Palpation muscle

Anxiety. Mental apprehension frequently accompanied by somatic signs such as increased heart rate, palpations, and increased muscle tension. 

Physical examination found him to be moderately built and nourished. Both hands showed diminished power of the flexors and the extensors to 2/5 on the right and 3/5 on the left.Wasting of the small muscles of the thenar eminence was also noted in both hands. Reflexes of the bra-chioradialis, biceps, and triceps were diminished to 1/4 in the right and 2/4 in the left arm. There was loss of pain and temperature sensation over the distribution of median and radial nerves. All other muscle groups and sensations were normal. Cranial nerves were normal. Abdominal palpation revealed hepatosplenomegaly, which was subsequently confirmed by ultrasound. Oral examination found yellowish plaques on the posterior pharyngeal wall. Eyes, ears, and nose were normal. 

Chest Obtain respiratory rate reassess breath sounds in anterior lobes for equality. Palpate chest wall and sternum for pain, tenderness, and crepitus. Observe inspiration and expiration for symmetry or paradoxic movement note use of accessory muscles. Reassess apical heart rate for rate, rhythm, and clarity. 

Premonitory symptoms and aura are absent with tension-type headache. The pain usually is mild to moderate in intensity and often is described as a duU, nonpulsatile tightness or pressure. Bilateral pain is most common, but the location can vary (frontal and temporal pain are most common occipital and parietal regions also may be affected). The pain is classically described as having a hatband pattern. Associated symptoms generally are absent, but mild photophobia or phonophobia may be reported. The disability associated with tension-type headache typically is minor in comparison with migraine headache, and routine physical activity does not affect headache severity. Palpation of the pericranial or cervical muscles may reveal tender spots or localized nodules in some patients. Tension-type headache is classified as either episodic (infrequent or frequent) or chronic based on the frequency and dmation of the attacks. ... 

Ishizuki etal., 1989) 59 f Japan Kombu 4 years 28 mg/day Diffuse enlargement on palpation Fine finger tremor, fatigue, chest pain, muscle atrophy, enhanced deep tendon reflexes, pretibial edema... 

The next step is important. The joint is returned slowly to its neutral position. The slow motion prevents re-initiation of the inappropriate proprioceptive firing. The point should be monitored at all times because it is possible to palpate the changes occurring in the muscle, and therefore perhaps less than 90 seconds may be needed for treatment. The degree of tenderness remaining in the tissues should be re-assessed. 

Fascia is also described as superficial, deep, and subserous. A continuous layer ofsuperficial fascia lies beneath and is continuous with the skin s dermis layer. Two layers exist, with a potential space between enable of accommodating flnid accumulation. Superficial fascia invests the outer corrqronents of skeletal muscle and helps to give form to the skin. In concept, it is a sac that helps to insulate and separate the body fiom the external enviromnent. Small fibrils act as anchors fiom the skin to the deeper fascia. Forces directed through palpation perpendicular to these tethers but parallel to the deep fasciae allow the examiner to appreciate a sense of resistance ("drag" or "bind") or freedom ("ease") to movement. 

Initially, the patient may report pain, spasm, or decreased function, but one goal of the treatment is to decrease the tonicity of the muscles. Patient symptoms appear to be directly related to the amount of increased muscular tone. The larger, more superficial muscles are easily identified, especially when hypertonicity exists. Even though a patient can be in any position, having them lie supine or prone will facilitate the process. A muscle, such as the trapezius, can be easily palpated in the cervical, shoulder, and upper thoracic regions. The trapezius between the shoulder and neck can be grasped, or other... 

Although palpation may be performed with the patient seated, it is best to have the patient supine. This allows relaxation of the postural muscles of the neck, making it easier to palpate more deeply. The physician is then seated at the head of the table. 

The physician palpates superficially at first and then more deeply into the tissues. The texture of the tissues is evaluated including bogginess, ropiness, or a change in tone of the muscles. Although the tissues posteriorly are being evaluated for an indication of the presence of somatic dysfunction, the anterior neck tissues should be evaluated as well. The scalene muscles and the sternocleidomastoid muscles can give important clues regarding cervical pain or motion restriction. 

The physician cups the patient s head in the palms ofhis hands and places a monitoring finger of eaeh hand on the articular pillar of the vertebra being evaluated. These are best palpated in the groove between the paravertebral muscle masses. 

Her physical examination was unremarkable for any problems other than findings related to the neck injury. The posterior neck musculature was tense and tender to palpation. Motion was grossly restricted in flexion, side-bending, and rotation bilaterally. There was some muscle tension and tenderness in the upper back to about the level of T4. A neurologic examination was normal. The cranial rhythm was sluggish and there was a tendency toward a right side-bending dysfunction of the basi-occiput. 

