Standing
If you wish to palpate on the skin, provide a private room. If you think this is necessary, the patient is asked if he/she is willing to either lower his/her pants, if needed, for direct palpation on the skin near the iliac crest. Palpation on the skin is possible also by lifting the shorts and placing the fingers on the skin proximal to the greater trochanter, with permission. While the skin can not be viewed with clothes covering the area, the gluteus medius can be palpated over clothing.
Lateral or posterior to the patient.
May I touch the outside of your thigh and along the top of your hip bone? (or point to the demonstrated area). To find a large bone on the side of your thigh, I am placing my hand on your thigh and am asking you to turn your whole leg in and out. Now shift your weight from foot to foot (or demonstrate).
Guide the patient to stand. With the patient relaxed and with permission, place your fingers just proximal to the greater trochanter and/or on the skin distal to the superior portion of the iliac crest, either on clothing or on the skin. Guide the patient to shift weight from one foot to the other. Palpate the tendon and muscle activity near the greater trochanter and/or near the iliac crest when the patient bears weight on the side of the palpation.
Note that the portions of the gluteus medius that are palpable are the anterior and middle portions. The posterior gluteus medius lies deep to the gluteus maximus, and both of these muscles have the same joint actions of hip extension, abduction, and lateral rotation. Therefore, activating the posterior gluteus medius also activates the gluteus maximus. All three portions meet near the greater trochanter, so that muscle activation there represents all three portions, without a clear distinction of the portions. This inability to palpate the posterior gluteus medius is clinically meaningful, as the posterior gluteus medius is thought to be overused in many functional situations, such as with a walking pattern involving excessive medial rotation of the lower limb and excessive pronation of the foot. This portion of the gluteus medius can not be palpated except through the gluteus maximus, which would be activated whenever the posterior gluteus medius is activated. Therefore, the posterior gluteus medius can not be palpated selectively.
Note that the portions of the gluteus medius that are palpable are the anterior and middle portions. The posterior gluteus medius lies deep to the gluteus maximus, and both of these muscles have the same joint actions of hip extension, abduction, and lateral rotation. Therefore, activating the posterior gluteus medius also activates the gluteus maximus. All three portions meet near the greater trochanter, so that muscle activation there represents all three portions, without a clear distinction of the portions. This inability to palpate the posterior gluteus medius is clinically meaningful, as the posterior gluteus medius is thought to be overused in many functional situations, such as with a walking pattern involving excessive medial rotation of the lower limb and excessive pronation of the foot. This portion of the gluteus medius can not be palpated except through the gluteus maximus, which would be activated whenever the posterior gluteus medius is activated. Therefore, the posterior gluteus medius can not be palpated selectively.
VH - Gluteus medius