt site for flexor retinaculum
-hook is often tender
-pisiform and hook of hamate form a small
channel called the Tunnel of Guyon- the ulnar
nerve and artery pass thru the canal
-knobby attchmt for FCU
-distal to flexor crease
-pisiform and hook of hamate form a small
channel called the Tunnel of Guyon- the ulnar
nerve and artery pass thru the canal
-lies deep to the biceps brachii on the anterior
arm
-it’s the biceps best friend because it helps to
bulge the arm further
-the lateral edge is palpable between biceps
and triceps
-the distal aspect is also palpable as it passes
on either side of the biceps tendon
Pisiform
Brachialis
O- distal ½ of the ant
surface of humerous
I-tuberosity and coronoid
process of ulna
A-flexes elbow
Brachiolradialis
O-Lateral supracondylar
ridge of humerous
I-Styloid process of radius
A-Flex elbow, assists in
pronation and supination of
forearm
Extensor Pollicis Longus
O-posterior surface of
radius and ulna
I-distal phalange of thumb
A-extends thumb
-on the lateral side of the forearm
-long, oval belly which divides flexors and
extensors
-it’s the only muscle that runs the length of the
forearm but does not cross the wrist
-lies along the posterior forearm, deep to the
wrist extensors
-forms the posterior wall of the snuffbox.
-extend the wrist and feel carpal
disappear
-shift thumb to the distal end of the
cavity and notice how it bumps into the
base of the 3rd MC
-passively flex the wrist noting how the
capitate rolls into your finger filling it’s
own cavity
-radial surface of scaphoid along flexor
crease
-walk thumb around to the palmer
surface side of scaphoid
-using your thumbpad, explore just distal
to the flexor crease for a prominent bony
knob
-flex wrist slightly to soften tiss.
-pisiform
-draw line from the pisiform to the base
of the 1st finger
-using thumb pad, slide off the pisiform,
½” along line feel hook
-flexor crease then slide medial and distal
rolling thumbpad in small circles
Shake hands, flex elbow to 90 degrees.
Ask partner to flex elbow against
resistance to isolate the edges of biceps
brachii.
Relax arm, slide ½ inch laterally of distal
biceps.
Strum across edge of brachialis and feel
the pronounced “thump”
Continue strumming distally to where it
disappears into the elbow.
Find biceps tendon and palpate either
side to find deeper portions of brachialis
Shake hands, flex elbow to 90 degrees.
With forearm in neutral position (thumb
up) have partner flex against resistance.
Palpate the tubular belly, try to pinch it
between your fingers and follow it distal
as it becomes tendon.
Wrist in neutral position, ask partner to
“bring your thumbnail towards your
elbow:.
Just distal to the styloid process of radius
you will see the snuffbox.
Follow the tendon proximally over the
posterior side of radius.
Have partner circumduct thumb to feel
muscle belly contract.
Spine and Thorax
Longissimus
O-Common tendon, TVPs
of upper five thoracic
vertebrea (cervicis and
capitis)
I-lower 9 ribs and TVPs of
thoracic vertebrea
(thoracis), TVPs of Cspine(cervical), mastoid
process (capitis)
A-(Bilateral) Extends vertebral column,
(Unilateral) Ipsilateral lateral flexion of
vertebral column
Multifidi
O-Sacrum and TVPs of L,
T, C-spines
I-SPs of L, T and C7-C2 deep lateral rotator
(transversospinalis)
A-extend vertebral column,
rotate column to the
opposite side
-surprisingly thick mm, directly accessible in
the lumbar spine
-the only mm with fibres that lie across the
posterior surface of the sacrum
Splenius Capitis
O-Ligamentum nuchae, SPs
C7-T3
I-Mastoid process, lateral
nuchal line
A-(Bilat) extends head and
neck, (uni) rotates head to
same side, laterally flexes
head and neck
-deep to the traps and rhomboids
-it’s fibres are angled towards the mastiod
-fibres are superficial between upper traps and
SCM
Shoulder and Arm
Bicipital groove`
Coracobrachialis
O: coracoid process
I: med surf hum
A: flex, add GH jt
Latissimus dorsi
O: SP T6-12, iliac crest, inf
4ribs, thoracolumbar fascia
I: floor of bicep groove
A: ext, adduct, med rot
- b/n greater and lesser tubercules
- biceps brachii LH tendon lies within
- deep to pec major and ant delt
- lat wall of axilla
- broadest mm of back
- post wall of axilla (w teres major)
Partner Prone. Lay both hand on either
side of lumbar vertebrea and have partner
raise and lower their feet slightly.