The soft tissues of the thoracic area should be palpated for texture changes skin, fascia, subcutaneous tissues, and muscle. Large muscle hypertonicity or small localized areas of muscle tension should be noted. Areas of tenderness or specific Jones tender points or trigger points should be noted. 

The physician then palpates deeper into the muscle tissue. The paraspinal muscles lie parallel to the spinal column. They are larger in the lumbar region than in other regions of the spine. The quadratus lumborum attaches to the twelfth rib, the spinal column, and the crest of the ilium. These muscles are frequently the source of low back pain and should be evaluated for hypertonicity, spasm, bogginess, and other tissue texture changes. 

Once the soft tissues have been palpated, the bony structures should be evaluated. The spinous processes and transverse processes are palpated and their symmetry compared. The tops of the iliac crests are in a line with the L4-L5 interspace. From this site it is possible to identify the other lumbar vertebrae. Another method for identifying the vertebrae is to find the twelfth rib and follow it to its attachment to T12. The first vertebra below T12 is LI, and the spinous processes can be counted down from there. The transverse processes lie at the same level as the vertebral body and are usually quite long in the lumbar region. They may be palpated deep to the erector spinae muscles. 

This tender point is palpated by pushing the monitoring finger medially on the lateral edge of the sacrum at the midpoint between the posterior superior iliac spine (PSIS) and the sacral apex. This is at the site of the piriformis attachment to the sacrum and probably represents a second piriformis tender point, it is often found in association with the tender point in the belly of the muscle. 

The muscle tissue of the tensor fascia lata is palpated starting at the anterior superior iliac spine (ASIS) and descending downwards for approximately 4 to 6 inches. It will feel like a firm rope and be tender to the touch when hypertonic. 

Muscle strengih in external rotation and abduction is generally normal but may exhibit some decrease. The muscle and Its attachments are tender to palpation. There are three counterstrain lender points associated wiih piriformis syndrome mid-pole sacrum, piriformis muscle, and the posteromedial trochanteric point. 

Pain is most noticeable with sitting, straining with a bowel movement, or during sexual intercourse. On examination, the coccyx is tender to palpation. There may be pain in the levator ani or coccygeus muscles. A rectal examination may help localize the tenderness to the coccyx. 

On examination, the left buttocks was lender to palpation and there were tender points at the mid-pole of the sacrum on the lateral border and one deep to the gluteus maximus, where a lense piriformis could be palpated. There was a unilateral sacral flexion (sacral shear) present on the left. No lumbar somatic dysfunctions were present. There was mild tenderness at the sciatic notch of the ischium. Deep tendon reflexes were normal and muscle strength of the ihigh was normal. There was some pain on internal rotation and adduction of the left hip. 

The first rib is unlike the other ribs because of its attachments to the scalene muscles and its functional relationship to the clavicle. It is customarily palpated at three sites ... 

Examination of the shoulder revealed no bruising, swelling, or inflammation. Motion of the right shoulder was restricted in comparison to the left in flexion, abduction, extension, and external rotation, both passively and actively. He was unable to perform the Apley scratch test fully. Muscle strength was relatively normal, although it was difficult to test because of pain. The neck, elbow, and wrist were normal on examination. There was marked tenderness to palpation ofthe biceps tendon and some tenderness of the supinator tendon. There was no tenderness or swelling of the bursa of the shoulder. 

Examination showed a healthy middle-aged man who was trim and fit. He was in good health other than the pain in the elbow. The lateral epicondyle was tender to palpation, as were the muscles of the lateral forearm. His grip was weaker on the right than the left, and supination against resistance was painful. 

The tone and quality of the muscles and fascia of the kneejoint should be identified during palpation. 

The gastrocnemeus, a bi-articular calf muscle, may be palpated behind the knee joint. 

The bursitis has as its cause trauma to the area, acute or chronic, as well as any dysfunction affecting the ischium or the structurai integrity of the knee joint. The patient reports pain at the medial aspect of the knee, but careful palpation will elicit point tenderness below the knee joint that is very specific and localized in its nature. The pain will be made worse with contraction of the semitendinous, sartorius, and gracilis muscles. An evaluation for somatic dysfunctions of the pelvis, sacrum, and lumbar region, as well as the postural balance of the lower extremity, must be performed. Treatment can be a local injection of a steroid, a prescription for a NS AID, ice, exercises, and osteopathic manipulative treatment (OMT) of all somatic dysfunctions, including knee, hip. and pelvic region. 

Masseter A quadrangular muscle that covers the coronoid process and ramus of the mandible. It is easily palpated at the cheek when the teeth are clenched. 

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