Palpation Skills: Identifying Bony Landmarks and Soft Tissue Guides

1) Palpation principles: repeatable technique over “guessing”

Hand positioning: use a “search hand” and a “confirm hand”

Palpation is more accurate when you separate tasks: one hand explores broadly (search), the other stabilizes or confirms (confirm). The search hand uses the pads of the index–middle fingers for precision; the confirm hand controls the segment so the target structure does not “escape” under your fingers.

• Finger pads, not tips: pads increase contact area and reduce painful poking.
• Short lever contact: keep your wrist neutral and fingers slightly flexed so pressure comes from body weight, not finger strain.
• Anchor first: find a known landmark, then “walk” to the next structure in small steps (1–2 cm).

Pressure grading: match depth to tissue and patient tolerance

Use a simple pressure scale so your technique is consistent across sessions and clinicians:

Increase pressure only after you have the correct region and the patient is relaxed. If the patient guards, you lose accuracy.

Patient positioning: place the target on slack

Accuracy improves when the overlying soft tissue is relaxed and the segment is supported.

• Support the limb: use pillows/towels so the patient does not hold the limb up.
• Slack the muscle: to feel a tendon, often place the muscle on slight tension; to feel a muscle belly border, place it on slack.
• Expose only what you need: maintain comfort and privacy; drape so the patient can relax.

Communication: consent, expectations, and “movement confirmation”

Before contact, explain what you will touch and why, and ask permission. During palpation, narrate what you are doing and invite feedback: “Tell me if this is tender or sharp.” When uncertain, use a small movement to confirm the structure under your fingers (bone stays still relative to skin; tendon tightens with contraction; joint line opens/closes with motion).

Continue in our app.

• Listen to the audio with the screen off.
• Earn a certificate upon completion.
• Over 5000 courses for you to explore!

Or continue reading below...

Download the app

2) Key bony landmarks head-to-toe: how to find them reliably

Head and neck

Mastoid process

• Where: posterior to the ear, inferior to the skull base.
• How: place finger pads behind the auricle; slide inferiorly until you meet a rounded bony prominence.
• Confirm: ask the patient to rotate the head gently; the mastoid stays fixed with the skull (no tendon tightening).

Shoulder girdle and thorax

Clavicle (shaft and ends)

• Where: S-shaped bone from sternum to acromion.
• How: start at the sternal notch, move laterally to the medial clavicle; “walk” along the superior border to the lateral end.
• Confirm: shoulder elevation/depression moves the lateral clavicle subtly; the shaft remains clearly bony under light–moderate pressure.

Acromioclavicular (AC) joint

• Where: junction of lateral clavicle and acromion.
• How: find the lateral clavicle; move laterally until the bone “drops” into a small gap, then rises again on the acromion.
• Confirm: ask for gentle shoulder flexion/extension; you may feel a small relative glide at the joint line.

Scapular spine

• Where: prominent ridge across posterior scapula.
• How: with patient seated or prone, locate the medial border of scapula; move laterally to the broad ridge (spine) and trace it toward the acromion.
• Confirm: ask for shoulder abduction to ~90°; scapula upwardly rotates and the spine’s orientation changes under your fingers.

Inferior angle of scapula

• Where: lowest tip of scapula.
• How: follow the medial border inferiorly until it converges to a point.
• Confirm: during arm elevation, the inferior angle moves laterally and upward with scapular upward rotation.

Rib angles (posterior)

• Where: posterolateral bend of each rib, lateral to the spinous processes.
• How: in prone, find a thoracic spinous process, move laterally 3–5 cm; feel a firm curved structure (rib) and follow it laterally to the angle region.
• Confirm: ask for a deep breath; ribs elevate subtly under your fingers (more noticeable laterally).

Pelvis and hip

Iliac crest

• Where: superior border of ilium.
• How: in standing or side-lying, place hands on the waistline; slide superiorly until you meet the firm ridge; trace anterior to posterior.
• Confirm: pelvic side-bending does not “tighten” it like a tendon; it remains a continuous bony rim.

