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(BQ) Part 1 book Palpation techniques surface anatomy for physical therapists presents the following contents: Basic principles, shoulder complex, elbow complex, hand, hip and groin region, knee joint, foot.
�a Palpation Techniques li rll Complementary Medicine Surface Anatomy for Physical Therapists Bernhard Reichert With the collaboration of Wolfgang Stelzenmueller �Thieme This lavishly illustrated guide to palpation techniques provides readers with a solid understanding of topographic anatomy using clear, step-by-step descriptions that teach how to first identify, then distinguish between, the various body structures Full-color photographs feature models with detailed drawings of muscles, bones, and tendons on their skin, indicating exactly where and how to palpate Comple mentary color drawings show the functional significance of each anatomic region Features: • In- pth coverage of the entire body-upper extremities, lower extremities, and the head and trunk-all in one comprehensive volume • Over 850 full-color photographs and illustrations enhance the text, making it especially useful for the visual learner • Easy-to-reference text boxes contain tips and tricks, including advice on finger placement, pressure application levels, and more • Study questions at the end of each chapter aid readers in self-assessment and review of the material Palpation Techniques: Surface Anatomy for Physical T herapists will enable students and practitioners of physical therapy or osteopathy to develop their anatomic knowledge and optimize patient care Bernhard Reichert, M, PT, MT, BSC PT, is Massage Therapist and Physical Therapist, VPT Academy, Fellbach, Germany An award-winning international medical and scientific publisher, Thieme has demonstrated its commitment to the highest standard of quality in the state-of the-art content and presentation of all of its products Thieme's trademark blue and silver covers have become synonymous with excellence in publishing ISBN 978-3-13-146341-8 11 11111111111111111111 783131 463418 www.thieme.com 'Thieme THIS PAGE INTENTIONALLY LEFT BLANK Palpation Techniques Surface Anatomy for Physical Therapists Bernhard Reichert, M, PT, MI, BSe PI Massage Therapist Physical Therapist VPT Academy Fellbach Germany With the collaboration of Wolfgang Stelzenmueller Dreieich Germany 861 illustrations Thieme Stuttgart New York Library oj Congress Cataloging-in-Publication Data Important note: Medicine is an ever-changing science Reichert, Bernhard, 1959- undergoing continual development Research and clinical [Anatomie in vivo English] experience are continually expanding our knowledge, in Palpation techniques : surface anatomy for physical particular our knowledge of proper treatment and drug therapists / Bernhard Reichert, with contributions by therapy Insofar as this book mentions any dosage or Wolfgang Stelzenmueller application, readers may rest assured that the authors, p ; cm editors, and publishers have made every effort to ensure ISBN 978-3-13-146341-8 (alk paper) that such references are in accordance with the state of Palpation Anatomy, Surgical and topographical knowledge at the time of production of the book I Stelzenmueller, Wolfgang II Title Nevertheless, this does not involve, imply, or express any [DNLM: Palpation Body Regions-anatomy & guarantee or responsibility on the part of the publishers in histology Physical Therapy Modalities WB 275] respect to any dosage instructions and forms of applica RC76.5.R4513 2010 tions stated in the book Every user is requested to exam 611 ' 9-dc22 ine carefully the manufacturers' leaflets accompanying 2010033219 each drug and to check if necessary in consultation with a physician or specialist, whether the dosage schedules This book is an authorized and revised, merged transla mentioned therein or the contraindications stated by tion of Volume (2nd ed) and Volume of the German the manufacturers differ from the statements made in edition published and copyrighted 2005 and 2007 by the present book.Such examination is particularly impor Georg Thieme Verlag, Stuttgart, Germany Title of the tant with drugs that are either rarely used or have been German edition: Anatomie in vivo (Vol 1: palpieren und newly released on the market Every dosage schedule or verstehen im Bereich der Extremitaten; Vol 2: palpieren every form of application used is entirely at the user's und verstehen im Bereich Rumpf und Kopf) own risk and responsibility The authors and publishers request every user to report to the publishers any dis Translator: Michelle Hertrich, Nettetal, Germany crepancies or inaccuracies noticed If errors in this work Illustrator: Martin Hoffmann, Thalfingen, Germany are found after publication, errata will be posted at Photos: Oskar Vogl; Benjamin Stollenberg; authors www.thieme.com on the product description page We wish to thank the leading manufacturer of anatomical teaching aids, 3B Scientific, for their kind support Please also see page 398-399 or www.3bscientific.com Some of the product names, patents, and registered © 2011 Georg Thieme Verlag, designs referred to in this book are in fact registered Rlidigerstrasse 14, 70469 