Shoulder Girdle — Palpation Landmarks

Palpation Landmarks

Clavicle (Full Length — Medial to Lateral)

• How to find it: Have the client seated or supine. Place your fingertips at the jugular notch (the dip at the top of the sternum between the two collarbones). Slide laterally along the superior surface of the clavicle. The bone is subcutaneous along its entire length — you are tracing it directly through the skin.
• What it feels like: The medial two-thirds curves convexly forward — it feels like a smooth, rounded bar. At roughly the junction of the middle and lateral thirds, the curve reverses and becomes concave forward. The lateral third flattens and widens slightly before ending at the acromioclavicular joint.
• Client position: Supine or seated. Arms resting at the sides.
• Confirmation: Ask the client to shrug the shoulders — the entire clavicle elevates under your fingers. You can also ask them to reach across and touch the opposite shoulder (horizontal adduction) — the lateral end moves posteriorly.
• Common errors: Losing contact with the bone at the lateral third, where the deltoid and trapezius cover it more thickly. Stay on the superior surface and press firmly but gently through the muscle bellies.
• Clinical significance: Most commonly fractured bone in the body (middle third). See Clinical Notes and Muscle Attachments table for attachment details.

Sternoclavicular (SC) Joint

• How to find it: Start at the jugular notch. Move laterally approximately 2 cm on either side. You will feel a prominent, rounded bump — this is the medial end of the clavicle. The SC joint line is the small gap between this bump and the manubrium of the sternum.
• What it feels like: The medial clavicle is bulbous and sits slightly higher than the manubrium. The joint line itself is a subtle depression you can feel with the edge of your fingernail. In most people, the medial clavicle is more prominent on the dominant side.
• Client position: Supine. Arms at the sides.
• Confirmation: Ask the client to protract the shoulder (reach forward toward the ceiling) — the medial end of the clavicle glides posteriorly and becomes less prominent. Retraction makes it more prominent.
• Common errors: Pressing too hard at the joint line — the SC joint is sensitive and close to the trachea and great vessels. Use gentle pressure.
• Clinical significance: Only true skeletal connection between the upper limb and axial skeleton. Tenderness or hypermobility may indicate SC joint dysfunction. See Joint Associations table.

Acromioclavicular (AC) Joint

• How to find it: Follow the clavicle laterally from the SC joint. At the very end of the clavicle, you reach a small step-off or gap — this is the AC joint. The clavicle ends and the acromion begins. You can also find it by placing your finger on the top of the shoulder and pressing down — the joint line is the first gap you encounter before the hard, flat surface of the acromion.
• What it feels like: A small depression or step between two bony surfaces. The gap is typically less than 1 cm wide. It may feel like a subtle notch under your fingertip.
• Client position: Seated or supine. Arm at the side.
• Confirmation: Ask the client to horizontally adduct the arm (reach across the chest toward the opposite shoulder). You should feel the clavicle glide on the acromion directly under your finger. This movement loads the AC joint and often reproduces pain if the joint is irritated.
• Common errors: Confusing the AC joint with the lateral end of the clavicle. The AC joint is the gap between the clavicle and acromion, not the end of either bone. If you feel a continuous bony surface without a gap, you are still on the clavicle or already on the acromion — reposition.
• Clinical significance: Tenderness is a hallmark of AC joint sprain. Cross-body adduction test loads the AC joint specifically. See Clinical Notes for age-related changes.

Acromion — The "Corner" of the Shoulder

• How to find it: From the AC joint, continue laterally and slightly posteriorly. The acromion is the broad, flat shelf of bone at the very top (and slightly lateral/posterior) of the shoulder. You can also locate it by running your fingers along the spine of the scapula from behind — the acromion is the anterior-lateral endpoint of the spine.
• What it feels like: A broad, flat, roughly rectangular plate of bone. It forms the hard "roof" over the glenohumeral joint. When you press down on the point of someone's shoulder, you are pressing on the acromion.
• Client position: Seated or prone. Arm at the side or resting on the treatment table.
• Confirmation: The acromion does not move when the client moves the arm at the glenohumeral joint (it only moves with scapular motion). If you press on a structure and it moves when the client flexes or extends the shoulder without moving the scapula, you are on the humerus, not the acromion.
• Common errors: Mistaking the greater tuberosity for the acromion. The greater tuberosity is inferior and lateral to the acromion and moves with humeral rotation — the acromion does not.
• Clinical significance: Forms the roof of the subacromial space — the basis of subacromial impingement. Acromion shape (Type I-III) varies genetically and influences impingement risk but cannot be determined by palpation.

