Livro de Anatomia Palpatória

Prévia do material em texto

Scanned by CamScanner
Scanned by CamScanner
Pe lu e
É U I 11 ; m c l o s t c o a r t i c u la r fe c h a do
, 
c o n s t i t u ído p o r q u a t m O SSO S e s e t o a r t ic u la ç õ e s :
O s s o s A r t i c u la ç i5e s
1 1 0 SSO S i n m n i n a do s (a s s o du q u & d r i l ) s l l c r o i l í i ï c a (d u a s )
 q u : ]dr i l (du n s )
 l u+ nb os s ; rcr a
 s nc r oc o c c í ge a
úb i s s :n f is e phi c : 1
团团园圃
D i v ide s e e , m P E L V E M A I O R e P E L V E M EN O R
, 
s e n d o e ss a d iv i s o r e p r e s e n t a d a p o r
u m a l i n h a i m a g in i i r i a , q u c p a s s a p e lo p r o m o n t ó r iu do s a c r o
, p e la l i n h a i l io p e c t :n c a c p e la bo r da
s u p e r io r da s :n : is e p ú b ic a
A P e l v e A p r e s e n t a A lgu m a s D i fe r e n ça s Se g u n t l o 0 Se x o
m a s c u l i n a f e m i n i n a
 me n o s l ar ga m a i s l ar ga
 ma i s f ec h a d a m a i s
 ab er t a
 e s t r ei to sup e r i or me n o s l ar go ' e s t r e i to
 su p e r i or ma i s I nr Ru
æ Es s a d i íe r c n ç a m o r fo lóg ic a da c i n t u r a p l v i c a t c m p a pe l fu n da m c n r a l n a g e s t a ç ìi o e , pr
c i p a lm c n t e , n o p a r t o
- da p e l v e ; 
FunÇÇÇÇÇÇi'" dddddda P e '''''' v e
fo r ç a s pmveni ent es da c a be ç a , b r a ç o s c t r o n c o i\s c x t r c m ida dc s i n fe r io r c a
: i os a bdo m i n a i s , c o m o t a m b m s u p o r t á lo s
, 
r e c e be n do 0 s c u p e s o 国
Scanned by CamScanner
É f rìnnrJo p c l i l j u n ç iì u Alc r r : ; u s s o s : 
l l io
, 
ísq u io c p ú
b i s ; a u n i ìi o 5c 
Ía z a t r a v s dc u m a g r a l l
c n v iLI ; r LIc : t l n CC t : 
ì hu lo
C o r 11t ) : c o n r r h u i e m i l 
111c n o s c]c 2/5 p ; t r : \ 11 n 1 1 
: 1çi i ) tk ) a c c ü ih u
lo
A : ; H : H 1nai r p n r t c u o 0 5
50 ; l i 1n i r a LI : \ c r : t n
i n i n l c l ì t c p c l " c r
is t a i l ía c a ; C i l u d a l m e n t e
eh
A p r e se n t a Un a s f : JC C S : 
fa c e c x t c r 11a g lú r c a e 
f l ec i n t l : r n a o u p
l v i c a E IPS c H e s p i n h a i l :n c a p t \ s t c r
o in Uc r iLr r E I
PI
C o r po : c o n t r ih u i c o m 1n n is 
de 2/5 p u r a a fo n n a ç fi o 
do a c c t : ibu ïo
A p r c s c n t n n 떠 l i n ha is q u
i : t r ie ; 1 c , s u ï'c r io r m c n
t c a c ta , a i n e i : i u r A 
i sq u i ; i t ic a m a io r , q u c é t ra
fo r m ; K ln c m u m 1 ; ) r n m c rm r m e i o 9
in l iga m c n r o s z : cmcspi nhal ; p e
l a r e g i ão p a s s a 0 m ús c u lo
l ign l ì 1c n r o s Sa c r e) 1 u hc r a l c s a c m c s p
i n h a l
, 
t r a n s fo r ï n a s e c m u m 
fo r a m e
Es l 1 i n h u i s q u i ; i t i c a : a t r a v s u c s i l a p
a l p n ç o c o n s e g u i m o s 
lo c a l i z a r 0 1n ú s c u lo gêm e o Supe 
-
; x :
, " " iSLIu I : ì t i c : 1 1n a i o r : r e fe r n c i a p a
l
.