With partner contracting, palpate inferior
to sacrum and superior along Tspine.(have partner extend back and neck
to palpate along Thoracic region.)
Follow the fibers up between the
scapulas and along the back of the neck
(lateral to laminar grooves)
Have partner relax and sink into the
fibres and feel their verticle fibre
direction.
Partner prone.
LM-SPs of lumbar vertebrea, slide
fingers laterally sinking between them
and the erectors.
Push the erectors laterally out of the way,
explore the deep, dense diagonal fibres of
the multifidi.
Progress inferiorly to the sacrum, rolling
your fingers perpendicular to multifidi.
*ask parnter to extend and rotate back
Prone, Locate upper fibres of the traps.
Have partner slightly extend neck to
isolate lateral edge of traps.
Have partner relax as you palpate just
lateral to traps for the oblique fibres,
follow them up to the mastoid and
inferior through the traps
OR
Find mastoid process and slide medially
and inferiorly onto the superficial capitis
fibres
- locate greater tub by shaking hands &
locating acromion. Slide inf & lat 1”
- rotate arm lat. As you rotate the gr tub
will be replaced by groove
- supine. Lat rot and abduct shoulder
- locate pec maj fibres
- lay hand on med side of arm and slide
into axilla
- have partner adduct against resistance
- find pec maj edge and slide off post to
find slender belly of coracob
Prone: arm of side of table, locate lat
border of scap
- grasp wad of mm tissue lat to lat border
- ask partner to med rot GH against
resistance
shoulder
Levator scapula
O: TVPs C1-4
I: sup med bord scap
A: down rot, elev
- located on lat/post side of neck
- inf portion is deep to UT but it emerges at lat
side of neck to b/c superficial
- follow fibres into ribs and axilla
Prone: locate sup angle of scap and up
med bord
- place fingers just of sup bord and strum
fibres
- follow fibres up lat side of neck
Supine: - abd arm slightly and locate
lower edge of pec major, then locate ant
border of lats
- place fingers b/n pec and lat
- strum across ribs to feel serratus fibres
isolate location by partner pushing hand
towards ceiling
have partner alternate abduct scap and
relax
Sidelying: - flex shoulder and pull arm
ant
- hold arm while other thumb locates lat
border (slide under lats)
- slowly curl thumb onto subscap fossa
Supine: cradle arm in flexed position and
locate lat border
- sink thumb onto subscap fossa
- ask partner to med rotate to activate
- prone: arm off table
- locate lat fibres and grasp
- move thumb and finger to lat border
- the mm that lie med to lats and attach to
lat bord will be teres maj
- follow towards axilla where they blend
with lats
- have partner med rot to distinguish b/n
lats
Serratus Anterior
O: lat ext surf of 1st 9 ribs
I: ant med bord of scap
A: abd protract,
Low F: may depress
Upp F: may elevate
- assists in forced respiration
- stab scap to prevent winging
Subscapularis
O: subscap fossa
I: lesser tub
A: med rot
- on ant side sandwiched b/n subscap fossa and
serr ant
- only rotator cuff mm that attaches to lesser
tub
Teres major
O: inf ang scap
I: bicp groove med lip
A: add, ext, med rot
-“ lat’s little helper”
- handcuff mm
Upper trapezius
O: sup nuch line, lig
nuchae, inion, SP C2-7
I: lat 1/3 clav, acromion
med side
A: elev, up rot,
LA: lat flex HN, rot chin
contralat side
BilatA: ext HN
- superficial
- blankets the shoulders
Prone: - grasp sup tissue on tob of
shoulder
- follow sup toward base of head at
occiput
- stand at head of table and ask partner to
extend head then follow inf to lat clavicle
Lower trapezius
See UT
Prone: draw line from sp of scap to SP
T12 to find border
- palpate along
- ask partner to superman
- attempt to lift up the fibres
Supine: - partners shoulder slightly abd
stand facing them
- locate med shaft of clav and move inf
onto fibres
- follow fibres lat as they blend with
deltoid
O: SP T6-12
I: root of spine of scap
A: up rot, depress
Pec Major
O: med clav, ant surf
sternum, cost cart ribs, apo
of abd mm
I: lat lip bicipital groove
A: add, med rot GH, hor add
- acc mm of respiration ( tired athlete props
arms on iliac crest)
- 3 sections: sternal , clavicular and costal
- the up and low fibres do opposite actions
making this mm it’s own antagonist
Clav head: flex hum
Stern head: ext (bring back
from flexion)
LA: acc mm of resp
Triceps
O: olecrenon
I: LongH: infranglen tub
MedH: post surf hum inf
to rad groove