Stuttgart, Germany trademarks or proprietary names even though specific re http://www.thieme.de ference to this fact is not always made in the text There Thieme New York, 333 Seventh Avenue, fore, the appearance of a name without designation as New York, NY 10001, USA proprietary is not to be construed as a representation by http://www.thieme.com the publisher that it is in the public domain This book, including all parts thereof, is legally protected Cover design: Thieme Publishing Group by copyright Any use, exploitation, or commercialization Typesetting by Hagedorn Kommunikation, Viernheim, outside the narrow limits set by copyright legislation, Germany without the publisher's consent, is illegal and liable to Printed in Germany by Offizin Andersen Nexb, Zwenkau prosecution This applies in particular to photostat repro duction, copying, mimeographing, preparation of micro ISBN 978-3-13-146341-8 123456 films, and electronic data processing and storage v Foreword to the English Edition The clinical practice community has been left wanting for suspicion of that structure's involvement in the patient's a textbook dedicated to the precise execution of in-vivo condition anatomical examination, and this excellent text emerges Surface anatomy is essentially manual in nature Thus, in a timely fashion Healthcare professionals have wit this text can serve as a segue for accurate localization of nessed an escalation in the need for relevant clinical ex structures involved in a manual therapeutic intervention aminations and the use of manual therapeutic interven Moreover, because a patient's response to manual thera tions, both of which rely on a thorough understanding peutic interventions could be influenced by a clinician's and execution of precision in-vivo surface anatomy skills confidence in technique execution, the clinician's thor Because surgical exposure may not be readily available, ough knowledge of structural architecture that is ac the clinician must rely on nonsurgical measures for iden companied by accurate tactile localization could serve to tifying relevant anatomical structures Thus, surface ana enhance the patient's response to treatment tomy skillsets become indispensible for localizing struc The knowledge and skills gained from this text can pro tures and landmarks This text can serve as a roadmap vide a foundation for increased clinical confidence, as it for locating relevant structures with exactitude The clear can reduce the clinician's guesswork when navigating to means by which this text instructs the clinician in tactile a particular structure The authors offer practical gui localization will compliment essential knowledge in dance for enhancing the clinician's success with an in structural and functional anatomy vivo surface anatomy experience So not only are clini The authors have organized the approach to identify cians instructed on what skills to utilize, they are addi ing structures by both layer and region This process of tionally guided on how to best implement them This organization can guide the clinician to visualizing a parti text can join the top ranks of a clinician's library and cular structure's relative depth and relationship to sur serve as a bridge between foundational science, clinical rounding structures Moreover, the text is complete, offer knowledge, and practical skills With these features in ing a thorough and methodical approach to all major mind, the text can support an individual's development musculoskeletal areas of the human body This will assist and progress as a master manual clinician the clinician in developing a musculoskeletal surface anat omy approach to the entire human, allowing for identifi cation of patterns, similarities, and differences between structures in the different regions Finally, the clinician is cued on how the information can be directly applied to clinical examination, which bridges the gap between knowledge and implementation When used in accompa niment to a thorough, systematic clinical examination, precise structural localization can help to confirm a Phillip S Sizer Jr., PT, PhD, OCS, FAAOMPT Professor and Program Director, ScD Program in Physical Therapy Director, Clinical Musculoskeletal Research Laboratory, Center for Rehabilitation Research School of Allied Health Sciences, Texas Tech University Health Sciences Center Lubbock, IX, USA VI Foreword to the German Edition Our understanding of the anatomy and biomechanics of Expert knowledge of in vivo anatomy plays a central the musculoskeletal system has increased manifold in re role when we want to differentiate between structures cent decades The enormous expansion of new scientific and identify at which level and in which layer the pain knowledge certainly represents the general trend in med is the strongest It is only then that we can address the sec icine Perhaps this is also the main reason why today's ond question: why is the patient suffering? medical students receive less and less information in To give an example: in cases of lumbo-pelvic pain, it is more and more specialties The medical study period is simply too short to keep up with the "explosion" of new important to find out whether pain is coming from (from