' " ó r ia m u i t o i ï n p o r t a n t e p a r a . 1. " Ii zaç . d
æ I n c is u r n ix l u i ; i t i c a m e n o r : 0 t c n t l o do m ú s c u
lo o b t u r a do r i nt er no d e s l i z a s o b r e e ss a in c
s u r a
R a m o : é a p a r t e a c h a t a t Ïa c f i n a do ís q u io q u e s e j u n t a a o r a m o 
i n fe r io r do p úb is (r a m o
f c r io r o u dc sc c n u (: n t c )
Pú b is :
C o r p o : c o n t r ibu i c o i n 1/5 p a r a a fo r m a ç ì io do a c c t ábu la
R a m o s u pe r io r : c o n [ m 0 t u bé r c u lo p u h i c o , ' o c a l de i n s e r ç
ão do l ig a m (: n t o i n gu in a l
Ra m o i n fe r i o r : c m s u a fa c e c x t c ma i n s (: r e m s e o s m ú s c u lo s g r : i c i l , o b t u r a do r e x t e m o
, 
adu :
t o r c u r t o c a du t o r 1n a g n o
1 2 SA CRO
A p r e s e n t a u m a ba s e , u m : ip ic e e c r ês fa c e s
Ba s e : a r t i c u la s e c o m a v r t c b r a L 5 ; l a r ga , e , e m s e u p o n t o r n éd io , e n c o n t r a s e a po r
s u pç r iu r J o c o r po d c S l , q u e s c p m j e t a à f r e n t e , f o r m a n do 0 p r o m o n t ó r io
A p ic e : a p r e s e n t a u m a fa c « : t a o v a l p a r a a r t i c u la r s e c o m 0 c ó c c ix
Fa c e p lv i c a : é c ô n c a v a ; e m s u a p a r t e m e d ia n a a p r e s « : n t a q u a t r o c r is t a s t r a n s v e r s a is ; Os es :
p a ço s e n t r e e l a s r e p r e s e n t a m o s c o r p o s v c r t c b r a i s s a c r a i s
N a e x t r e m ida de d a s c r is t a s t r a n s v e r s a i s
, 
e n c o n t r a m se o s fo r a m e s s a c r a is v e n t r a is
, qu e di/
m i n u u n de t a m a n h o c zr u da l m e n t c ; a s s u bd l v is õ e s v c n t r a is do s n e r v o s s a c r a is s a e m do s fo r a.
m c s
, 
c e n t r a m a s a r t é r i a s s a c r a i s la t e r a is
Fa c e do r s a l : c o n v c x a c e s t r e i t a ; e m s u a p a r t e m e d i a n a s it u a s c a c r i s t a s a c r a l m e d ia n a ; a pr e]
s e n t a a lgu n s t u b r c u lo s , q u e s i o o s p r o c e s s o s r u d i m e n t a r e s de t r ês o u q u a t r o s e gm e n t o s sa c r as :Lat cr al mcnt c à c r is t a s a c r a . m e d i a n a
, 
e n c o n t r a s c 0 s u lc o s a c r a l ; r a so e c o r r e s po n de à u n iãd
da s lâm i n a s da s v r t e b r a s c o r r e sp o n de n t e s
æ 0 m ú s c u lo e r c t o r da e s p in h a e 0 g r a n de do r s a l t êm p a r t e Al c s u a o r ige m n a c r is t a sa c ra】
m e d i a n a
A s lâm in a s de 55 n ão s e u n e m n a l in h a m e d ia n a e fo r m a m 0 h i a t o do s a c r o
A s c r i s t a s s a c r a i s i nt er mcdi i r i as s o c o m p o s t a s p o r a lg u n s t u hé r c u lo s , d is p o s t o s la t e ra i
n i e n t e a o s u l c o s a c r a l ; r e p r e s e n t a m a f u s ão do s p r o c e s s o s a r t ic u la n : s d a s v é r t e br a s s a c r a s NO
n ív e l de 54 a 5 5
, 
e ss e s t u bé r c u l o s p a s s a m a t e r u m f o r m a t o a lo n g a do , e fo r m a m o s c o r n o s dQ
sa c r o
Scanned by CamScanner
も回国国团团国ダ
。 : I瑙 罢 にじ
一
Pe lv e 1 3
A s c r is t a s s u c r a is 1n [ c r a is c s f £i u s i l u n da s In t c r a lm c n t c a o s fo r a m c
s s a c r a is
, 
c r q 1 r e s c n t a m o s
A f i l c e 1 ; 1t c r a l w r c M : n [ ; 1 t l n l ; \ supcmci c c m n 0 UDr m M c ) Cíc u [ n a 
