Standing or sitting or lying supine
For women, a gown over the non-examined side with the examined area exposed or a halter top is recommended.
For men, removal of the shirt is requested.
Lateral to the patient.
May I place my fingers on your shoulder and rib area? (or point to the demonstrated area).
Bring your arm down toward me (or demonstrate shoulder extension from a fully flexed position).
The structure you wish to palpate is in the area of the breast. Ask permission to place your fingers on the medial or lateral aspect of the muscle (not on the breast), which might be under a halter top. With the patientÃs shoulder relaxed, place your fingers on the muscle. Ask the patient to extend the shoulder from a fully flexed position. With unclear muscle activity in the sternal portion of the pectoralis major, ask the patient to hold against a gradually increasing attempt to produce a push on the arm in the direction of shoulder flexion and horizontal abduction to resist shoulder extensor effort and horizontal adductor effort. Clavicular and sternal portions of the pectoralis major can be activated by alternately resisting shoulder flexion to activate the clavicular portion and then resisting extension at or greater than 90 degree of shoulder flexion to activate the sternal portion.
VH - Pectoralis major sternal portion.