where) the gluteus maximus (large muscle of the but medical information and too short to be able to properly tocks), the multifidus muscle (multiply divided muscle and thoroughly absorb all this information during the ba in the back), the gluteus medius (middle muscle of the sic medical training This unfortunately results in medical buttocks), or the long posterior ligament of the sacroiliac universities worldwide paying too little attention to the joint These structures are located close to each other study of the complicated musculoskeletal system In the when the area around the posterior superior iliac spine past, students studied the anatomy of the musculoskeletal is being palpated It is only after structures have been dif system over a period of three year,s In many faculties, the ferentiated in detail and the most painful structures have same material is now being covered in just three weeks! It been identified that we can begin to search for the source is no exaggeration to say that the study of anatomy plays of this specific pain an increasingly smaller role in medical studies As author of one of the first detailed books on in vivo In order to examine and treat our patients' musculo anatomy in the musculoskeletal system, I am glad to see skeletal problems effectively, we must be able to answer that a real evolution has been set into motion in this field where does the pain of knowledge This book not only represents a large step in come from (i.e., which part of the body is diseased or in the right direction compared with the first edition: most jured?) and what at least two fundamental questions: has triggered the pain? We have to pos importantly, it also presents in great detail the alterna sess detailed knowledge in topographical anatomy to an tives available to expand our knowledge of the "anatomy swer the first question when diagnosing However, this on the living body" to the benefit of our patients alone is not enough It is also necessary to be able to apply It is my sincere hope that this book will be accepted as deep insight into in vivo anatomy (anatomy on living sub from where and why and contribute to the better care of our pa jects) Do we pay enough attention to our patients as liv tients for not only students and clinicians in the fields of this knowledge to the benefit of our patients.This requires an important tool for answering the questions of ing beings capable of feeling when we apply our structural physical therapy, osteopathy, and manual therapy, but anatomical knowledge? Are we able to combine receptive also for medical students and physicians This book is ex touch with our knowledge of anatomy to such an extent ceptionally well-suited for deepening our understanding that we can answer our patient's specific questions and of human anatomy Knowledge of in vitro anatomy (anat provide clarity about the circumstances surrounding their omy outside the living organism) can only be applied if we pain? combine it effectively with hands-on in vivo touch This re It is of great importance that the clinician recognizes quires extensive practice, intuition, and "listening touch." and understands what the patient reports about their An improvement in skills on living subjects will undoubt pain so that the patient feels their complaints are being ac edly bring about improvements in diagnosis and clinical knowledged in a discerning manner.Although this is often practice and hence contribute to better patient care not always possible, the application of in vivo anatomy can assist us in making the right decisions, even in cases of generalized and sensitized pain Perhaps the first rule of medicine should be "to recog nize the patient as an individual": the clinician must inter pret the patient's physiological symptoms and complaints as being unique and personal Prof Dr Andry Vleeming, PhD, PT Chairman, World Congress on Low Back and Pelvic Pain Founder oj the Spine and joint Centre Rotterdam, The Netherlands VII Preface The aim of this book is to make the introduction to in vivo subject matter The experienced therapist or physician anatomy (anatomy on living subjects) easier and to help has a reference book to selectively search for specific standardize palpatory techniques I am very pleased with how well this English edition has turned out The original German version of the book structures Teachers involved in therapist training can ex tract several aspects to round off classes in assessment or anatomy invoked an interest for palpation in many of its European Cross-references are continually used to link the indi readers I hope the same holds true for readers of the Eng vidual sections and improve navigation between the lish edition chapters In the end the connection between theory and Palpation is learnt by palpating It cannot be learnt by practice should be successful Quite a large section of reading It is for this reason that this book claims to be the book involves information on assessment and treat an easy-to-understand guide to the independent study ment to clarify how important in vivo anatomy is The of in vivo anatomy We achieve this by starting on the surface before mov study questions at the end of each chapter should