or cl h1 d c m ) m in Mh fa c e a u 
r ic u l a r ; cobcr m dc c a r r i l a pc m c a r t ic u la h= c o r n a fa c e a u r
i c u in r 9lo : l io Em s u a m e t a de c a u 
d a l
, 
e n c o n t r a s c a A ILS ( : i n l : u l :n f= m Ïn r c r a l t lo s a e m ), o n de s c i n s e r e m a s l iga m c n t o s s
ac
[ u hc r a t c sacmcspi nl l osü
, 
11c m c [ 1n m 11 0 m : d : 1 : ; m r : 1 : I 9I¯ n i l l s c u
lc) F : lú [ c o m : i x i m t ] c d o m ús c u lo
c o c c ígc o
D i :c r c n ça s A n a t ô m i c a s do Sa c r o Q u a n t o a o Se x o
m u lhe r e s ho n r c n s
' 5
, 
x " h l ' " " \ n " " , " " di rcçi i 1n n is c l [ r v ; ï [ u r a 1n n
is h o n ì o g n c a
t lo r : n l a u n l c n r n n J n n t : 1111 M l 1n LIa c i t v i LIn Jc
p 1v i c : 1 nï n l LIc [ ; 1n r h m m n l c n m r Ä i n g l l l , :
sn c r { 1y c r t c h r 1l
1 3 Có c c lx
Eo r m a l m c n t c fo n n a do p o r au at m v r m b r a s r u 9l im cn [ a r e sÉ c o m p o s t u pl a h a s e c ; i p ic e ; p e la s f a c e s p l v i c a c t Jo r s a l ; : 1c lJ S ho n Ia s la t e r a isFa c e p é lv i c a : a p r e s e n t a t r ês s u ic o s q l l c s ig n if i c a m a j u n çñ o dc s e u s c o r p o s v c r t c b r a i sFa c e d o r s a l : H p r e s c n t a ; l lg u n s t u h r c u lo s
, q u e r e p r c s c n t Bn n o s p r o c e s s o s n r t i c u l a r c s r u d i1 nca r e s do c t 5c c i x O s p r i m e i r a s t u bé r c u lo s s i u a lo n g : u lo s e d e n o m i n a do s c o r n o s c o c c íg e o s ; a rc u la m s e c o i n o s c o m o s Un s a c r oBo r d a s ta t c r a i s : r e c e be m a s i n s c r ç · ì s do s l ig a m c n t o s s a c r o t u bc r a l c s a c r o c s p i n h a lN a s r c g iMc s v c m r a is J H s bu r d n s la t e r a is
, 
i n s e r e s c 0 m [ i s c u lo c o c c :ge o , c , e m s u a s r e g i õ e sd o r s a i s
, 
0 m ú s c u lo g lú t c t ì m : i x i m oBa s e : a r t i c u la s c c o m 0 s a c r oÁ p i c e : t c m u m fo n n a t o a r r e do n da do e p o de s e r h íf ido
PA LPA Ç o
Re g i o Po s t e r io r
1 1 o SSO D o q U A D RIL O SSO IN O M IN A D O
EL EJH EN T O S ÓSSEO S
Pa lp a ç ii o D i r e t a e I n d i r e t a
a c r is t a s i l :a c a s
b E. PS (1)
d i n c i s u r a is q LI iDt ic a 1n a i o ; (4 i
f t u be m s idn dc isq u i ; i t ic a (5 )
(3 )
/ O s n : i n c l u s i n d i c . : a " l c m dc pa lw ç ° ·
、 冲
Scanned by CamScanner
4 1 Pe lv e
1 (a ) c F i s t a s i l i a c a s + p a lp a ç ão d i r e t a
I ! l j) o s 5 ib i [idade
Po s ic io n : i m c n m :
Q p a c ie n t e : 0 111 p
> t e r a pe u t a : a t r ás do p a c i c n r c
 0
 ter ap e u t a Uc s c c r á as su a s
 1nã os pe l os na n c a s , p o si ci o nz l nd
a s d a s c p u i n t c m a n e i r a :
p o lc g t l r c : H i r ig ic ln : ; LI( ) r s a l t n c n t c
, 
c i ndi catbresdi ri gi l c ) s v c n 
r r n l m c n r c
, 
u is w s t o s h o r iz a n t a l m c n t c (11 : i r ; 1<= l o s a o p l n n n do
* N u l i m i r c in fe r io r u o fi a n c o
, 
a s m n s i r i o i l o e n c o n t r o Uc LU n a
s u p c r í íc ie r íg id a , a c a da 1 ; I J a
, 
L1U C n a 9la m a is do q u c o s ; i p i c e sd n s c r i s t a s i ï ía c a s
1 0 t c r a p c u r a r e a l iz a a p a l pa ç ii o a t r a v s d c s e u s i n d ic a do r e s
. 
