Hip and Thigh — Palpation Landmarks

Palpation Landmarks

Greater Trochanter — Most Important Lateral Hip Landmark

• How to find it: With the client standing or side-lying (affected side up), place the heel of your hand on the lateral hip, approximately halfway between the iliac crest and the knee. The greater trochanter is the broadest bony prominence under your hand. It is approximately a hand-width (8–10 cm) below the iliac crest. Alternatively, locate the midpoint of a line between the ASIS and the ischial tuberosity — the greater trochanter is at this level, directly lateral.
• What it feels like: A broad, flat bony surface facing laterally. It is larger than most students expect — approximately 5 cm tall and 3 cm wide. The superior border (tip) is approximately level with the pubic symphysis anteriorly. The ITB and the trochanteric bursa overlie it — you palpate through these structures to reach bone.
• Client position: Side-lying with the affected side up (best for detailed palpation and confirmation) or standing (for functional assessment). Prone is also acceptable.
• Confirmation: Place your fingertip on the trochanter and ask the client to slowly internally and externally rotate the hip (with the knee flexed to 90 degrees in side-lying). The trochanter rolls under your finger — it moves anteriorly with internal rotation and posteriorly with external rotation. This rolling motion is the definitive confirmation. No soft tissue structure moves in this rotational pattern.
• Common errors: Palpating too far anteriorly (onto the femoral neck region, which is not palpable) or too far posteriorly (onto the gluteal muscle mass). The trochanter faces directly laterally. Also, confusing the soft tissue fullness of the ITB and trochanteric bursa with the bone itself — press firmly through these structures to feel the hard bone underneath. In overweight clients, the trochanter may be deeply buried — the rotation test is essential for confirmation.
• Clinical significance: The gluteus medius and minimus insert on the trochanter (see Muscle Attachments) — tenderness here is the hallmark of greater trochanteric pain syndrome, which is more commonly gluteal tendinopathy than true bursitis. The trochanteric tip approximates the center of the femoral head — a trochanter sitting higher than expected on one side suggests coxa vara, femoral neck fracture, or hip dislocation. The midpoint between the PSIS and the greater trochanter is where the sciatic nerve emerges — a critical avoidance zone during deep gluteal work (see anatomy/bones/lumbar-spine-pelvis-landmarks for details).

Femoral Condyles — Medial and Lateral

• How to find it: With the client supine and the knee flexed to 90 degrees, place your hands on either side of the knee. The femoral condyles are the two large, rounded bony masses at the distal femur — one on each side of the knee. They are most prominent posteriorly and inferiorly. With the knee flexed, the condyles become accessible as the patella shifts superiorly and the joint line opens.
• What it feels like: Large, smooth, curved bony surfaces — each approximately 3–4 cm in diameter. The medial condyle extends more distally than the lateral condyle (contributing to the normal valgus alignment of the knee). Both condyles are covered by a thin layer of soft tissue and are easily palpable.
• Client position: Supine with the knee flexed to 90 degrees (foot flat on the table). This position exposes the condyles optimally.
• Confirmation: The condyles are the bony masses immediately proximal to the joint line of the knee. If you slide your finger distally from the condyle, you drop off the edge into a depression — this is the joint line (the gap between the femur and tibia where the menisci sit). The condyles do not move independently — they move with the femur during knee flexion and extension.
• Common errors: Confusing the femoral condyles with the tibial plateau (which is immediately distal to the joint line) or with the tibial condyles. The femoral condyles are proximal to the joint line; the tibial structures are distal. Also, palpating the condyles with the knee extended makes them harder to distinguish because the patella covers the anterior surface.
• Clinical significance: Condylar tenderness may indicate osteoarthritis, osteochondral defect, or contusion. The medial condyle is the femoral attachment of the MCL — tenderness at the medial femoral condyle (specifically at the epicondyle above it) may indicate MCL injury. The lateral condyle is the origin of the popliteus — tenderness at the posterolateral condyle may indicate popliteus involvement.

Adductor Tubercle

• How to find it: With the client supine and the knee flexed, locate the medial femoral condyle. Slide your finger superiorly along the medial condyle — the adductor tubercle is a small bony prominence on the superior-medial aspect of the medial condyle, approximately 1–2 cm above the joint line. It is the most medial bony point of the distal femur.
• What it feels like: A small, rounded bony point — approximately the size of a pencil eraser. It is less prominent than the condyle below it but distinct enough to feel as a small bump on the superomedial femur.
• Client position: Supine with the knee flexed to approximately 90 degrees.
• Confirmation: The adductor magnus (ischial fibers) inserts on the adductor tubercle. Press on the tubercle and ask the client to adduct the thigh against resistance — you may feel the tendon of the adductor magnus tighten at the tubercle.
• Common errors: Confusing the adductor tubercle with the medial epicondyle of the femur (the medial epicondyle is the broader prominence where the MCL attaches — the adductor tubercle is a more discrete point on its superior aspect). In practice, the adductor tubercle and medial epicondyle are adjacent and sometimes difficult to distinguish.
• Clinical significance: Insertion of the adductor magnus ischial fibers — tenderness here may indicate distal adductor tendinopathy. Also used as a measurement landmark: the adductor tubercle marks the distal extent of the medial thigh for draping purposes and is a reference point for Q-angle measurement.