help readers to consciously reflect on certain topics This ing deeper layer by layer toward the more deeply situ book contains only a selection of the palpable structures ated structures The interest in neighboring structures in of interest for the clinical practice I would be happy to the musculoskeletal system understandably grows as we receive suggestions from readers to strengthen and also become more specialized and improve our knowledge in broaden the repertoire of techniques I also hope that biomechanics and pathology When this happens I am this book will instigate a discussion on the standardiza under the impression that we "forget" during palpation tion of anatomy in vivo With this in mind the palpatory to view the skin as a signal organ and the muscles as sta techniques demonstrated in this book should only be bilizers and mobilizers Including the skin and muscles seen as an attempt to standardize both technical pro was therefore of particular concern to me cedures and the criteria used to evaluate palpatory re The level of difficulty gradually increases in the book sults The basic features of palpation are practiced at the start The language has been selected so that the facts are and the specific tests and complicated maneuvers are presented as accurately as possible while still being easy found at the end This book is therefore suitable for differ to read ent target audiences.The beginner can start with the easy material and gradually work through to the more difficult Bernhard Reichert VIII Acknowledgements I have collected quite a lot of knowledge and skills from VPT's ( Verband Physikalische Therapie-Physical Therapy previous publications ( Hoppenfeld, Winkel, and Vleem Association) manual therapy group, starting with Omer ing) in this volume in addition to suggestions, tips, and Matthijs, Didi van Paridon-Edauw, and Sabine Reichel, knowledge gained in my long involvement with anatomy are responsible for my continuing professional develop and manual therapy ment Notes in the text regarding personal correspon This book would never have come into being without a dence from the IAOM group (International Academy of large number of people, whom I would like to thank First Orthopedic Medicine) reflect the IAOM group's knowl of all, I would like to thank the team at Thieme responsible edge gained from years of literature studies and clinical for the original German edition of this book The profes experience sionalism of the publisher can also be judged by the qual A further great role model is Professor Andry Vleem ity of the editor and the graphic artist Martin Hoffmann's ing I was permitted to observe his lectures and courses graphics captivate with their preciseness and three over many years Professor Vleeming and his study group dimensional brilliance He was able to find a good way at the Spine and Joint Centers in Rotterdam, the Nether to demonstrate precise anatomical details while still high lands, are responsible for the enthusiasm associated lighting particular relationships with linking topographical, functional, pathologically The Thieme Publishers team responsible for the com oriented, and palpatory anatomy pletion of this English edition was just as professional A great deal of thanks goes to my model Andreas This book has been able to reach the English-speaking Hofacker for the good teamwork and friendship He un public thanks to the initiative of Angelika-M Findgott derstood how to prepare his amazing body perfectly for Anne Lamparter coordinated the team at all stages of the photo shoots His cheerful nature and his excellent the publishing process and helped and supported me in specialist knowledge have contributed to the successful numerable times photographs My next thanks go to the photographers Benjamin The biggest thanks go to my family I tested their pa Stollenberg and Oskar Vogl, whose enthusiasm and exper tience more than once with my many hours of writing tise made the photo shoots pleasant and effective spread over approximately three years My wife, Ulrike, I would also like to sincerely thank Mr Wolfgang Stel and my children, Yvonne and Svenja, have followed the zenmueller for his chapter on the palpation of the skull development of this book with their patience and love and the jaw His extensive specialist knowledge and amaz My wife is also my biggest and most important critic: ing illustrations enhance this book tremendously "You have to get to the point quickly and accurately." Thank you to Sabine Reichel, who advised me in the I hope that I have done it well details of the anatomy of the skull, and Christiane Pauling, who saw me through the correct procedure for the re spiratory therapy techniques All of the colleagues in the Bernhard Reichert ... publishing ISBN 978-3 -13 -14 63 41- 8 11 11 111 111 111 111 111 111 78 313 1 463 418 www.thieme.com 'Thieme THIS PAGE INTENTIONALLY LEFT BLANK Palpation Techniques Surface Anatomy for Physical Therapists Bernhard... 14 1 Medial Femoral Triangle 11 3 Head of the Fibula 14 1 Sartorius 11 3 Lateral Collateral Ligament 14 1 Adductor Longus 11 3... 11 0 Iliotibial Tract 13 9 13 7 Tensor Fasciae Latae 11 1 Gerdy Tubercle 14 0 Rectus Femoris 11 2 Lateral Epicondyle