c o m
a s s u a s bo r da s r a d i a is
Fig 1 1 :ho : c r is t a s i l ía c a s
-
p a lp a q o di re
1 · p o s s ib il id a d e
2 9 Po s s i b i l id a d e
Po s ic i o n a [ n e n t o :
p a c i e n t e : c m D D
, 
c o x a h o m o l a t c r a l il p a lp a ç ii o a bd u z id a
, p e r n ap e n d c n t c
t e r a p e u t a : c m p
,
l c f r e n t e p a ma a c o x a h o m o la t e r a l à p a l p a ç ã o
T
-
*
1 i vci s ; e m i n LI iv íd u o s b s u : ; n c m s e m p r e c o n s e gu i m o s e n c o n t r a rc o m fa c i l id a d e a s c r i s t a s i l îa c a s
, p o r e s s e m o t i v o
, 
O u t r o s P os i c i om c n t o s Uc v c m s c r a do t a J o s
f .a n c o
, 
c l l c o n t r a r ; I u n i a ba r r e i r a r íg id a
, 
C O m fo n n a t o d e a r c o c 
F i g 1 2 lho : c r is t a s i lía c a s
c o n v c x id a dc d i r ig id a c e fa l ic a m e n t e : e s t a r á s o b r e
. . R is t a i l ín c a
2 ° p o . . Ib : : : 
" a ç ' " r e
日
月
L
Scanned by CamScanner
Scanned by CamScanner
6 1 Pe lv e
1 (a 1) p r o c e s s o s e s p i n ho s o s de L 4 e L 5 j pa lp a ç ão d i r e t a
E o s s ib i l idade m o v j m c n m dc c x t c n Mio c a bd u ç u de C F
Po s ic i{1n a m c n m :
Q p a c ie n t e : c m n v
, 
c o l c h ìiu s o b u a b l u m e
t e r a p e u t a : c n i p , a o la j u du mc mb m i n fe r io r a s c r d (: s lo c a do T ,
· I n ic ia .m c n r e
, 
0 t c r a p c u t u p a lp a r zi 0 5 : i p ic e s d a s c r is t a s i l ía c a s c 
J
de L4 L 5 ;
 C o l oc a r á a
 po l pa do 3g e 29 ded os
 de su a mi o ce f ál i ca ac i ma c
a ba i x o do e s p a ç o i n t e r e s p in h o s o
, p a r a e n c o n t r a r o s p r o c e s s o s 
L J
cspi nhw1i de L 4 c L 5 ; F ig 1 6 Pr o c e sso s e s p in h o so s d e L4 e L5 : m o v îm g n h
 P a r a
 sc
 ce r t i f i ca r da
 pa l pa ç ì io,
 r
ea l i za r á i l ma ma n o b r a
 cm mo · x
t en s o e ab du ç o de CF - a l pa q o di ret a-
e
b i l i t l a LIc : fa r á a c x t c n s o c o m b in a da à a hJ u ç o J = C F , c o m a 
1 ' p o s s ib i l id a d e
s u a m ño c a t ] tL t l ;
 S c
 ( ) s dc L ] os
 cl c sua mi io
 cc f i i l i ci 1 cM i vc r cm &J s i ci (1n : idos so h r e
o s du i s th i n i L) s w Jc e ss t v i e s p i n 11 o s o s da r c g i t ) Iuni 111r