Tibial Tuberosity

• How to find it: With the client supine and the knee extended or slightly flexed, locate the inferior pole of the patella. Slide your finger distally — you pass over the patellar tendon (a thick, taut band) and arrive at a prominent bony bump on the anterior proximal tibia. This is the tibial tuberosity. It is approximately 3–4 cm below the inferior patellar pole.
• What it feels like: A distinct, broad bony prominence on the anterior tibia, approximately 2 cm wide. It is easily palpable and often visible as a prominent bump below the knee. The patellar tendon attaches to its superior surface.
• Client position: Supine or seated with the knee extended or slightly flexed.
• Confirmation: The tibial tuberosity is in the anterior midline of the proximal tibia. It does not move. The patellar tendon inserts directly onto it — palpating from the patella distally, the tendon leads directly to the tuberosity.
• Common errors: Confusing the tibial tuberosity with the anterior tibial crest (the shin), which begins at the tuberosity and extends distally. The tuberosity is the distinct bump; the crest is the long, sharp anterior edge of the tibial shaft below it.
• Clinical significance: Insertion of the patellar tendon — tenderness at the tuberosity in adolescents is the hallmark of Osgood-Schlatter disease (traction apophysitis of the tibial tuberosity growth plate). In adults, tenderness here suggests patellar tendinopathy (distal). The tibial tuberosity is a component of Q-angle measurement (line from ASIS to patella center to tibial tuberosity — see Assessment Reference Points).

Gerdy's Tubercle

• How to find it: From the tibial tuberosity, move laterally approximately 2 cm. Gerdy's tubercle is a small bony prominence on the anterolateral aspect of the proximal tibia, just below and lateral to the lateral tibial condyle. It is approximately at the same level as the tibial tuberosity but on the lateral side.
• What it feels like: A small, rounded bony point, less prominent than the tibial tuberosity. It may feel like a subtle bump on the lateral tibial surface.
• Client position: Supine with the knee slightly flexed.
• Confirmation: The iliotibial band (ITB) inserts on Gerdy's tubercle. Ask the client to extend the knee against resistance while you palpate — the ITB tightens and you may feel its insertion tighten at Gerdy's tubercle.
• Common errors: Confusing Gerdy's tubercle with the fibular head (which is more lateral, more posterior, and more distal — the fibular head is a distinct bony prominence on the posterolateral aspect of the proximal leg). Gerdy's is on the tibia itself, anterior to the fibular head.
• Clinical significance: Insertion of the iliotibial band. Tenderness at Gerdy's tubercle is less common than ITB tenderness at the lateral femoral condyle (where ITB friction syndrome occurs), but it can indicate distal ITB irritation or proximal tibiofibular joint involvement.

Femoral Triangle

• How to find it: The femoral triangle is a soft tissue space, not a bony landmark, but its boundaries are defined by bony and muscular landmarks. With the client supine, locate the inguinal ligament (a taut band running from the ASIS to the pubic tubercle) — this forms the superior boundary. The medial boundary is the adductor longus (ask the client to adduct the hip to make it prominent). The lateral boundary is the sartorius. The floor is formed by the iliopsoas (laterally) and the pectineus (medially).
• What it feels like: A soft, depressed triangular area in the proximal anterior thigh, just below the inguinal ligament. The femoral pulse is palpable within the triangle, approximately midway between the ASIS and the pubic symphysis.
• Client position: Supine with the hip slightly flexed, abducted, and externally rotated (frog-leg position relaxes the musculature and opens the triangle).
• Confirmation: The femoral pulse is the key confirmation — palpate approximately midway between the ASIS and the pubic symphysis, just below the inguinal ligament. The pulse confirms you are within the femoral triangle. The contents from lateral to medial follow the mnemonic NAVEL: Nerve, Artery, Vein, Empty space (femoral canal), Lymphatics.
• Common errors: Pressing too deeply and aggressively — the femoral nerve, artery, and vein are within the triangle and vulnerable to compression. Use gentle palpation. Also, not locating the inguinal ligament first — without this boundary, the triangle is difficult to orient.
• Clinical significance: The femoral artery pulse is palpated here for vascular assessment. The femoral nerve emerges from beneath the inguinal ligament lateral to the artery — femoral nerve entrapment produces anterior thigh weakness and numbness. Inguinal lymph nodes are palpable in this region when enlarged. This is a sensitive area — explain the clinical reason for palpation and obtain consent before accessing the proximal anterior thigh. Follow CMTO Standards of Practice for sensitive area protocols.