LatH: post surf hum sup
to rad groove
A: ext elbow, ext GH jt
- only mm on post arm
- med head is also deep head b/c most is deep
to long head
- grasp belly by sinking thumb into axilla
- ask partner to medially rotate against
resistance
sidelying: - supporting partners arm, flex
shoulder and pull ant
- grasping pec major explore it’s mass
- passively ext and flex shoulder
Prone: - bring arm off side of table
- palpate post aspect
- locate olecrenon to outline distal tendon
- ask partner to exten elbow as you resist
at forearm. Slide free hand off olecrenon
proximally to find tendon
Leg and Foot
Peroneal tubercule
- helps stabilize the peroneal mm
Navicular tuberosity
Attcht site for tib post and spring ligament
Sustentaculum tali
- shaped like plank
- supports the talus on the calcaneous
- atchmt site for deltoid ligment
- most of it is deep to flexor tendons
Head of fibula
- attmt site for biceps femoris, part of soleus
and lat collateral ligament
Tibialis posterior
O: tib and fib
I: navic tub and surr bones
on plantar surf
A: TC: plantarflex, ST:
inversion
- Tom, Dick and Harry: most ant: tib post;
flexor digitorum longus, tib artery, flexor
hallucis longus
- deepest mm of ant compartment
- prime function is to slow pronation after heel
contacts ground during gait
Peroneus Longus & Brevis
PL:
O: lat prox fib incl head
I: 1st MT, 1st cuneiform lat
surf
PB:
O: fib lat dis
I: 5th MT styloid
Both A: TC: planterflex
SC: eversion
- peroneus longus aka fibularis
- located on lat side of fib b/n ext dig long and
soleus
Supine/seated: dorsiflex & locate lat
malleolus
- slide and inch inf
- may feel like small ridge
Supine/seated: locate base of 1st MT
- slide along med foot
- move prox across med cuneiform and
the jt b/n med cun and navicular
- explore tuberosity
- tub will lie 1-2” dist to med malleolus
Supine/seated: ankle in neutral position
- locate med malleolus and slide 1’ dist to
small tip of susten.
- passively inverting the foot will soften
surrounding tissues
Seated w knee flexed
- locate tib tuberosity
- slide fingers lat 3-4’
Supine, prone: locate med mall
- slide of pos and prox into space b/n post
shaft fo tib and calcaneal tendon
- explore tendons and follow around back
of med malleolus
-hard to isolate but tib post will be most
ant
- have partner invert as you follow T to
underside of foot
Supine/prone: finger on head of fib and
lat malleolus
- ask partner to alt evert and relax
- follow peroneus long to head of fib
- now follow both dist to where the T’s
wrap around back of lat mall
- follow per brev T to base of 5th MT
Tibialis Anterior
O: prox lat surf tib
I: 1st MT base, 1st cuneiform
& plant surf
A: TC: dorsiflex, ST: invert
- ant compartment
- lies directly lat to tib shaft
- large and sup
Gastrocnemius
O: fem condyles
I: calcaneous
A: TC: plantarflex, flex
knee
- triceps surae composed of 2 heads of gastrox
and soleus and reaches the calcaneous via the
Achilles aka tendocalcaneous T
- it crosses 2 jts (knee and ankle)
Soleus
O: prox fib, tib soleal line
I: calcaneous
A: TC: plantarflex
- deep to gastrox
- “2nd heart” b/c of impt role it’s strong
contractions play in returning blood from leg
to the heart
HIP AND THIGH
Supine:- locate shaft of tib and slide lat
onto tib ant
- ask partner to dorsiflex
- w ft dorsiflexed follow mm distally as it
b/c thick tendon until it disappears at the
med cuneiform
Standing: - supported by chair stand on
toes
- palpate post leg sculpting gastrox oval
heads
- follow both heads to back of knee and
distal noting that med head goes farther
dist
Prone: - bend knee to 90 and
‘investigate’
See Gastrox:
Standing: - move dist to gastrox and
palpate dist portion of soleus
- also plapate med and lat sides that bulge
from under gastrox
Prone: - w knee flexed gastrox is
ineffectual as plantar flexor. Ask partner
to gently plantar flex against resistance
- notice soleus contracted while gastrox
stays FLACCID
Greater Trochanter
-located distal to the iliac crest
-lrg superficial mass
-attchmt site for glut. Medius and minimus and
deep rotator Mm
Adductor Tubercle
-located prox to the medial epicondyle btw
belly of vastus medialis and the hamstring
tendon
-small tip sticks out fr the top of the med
epicondyle
-attchmt site for the adductior magnus tendon
-often tender to touch
Adductor Longus&
Gracilis
-pubic tubercle to medial aspect of the linea
aspera
-pectinius and adductor longus are the most