ASIS (anterior superior iliac spine)

• Where: anterior end of iliac crest.
• How: trace the iliac crest anteriorly until it ends in a distinct point.
• Confirm: ask for gentle hip flexion; ASIS remains bony while nearby sartorius/inguinal tissues may tension.

PSIS (posterior superior iliac spine)

• Where: posterior end of iliac crest, near the “dimples” in many people.
• How: trace the iliac crest posteriorly; the PSIS is a firm prominence just lateral to the sacrum.
• Confirm: ask for small anterior/posterior pelvic tilt; PSIS moves with the pelvis as a unit.

Greater trochanter

• Where: lateral proximal femur.
• How: in side-lying, place palm on lateral hip; press moderately and roll fingers anterior–posterior to find the large bony mass.
• Confirm: passively internally/externally rotate the hip; the greater trochanter moves under your fingers (a key confirmation cue).

Knee

Femoral epicondyles (medial and lateral)

• Where: bony prominences on either side of distal femur.
• How: with knee flexed ~30–60°, palpate above the joint line on each side; identify the rounded prominences.
• Confirm: flex/extend slightly; epicondyles move with femur, while joint line is the gap between femur and tibia.

Lower leg and ankle

Tibial tuberosity

• Where: anterior proximal tibia, just below patella.
• How: find the inferior pole of patella; move inferiorly to the prominent bump.
• Confirm: ask for gentle quadriceps contraction; patellar tendon becomes taut inserting onto the tuberosity.

Malleoli (medial and lateral)

• Where: distal tibia (medial) and distal fibula (lateral).
• How: grasp the ankle; palpate the medial bony prominence (usually more anterior/superior) and the lateral prominence (often more distal/posterior).
• Confirm: ankle inversion/eversion does not change their firmness; tendons around them will glide/tension with movement.

Calcaneus

• Where: heel bone.
• How: cup the heel; palpate the posterior calcaneal tuberosity and the medial/lateral borders.
• Confirm: plantarflexion/dorsiflexion tightens Achilles tendon above it; the calcaneus remains a broad bony mass.

3) Soft-tissue guides: tendons, muscle borders, and fascial septa

General rules to identify soft tissue

• Tendon: cord-like, becomes more distinct with isometric contraction; often changes tension with joint position.
• Muscle belly: broader, “fills” under the fingers during contraction; borders can be traced by moving perpendicular to fiber direction.
• Fascial septum: subtle groove/firm line between muscle compartments; best felt with light–moderate pressure and skin glide.

Upper quarter soft-tissue guides

Upper trapezius border (neck–shoulder contour)

• How: in sitting, lightly pinch-and-roll the tissue from lateral neck toward acromion to appreciate the superficial border.
• Confirm: ask for shoulder shrug; the muscle thickens under your fingers.

Rotator cuff region guide: posterior cuff vs deltoid

• How: posterior shoulder, find scapular spine; just inferior to it, palpate the infraspinatus fossa (broad muscle). Move laterally toward humeral head where tissue becomes more tendinous.
• Confirm: resisted external rotation increases posterior cuff tension; resisted abduction emphasizes deltoid more superficially.

Lower quarter soft-tissue guides

Patellar tendon

• How: knee flexed ~20–30°, palpate from inferior patellar pole to tibial tuberosity; feel a firm band.
• Confirm: gentle quadriceps set makes it stand out; relaxation softens it.

Hamstring tendons (medial vs lateral) at the knee

• How: prone with knee flexed ~30–60°, palpate the posteromedial knee for semitendinosus/semimembranosus and posterolateral for biceps femoris tendon.
• Confirm: resisted knee flexion increases tendon definition; add tibial internal rotation bias to medial hamstrings, external rotation bias to biceps femoris.

Achilles tendon

• How: prone with foot off table, palpate proximal to calcaneus; identify the thick cord and trace it distally.
• Confirm: gentle plantarflexion (or resisted plantarflexion) increases tension; dorsiflexion slackens it.

Fascial septa in the leg (anterior vs lateral compartment guide)

• How: mid-leg, palpate the tibial crest (hard edge). Move laterally into tibialis anterior (muscle belly). Continue laterally until you feel a subtle groove/firm line (intermuscular septum) before peroneal muscles.
• Confirm: dorsiflexion/inversion biases tibialis anterior; eversion biases peroneals, helping you “see” the border by contraction.