, p e r e c h(: r i t i ( ) s SC U S m o v m l c n t c) s dc u ) r r c n t e s h C X [ (: ns i o c cL1 ax1
c it o t lc C F ; s c c s r i v c r c m s a b r e L 5 e 5 1
, 
so m c n [ c 0 d e do t u a is
c c f ; i l i c n s c n [ i r Ai a SU l L n 1( ) b i l iLI ; l dc
2 9 j) o s s ib i1ida de m o v i m e n t o s r c : s p i r a t ó r i n : ;
Po s i c i o n a m c n t o :
p a c i e n t e : e m D V
, 
c o l c h $ o s o b 0 a hdo m ct e r a p e u t a : c m pé , a o la J u do p n c ic n t c
 0
 t er a p e u t a c o l oc a r á a
 p o l pa d e SCu s
 d cLI o
s
i n t e r e s p i n h o so s dc L 3 L4 L4 L 5 c dc L 5 S Ï ; 
n o s e s p a ç o s
 P e d i rá ao pa c i en c c um a
 i ns p i raq i iu f or ç a d a : i r ;
 I Pe r ce b er
 qu c osp r o c e ss o s e s p in ho s o d a s v r t c b r a s L 3
, 
L 4 e L 5 s c a fa s t i t r a t n
,
c n q l i a n t o 0 p r o c e s s o e s p i n h o s o de 5 1 n o s c de s lo c o u N a
 cx p i raç i io,
 o s pr oc e s sos
 cs p i nh o s os
 i r i io
 sc
 apmx i mar .
Fig 1 7 Pr o c e s so s e s p i n h o so s d e L4 e L5 m o v i m en tos
r e s p ir a tó r io s p a lp a qä a d , r g t a 2 ' p o ss ib i l ida de
c
Scanned by CamScanner
pe ly e 1 7
2 (h ) E I P S - > p a lp a çã o d i r e t a
l e po s s i b i l ida d e
>m ic io n ; 1n l c n m :
# p a c ie n t e : c m p
t e r a p e u t a : c m p n u s c n r a LIn , a t r ; j 5 do p a c ie n t e
 I ni ci a- c a pa l pa ç ì iu pe l os ; ipi ce s das cr i st as i l íac a s ,
 co m as dua s
\n ã t ) s
 A C s t cr cn c mi r mL ] mi s cr i sms i l 91ca s ,
 0 t cr ap c u [ a dcs1t ]car i as
s u a s mi n s · Io r s u l m c n r =
, 
fa ze n do c o m q u c a hr J n r a d ia l da p
p a d o s i n d ic a do r e s p c m i a n c ç a n a s c r i s t a s i l ía c a s
 O s
 po l eg ar c s ser i o de s < oc n t l us cm se n t i do ca u 1 lal e i rão
 a p m x
m a r s c
, 
1ig= i r i t m c n t = ; c a i r ii n s o br e a s El >S 
Fig 1 8 ilia EIPS (e sp in ha il la c a pó s t e r o Su pe r io r)
æ O s 1ul eg ; i r e s ni wl odcr i +o ; 11 · m x i ï n a m c d : n l ; 1si 1d : 1m c n r c ; [ c r o 1' po ss ib ilida de
c
 1na n t cr i m ·
 a f as mm c n r o, . c,
 p c l u me n o s ,
 t r ex dc , - ns t mn s v c
s o s ; c a so c u n t r ; i r io
, 
c s [ n r ii u v a lp ; m J n n sa c r o
p : j7 gí >.