Coracoid Process — "The Lighthouse of the Shoulder"

• How to find it: The coracoid process is deep to the anterior deltoid and pectoralis major. Start at the lateral end of the clavicle (you have already found this from the AC joint). Drop your finger approximately 2–3 cm inferiorly and slightly medially from the clavicle. You are now pressing into the deltopectoral triangle — the gap between the anterior deltoid and pectoralis major. Press posteriorly (toward the back of the body) through the soft tissue. The coracoid is a firm, bony point deep to these muscles.
• What it feels like: A rounded, beak-shaped projection approximately the size of a fingertip. It is smaller and deeper than you expect. It is often tender to palpation even in healthy individuals because the musculocutaneous nerve and brachial plexus are nearby.
• Client position: Supine. Arm at the side, slightly externally rotated. Relaxing the pectoralis major and anterior deltoid makes the coracoid more accessible.
• Confirmation: Once you have located the bony point, ask the client to flex the elbow against your resistance (biceps contraction). The short head of the biceps and coracobrachialis originate from the coracoid — you should feel their tendons tighten directly under or adjacent to your palpating finger. Alternatively, pectoralis minor inserts on the coracoid — having the client protract the scapula against resistance tenses the pectoralis minor tendon at the coracoid.
• Common errors: The most common error is confusing the coracoid with the humeral head. The humeral head is larger, smoother, and more lateral. It moves with arm rotation — the coracoid does not (it is part of the scapula). If the structure you are pressing on rolls under your finger when the client rotates the arm, you are on the humeral head. Move medially.
• Clinical significance: Three muscles attach here (pec minor, short head biceps, coracobrachialis — see Muscle Attachments). The brachial plexus and axillary artery pass just lateral and posterior — use short-duration palpation. Called "the lighthouse of the shoulder" because it orients you to the bicipital groove (lateral), GH joint line (posterior-lateral), pec minor (posterior-superior), and brachial plexus (lateral-deep).

Spine of Scapula

• How to find it: With the client seated or prone, locate the acromion at the point of the shoulder. From the acromion, slide your finger medially along the bony ridge running across the posterior scapula. This ridge is the spine of the scapula. Follow it medially until it flattens into the medial border at approximately the level of T3.
• What it feels like: A prominent, sharp bony ridge running horizontally across the upper posterior shoulder. It is subcutaneous for most of its length and easy to trace. The ridge has a superior lip and an inferior lip — the supraspinous fossa is above it, and the infraspinous fossa is below it.
• Client position: Prone or seated. Arms resting at the sides or on the treatment table.
• Confirmation: The spine of the scapula does not move when the arm moves at the glenohumeral joint alone (only with scapular motion). If the client is prone and you trace the ridge, it should remain continuous from the acromion to the medial border.
• Common errors: Losing the spine near the medial border where it becomes less prominent and blends into the scapular body. Press slightly harder — the root of the spine (medial end) is lower and broader than the lateral portion.
• Clinical significance: Divides posterior scapula into supraspinous and infraspinous fossae. Tenderness in either fossa suggests rotator cuff pathology. See Nerve Passages for suprascapular nerve at the notch.

Inferior Angle of Scapula

• How to find it: With the client seated or prone, follow the medial border of the scapula inferiorly. The inferior angle is the lowest point of the scapula — the sharp corner where the medial and lateral borders converge. It sits at approximately the T7 level with the arm at the side.
• What it feels like: A sharp, easily identifiable bony point. It is the most mobile part of the scapula — you can grasp it between your thumb and fingers and lift it away from the rib cage.
• Client position: Prone with arms at the sides, or seated. For enhanced access, have the client reach across the chest (placing the hand on the opposite shoulder) — this protracts the scapula and makes the inferior angle more prominent and accessible.
• Confirmation: Ask the client to slowly abduct the arm overhead. Watch and feel the inferior angle — it should rotate laterally and superiorly as the arm elevates past approximately 60 degrees (scapulohumeral rhythm). This confirms you are on the scapula, not a rib.
• Common errors: Confusing the inferior angle with a rib prominence, especially in muscular clients where the scapula sits deeper. The movement test resolves this — ribs do not move with arm elevation.
• Clinical significance: Approximates T7 vertebral level. Inferior angle winging suggests serratus anterior weakness (long thoracic nerve). Must rotate laterally during arm elevation above 60° — failure indicates scapular dyskinesis. See Assessment Reference Points.

