Palpation in the Area of the Shoulder Girdle

A palpation is one of the most important methods during the examination because it can find a pathological structure. The most valuable symptom for an exact determination of a pathological focus during the palpation is an evoking of a pain which is intensive, and its quality corresponds to patient's problems. The palpation is able masterfully localized the pathological focus in the areas which are closely under the skin, and simultaneously there is not a danger of a replacement with other structures5.

The palpation is suitable to be made systematically. We also examine structures which the patient does not speak as about painful ones. The patient is surprised very often with a discovery of the painful structures in areas, in which he/she did not originally localized the pain, by the palpation. A typical example is a pain at the affection of the acromioclavicular articulation  which the patient is not able to localize  exactly. We have to ask the patient to show us the most painful structure in the area of the shoulder girdle at the beginning of the examination. If the patient is able to localize the pain well, it is the question of pathology of this structure6.

Places with the Exact Localization of the Pathological Focus during the Palpation

  1. an acromioclavicular articulation

  2. a sternoclavicular articulation

  3. a tendon of the long head of the biceps

  4. processus coracoideus

  5. muscles and their trigger points typical for myofascial pains

5but the glenohumeral articulation is worse accessible for the palpation, and there is a danger of a replacement with other structures (f. e. rotator cuff). It is almost impossible to find out the filling of the glenohumeral articulation, and fluctuation rather belongs to bursitis.

6In summary we can say that if the patient localizes exactly the pains into a certain place himself/herself, it deals with an affection of this place. But on the other hand, there exist structures where the pain radiates more diffusively, so the patient localized their affection wrongly, and therefore we cannot forget to palpate these places during each examination.