r d
"
Fig 1 9 :lio : EIPS (e sp in ha i l:a ca pó s t e ' " Su p e , ia r )
pa lpa q a d ir e ta 1' po ss ibi lida de
2 0 po s s i b i l ida de
Po s ic io n a m e n t o :
p a c i e n t e : c m D L
t e r a p e u t a :c m lr \t , a t r ás o u à f r e n t e do p a c i e n t e
 0
 t er ap e u t a pa l pa r á 0 ápi ce da c r i st a i l íac a e des l oc a r á 0 sc u
d (: do do r s a l m c n t c
, 
a c o m p a n h a n do SU LI fo r m a t o de a r c o a r é 0
m o m e n t o c m LILIC p c r c c hc r s c u c s p c ss a m c n t o ; s e n t i r á u m a 
pe r f íc ic de fo r m a t o a r r c LIu n da do c c o n v c x o : é a E[PS
æ A s EI PS s i t u a m s e
, 
n n r m u l ï n c r 1t c
, 
n a s fL» s a s dc M i c h a e l is ; n ão é
i n c o m m n en c on Fr la s a ba i x o cle ss a s fo s sa s b - - d 1
æ En t r c a s EIPS e n c o n t r a s c 0 pmcesso e sp i n h a so r u d i m c n t a r de 52
æ s n s de do s fo r e m p o s ic io n a do s : ] ba i x o d i t s E1PS , c s r a r o so b r e a
Proj eçi o d a r e g ião do r s a l d a a r t i c u la ção s a c r u i l :a c a Fig 1 10 il ia EIPS (e spin ha l l ia ca pó st e r o s u pe , io r)
pa lpa çâo d ir e ta 2' po s s ib i lida de
剧
遍
l
Scanned by CamScanner
& 1 Pe lv e
3 (f ) t u be r o s i t l a de i squi t i ca + p a l p a ç ii o d i r e t a
1g Il o s s ib i l ida t 1e
Po s ic i c) n a m c n m :
Q p a c i c n t c : D V
, 
c o 1c h ii o M ) h 0 q u M Jr i w ac i l i r a a p a lp a ç i i ( 1 )
Q t e r a p e u t a : c m p , : 10 la do Uo p a c ic n r c
 I ni ci a- c a pa l pu ç i it ) pe l a r c g i fio Hl t ìr c ; 1 s u p e r i nr ;
* O s dc J o s i r ii m c u m 11 ; m h ; 1r a mi s s a : Mr : a , c m s c u s c n [ ido c a u 
d a l
, 
a t s c s i t u a r e m s o b r e H Ï1n r u a i n te r io r do 1n ú s c u lo g 1ú t e o
n l ; i x i l n c ) ;
 N e s sa r cg i iio, o s po l cg a r es np r t ) íLt nd a r . o a pu l l ì ; lção , p a r a al ca n ·
ç a r c 1n a s r u be r o 5 i t la d = s I : R l r t i ; i t i c u x : i r ; i o p c r c c bc r s c u fu r 1n a r o
c o n v c x a ; s c fu r c m Jcsl ocr Jos c m s c n FiJ o c e f : ì l ic n , » c m p c n i c r
c o n f a [ ü c a n i 0 o SSO
, p u dc r iì o p c r e c .1c r 0 f n r ï n n t o 91u a d r a n g u 1 ; t r 
Fig 1 1 1 ls q u ia t u be , o s ida d e isq u iâ t ica H po su bDdd
t lc s u a pnr çi n pmxi mal
æ A rubcmsi dat l es isq u i ; i t i c a s e n c o n t r a m s c mï r n a p r u j e ç i i o ho
z o n r a t d c) ii n l Is
æ I4 ; I u m e r r o m u i t o f r c q i ie n t e n e s s a p a lpa çäo 0 d c t e n t a r to c a l i z : 
la s Ucsl ncar ul o s pl cgares m u i t o lu t c r a lm c n t c
Fig 1 12 ls q u io : t u be r o s ida d e isq u ià t « a pa lpa Q o d, r
H po s s ib il ida de
Fig 1 13 :sq u io : l u b e r o srda de isq u ià t ' " a pa lpa çào dr re
2 · po ss ib il id a d e
ノp
Scanned by CamScanner
Pe lv e 1 1
2 (b) E I PS + pa lpa q ii o d i r c t : 1
g Þo s s i hi l idad c
Po s ic i t , n n m c n r o :
p a c ie n t e : c m p