Medial (Vertebral) Border of Scapula

• How to find it: With the client prone or seated, locate the inferior angle (described above). Trace the bony edge superiorly toward the spine of the scapula. The medial border runs parallel to the vertebral column, approximately 3 finger-widths (5–7 cm) from the midline in most adults. Follow it from the inferior angle all the way up to the superior angle.
• What it feels like: A thin, sharp bony edge running vertically. In lean clients, it is easily palpable through the overlying trapezius and rhomboids. In muscular or heavier clients, you may need to have them protract the scapula (reach forward) to bring the medial border into prominence.
• Client position: Prone or seated. For better access, have the client place their hand on the opposite shoulder or rest the ipsilateral hand on the low back — both positions protract or retract the scapula and reveal the border.
• Confirmation: Ask the client to retract the scapulae (squeeze the shoulder blades together). The medial borders move toward midline. Ask them to protract — the borders move away from midline.
• Common errors: Confusing the medial border with the overlying rhomboid muscle bellies. The border is a thin, sharp edge — the rhomboids are thick, fleshy tissue overlying it. Press through the soft tissue to feel the bone underneath.
• Clinical significance: Normal distance from midline is ~3 finger-widths — increased distance suggests protraction. Medial border winging = serratus anterior weakness (long thoracic nerve); inferior angle winging = trapezius weakness (spinal accessory nerve). See Assessment Reference Points for scapular symmetry details.

Greater Tuberosity of the Humerus

• How to find it: With the client seated and arm at the side, locate the acromion. Drop your finger approximately 2 cm inferiorly from the lateral edge of the acromion. You are now on the greater tuberosity. It is the most lateral bony prominence of the proximal humerus.
• What it feels like: A broad, rounded bony prominence. It is larger than most students expect — roughly 2–3 cm wide. With the arm in neutral rotation, the greater tuberosity faces directly laterally.
• Client position: Seated. Arm hanging at the side in neutral rotation.
• Confirmation: Ask the client to slowly internally and externally rotate the arm (elbow bent to 90 degrees, rotating the forearm in and out like a gate). The greater tuberosity rolls under your finger — it moves anteriorly with internal rotation and returns to lateral with external rotation. The acromion above it does not move. This is the definitive confirmation.
• Common errors: Confusing the greater tuberosity with the acromion (above) or the deltoid tuberosity (well below, mid-humerus). The rotation test distinguishes them — only the tuberosity moves.
• Clinical significance: Three rotator cuff muscles insert here (supraspinatus superior facet, infraspinatus middle, teres minor inferior — see Muscle Attachments). Tenderness is a primary finding in rotator cuff tendinopathy. Internal rotation brings the tuberosity anteriorly for supraspinatus palpation.

Lesser Tuberosity of the Humerus

• How to find it: From the greater tuberosity, rotate the client's arm externally (or ask them to do so). As the humerus externally rotates, the lesser tuberosity rotates into a more anterior and lateral position. It is medial to the bicipital groove, on the anterior aspect of the proximal humerus. Alternatively, from the coracoid process, move directly laterally — the lesser tuberosity is the first bony prominence you encounter.
• What it feels like: A smaller, rounder bony point than the greater tuberosity. It is located approximately 1–2 cm lateral to the coracoid and is most accessible when the humerus is externally rotated.
• Client position: Supine or seated. Arm slightly externally rotated to bring the lesser tuberosity into a palpable position.
• Confirmation: With your finger on the lesser tuberosity, ask the client to internally rotate the arm against resistance. You should feel the subscapularis tendon tense under your finger — the subscapularis is the only muscle that inserts on the lesser tuberosity.
• Common errors: Confusing the lesser tuberosity with the coracoid process (which is more medial and does not move with arm rotation) or the bicipital groove (which is a depression, not a prominence).
• Clinical significance: Subscapularis inserts here (the only rotator cuff muscle on the anterior humerus). Tenderness suggests subscapularis pathology — underdiagnosed due to access difficulty. Forms the medial wall of the bicipital groove.

Bicipital Groove (Intertubercular Sulcus)

• How to find it: With the client supine or seated, externally rotate the arm to bring the anterior humerus into a more accessible position. The bicipital groove is the vertical depression running between the greater tuberosity (lateral) and lesser tuberosity (medial) on the anterior proximal humerus. With the arm in about 10 degrees of external rotation, the groove faces almost directly anteriorly.
• What it feels like: A shallow vertical channel between two bony ridges. It is approximately 1 cm wide. You can roll your fingertip medially and laterally across it and feel both tuberosities as ridges on either side. The biceps long head tendon lies within the groove and may feel like a firm cord under your finger.
• Client position: Supine. Arm in slight external rotation (about 10 degrees). Elbow extended or slightly flexed.
• Confirmation: Place your fingertip in the groove. Ask the client to slowly internally and externally rotate the humerus. The groove rolls under your finger — you feel the ridges of both tuberosities alternately passing beneath your fingertip. Alternatively, ask the client to flex the elbow against resistance — you may feel the biceps tendon tense within the groove.
• Common errors: Palpating too far inferiorly (the groove becomes less distinct below the surgical neck). Also, pressing too hard — the biceps tendon within the groove is sensitive, and excessive pressure causes pain that the client may misinterpret.
• Clinical significance: Houses the biceps long head tendon — tenderness is a primary finding in bicipital tendinopathy. Speed's and Yergason's tests are performed here. The groove orients you to the entire proximal humerus (greater tuberosity lateral, lesser tuberosity medial).