4) Common errors and confirmation using movement cues

Common palpation errors

• Pressing too hard too early: triggers guarding and pain; start light, then deepen.
• Not anchoring to a known landmark: increases drift; always start from a structure you can identify confidently.
• Confusing tendon with bone: tendons feel cord-like and change with contraction; bone is broad/unyielding and does not “tighten.”
• Chasing tenderness: pain is not a landmark; confirm anatomy first, then interpret symptoms.
• Poor positioning: unsupported limb leads to constant muscle activation and “false firmness.”

Movement cues to confirm location (examples)

• Scapular rotation during arm elevation: palpate scapular spine or inferior angle; ask the patient to elevate the arm. The scapula upwardly rotates—your landmark should translate and rotate with it. If it doesn’t move, you may be on rib or soft tissue.
• Greater trochanter with hip rotation: if the structure under your fingers moves clearly with passive hip internal/external rotation, you are likely on the trochanter rather than gluteal tendon or IT band.
• Patellar tendon with quadriceps set: tendon becomes taut and more defined; the tibial tuberosity remains bony and unchanged.
• Ribs with breathing: ribs subtly elevate with inhalation; transverse processes/spinous processes do not move with respiration in the same way.

Palpation drills (step-by-step) with expected findings

Drill 1: AC joint identification and confirmation

1. Position: patient seated, arm relaxed by side.
2. Anchor: palpate the lateral clavicle along its superior border.
3. Find the joint: slide laterally until you feel a small step/gap (AC joint line), then the acromion.
4. Confirm: ask for small shoulder flexion/extension; feel subtle motion at the joint line.

Expected findings: a small, discrete joint space; mild tenderness can be normal with direct pressure, but sharp pain or marked asymmetry may be clinically relevant.

Drill 2: Scapular spine and inferior angle with movement cue

1. Position: patient seated or prone; shoulder relaxed.
2. Find scapular spine: locate medial border, move laterally to the ridge; trace toward acromion.
3. Find inferior angle: follow medial border inferiorly to the pointed tip.
4. Confirm: patient slowly elevates arm overhead; feel the spine rotate and the inferior angle move laterally/upward.

Expected findings: clear bony ridge (spine) and pointed inferior angle; both should move with scapular motion. If the “inferior angle” feels fixed, reassess (you may be on rib or soft tissue).

Drill 3: Iliac crest → ASIS → greater trochanter mapping

1. Position: patient standing or supine for pelvis; side-lying for trochanter if needed.
2. Iliac crest: locate and trace the crest anteriorly.
3. ASIS: identify the distinct anterior point.
4. Greater trochanter: move lateral/inferior from ASIS region to lateral hip; palpate the large bony mass.
5. Confirm: passively rotate hip; trochanter should roll under your fingers.

Expected findings: iliac crest feels like a continuous ridge; ASIS is a sharp point; trochanter is broad and mobile with hip rotation.

Drill 4: Femoral epicondyles and tibial tuberosity (knee landmarks)

1. Position: patient supine, knee flexed 30–60° with support.
2. Epicondyles: palpate medial and lateral prominences above the joint line.
3. Tibial tuberosity: find inferior patellar pole, slide inferiorly to the bump.
4. Confirm: gentle quad set makes patellar tendon taut to the tuberosity; epicondyles remain bony and unchanged.

Expected findings: epicondyles are rounded and firm; tuberosity is a distinct anterior prominence; tendon becomes more defined with contraction.

Drill 5: Malleoli and Achilles insertion

1. Position: patient supine or prone; ankle relaxed.
2. Malleoli: palpate medial and lateral prominences; note lateral is typically more distal/posterior.
3. Calcaneus: cup heel and identify posterior calcaneal tuberosity.
4. Achilles: trace tendon distally to its insertion above the calcaneus.
5. Confirm: plantarflexion tightens Achilles; malleoli/calcaneus remain bony and unchanged.

Expected findings: malleoli are sharply defined; Achilles is a thick cord; insertion region may be sensitive in symptomatic patients.