anterior of the adductor group
Biceps Femoris
-the lateral hamstring
-two heads
superficial long head
deeper and indiscernible short head
Gluteus Medius
-superficial except for posterior portion which
is deep to maximus
-strong extensor and abductor of the hip
-convergent fibres pull the femur in multiple
directions
-“the deltoid muscle of the coxal joint”
Piriformis
-anterior surface of sacrum to GR troch
-lat rot
-abduction while hip is flexed
-locate the middle of the iliac crest
-slide your fingerpads inferiorly 4-6”
along the lateral side of the thigh until
you reach the superficial mass
-medially and laterally rotate your hip as
you palpate the troch, it’s knobby surface
will wwivel under your fingers
-partner supine
-locate medial epicondyle
-slide superiorly along medial side of
femur
-as femur drops off into soft tiss., explore
for the small point of the tubercle
-strum across adductor magnus tendon by
rubbing your thumbpad anteriorly and
posteriorly
-supine with hip slightly flexed and
laterally rotated
-place flat hand in middle of the medial
thigh
-ask partner to adduct hip slightly
-as they contract slide your fingers
proximally to the pubic bone and olcate
the taut tendon of gracilis & longus
extending off the pubic tubercle
-follow tendon distally as it develops into
muscle tiss
-if the M belly angles to the medial thigh,
you are palpating adductor longus
-if the belly is slender and continues
down the medial thigh toward the knee,
you are accessing graclis
-partner prone with knee slightly flexed
-locate lateral half of hamstrings
-its belly will lead toward the head of the
fibula
-palpate the lateral side of the knee for
the long prominent tendon of biceps
femoris and follow it to head of fib
-sidelying
-isolate the shape of the Mby placing the
webbing of one hand along the iliac crest
(fr. PSIS to ASIS) while the other hand
locates the GR. Troch
-hand form the pie shape of the M
-palpate the dense fibres btw the crest
and the GR troch
-ask client to abduct hip slightly to feel
M contract
-prone
-locate coccyx, PSIS, and gr troch to
form “T” landmark
-place fingers along the base of the “T”
-working through the thick glut max, roll
your fingers across the belly of the
slender piriformis
Rectus Femoris
-cylindrical and superficial
-only quadriceps M that crosses 2 joints
thigh and knee
Semitendinosus
-leaner and more superficial than
semimembranosus
Tensor Fasciae Latae
-approx 3 fingers wide
-easily accessed btw the upper fibres of rectus
femoris and the glut med
-attchs to IT band
Iliotibial Band
-superficial sheet of fascia
-vertical fibres
-runs along lateral thigh
-emerges from gluteal fascia
-wide and dense over vastus lateralis, and
funnels into a strong cable along the side of
the knee
-inserts at the tibial tubercle
-strong stabilizing component of hip and knee
-“like packing tape”
Vastus Medialis
-forms a tear drop shape at the distal portion of
the medial thigh
-extends further distally than vastus lateralis
-assists to track patella by pulling it medially
-ext knee/ fl hip
-medial lip of linea aspera to tibial tub
-strum across belly to clarify its location
staying mindful of the deeper sciatic N
-supine with knee bolstered
-locate AIIS and the patella
-draw line btw points and follow the path
of the M
-palpate along this line and strum across
the fibres
-ask client to flex hip and hold foot up
off the table to make M more pronounced
-move to the medial side of the knee and
palpate for the tendon
-semitendinosus tendon is more
superficial
-follow it up as it merges with the pes
anserinus tendon
-supine
-place flat of hand posterior and distal to
ASIS and iliac crest
-ask client to alternate the medial rotation
with relaxation of he hip
-upon medial rotation the TFL will
contractinto a solid oval mound
-palpate its vertical fibres, outline width,
and follow distally until it blends with IT
Band
-sidelying
-locate biceps femoris tendon just prox to
back of knee
-slide anteriorly form the tendon to th
elateral thigh
-roll your fingers horizontally across the
fibres of the IT band
-tough, superficial
-similar to size and shape of biceps
tendon
-follow distally as it disappears toward
tibial tub
-prox it becomes broader and thinner
-ask client to alternately abduct and relax
hip
-supine, knee bolstered
-ask them to extend knee
-palpate medial and prox to the patella
for the bulbous shape of the medialis