¢ t e r a pe u t a : c t n p o u s c n r a t lü , n t r zis dn r ei t : n r c
* 1n ic ia 5 0 1 P1pnçi i wcl us i1l i c s d s i l L 1s i ha c s
, 
c o l n Hs du a s
m a r s c
, 
l ip i r n m c n r c : c n i r iio s o b r e u s EIPS
c r O s pu l c Rn r c s n ii t ) pu _lc r iì u n p mì x i 1n u r s c Uc m u : ; iu L In m c n r e ; t c r ii o
t lc m a l l r c r 11111 n f u t i r n m c n r o d c , p e lo m e n o s , t r s Uc t la x t r i ms v
s o s : a l s o c t t n f r ; i r io , c s t a r ii cì p n lp u n dk ( , s a e m
与
国
r q yiq
Fig 1 8 Ilia : E*PS (e s p in ha itía c a pó st e r o q u p e r io "
1 · po ss ib i lida de
Fis 1 9 lho : EIPS (e sp in ha i l ia c a p ó s t e ro s u p e r ' " r )
p a lp a qã o d i r e t a H Po s s ib i l id a d e
2 9 Po s s i b i l ida d e
Pa s ic iu n a m c m t ) : -
Pi1c i c n t e : c m D L
4 t e r a p e u t a : c m p , a t r : i s 0 11 à f r e n t e Uo p a c ie n t e
 0
 t er ap e u t a pa l pa r : I L ; ipi ce UH c r i st a i l íac a e des l oc a r : I 0
 se l l
l edu d o r s a l n i c n t c
, 
a c o m p a n h a r 1J ( ) s c u fo r n i a r o de a r c u a [ 0
m o m e n t o e m q u e p e r c = hc r s c u i pc s s ar te n t a ; s e n t i r ; I u n i a 
p e r : :c ic de f or ma[ u a r r c do n LIa do c c o n v c x o : a EI PS
a r A s EI PS s i t u a m s e
, 
n o n n a l m c n t c
, 
n a s 1 : s n s J Mi chal i s ; n £io i n c o m u m c n c o n t r ; I la s a ha i x n Uc ss a s fo ss a s
- E n t r e a s EI PS e n c o n t r a s c a p r o c e sso c s p i n h o so r u d i m e n t a r t le 5 2 ;
-
æ S(: o s u c du s fo r e m p u s i c io n a :. In s a ba i x o d a s EI PS
, 
e s t a r ã o s o b r e a
p r o j e ção d a r e g ião Uu n i l l da a r r i c u l a ç ii o s a c r o i l ía c a Fig 1 1 0 irio : Elps (e s p , n h a \ l [a c a pó s t e r o su p e r io r )
p a lpa qâo d i r e ta 2 · po ss ib Md a d e
回
国
冒
乙
Scanned by CamScanner
Scanned by CamScanner
Fe lv e 1 9
3 9 Po s s i b i l ida d e
Po s i c io n a m e n t o :
Q p a c ie n t e : c m D L
, 
c o m a s a r t ic u la ç i 5c s c n x o fe m o r a is e jo e lh o s f
x io n a d n s
t e r a p e u t a : c lm p , a t r ás do p a c ie n t e
 0
 t er ap e u t a r ea l i za r ; I os ï T1 cs mo s pa r i mc t n) s pa l pn r t i r i os t i e
c r i t o s a n t c r io r m c 11 [ c
 0
 po s i ci un a mc n t o cm DL f ;
 ìr Ai co m qu c a t ubcmsi dade i squ i ; 
t ic a = s t c j a U( : s c o be r t a I n m ú x c u lo Rl [ co m ; i xi l
m a l d n t u bc r o s id n LIc is l u i Dt i c a t c m m n f : ) n n u : q u a J r a n g u la r = .
-
J
c u m p o u c o o v a la r
, 
c q u e s t i a p u r ç £i ° d is f a l m a is e s t r e i t a
. 
de
fo n n a t o c o n v c x o c t r ia n g u la r
Fi g 1 14 ls q u io : t u be r o s ida de isq u iá t ic a p a lp a ç o di re
3 · po ss ib i lida de
4 ( c ) E 1P L + p a l p a qii o i n d i r e t a
I F Þ o s s i b i t id in d e
Po s ic i o n a m e n t o : 
& CW
Q p a c i e n t e : D V
, 
c o lc hã o s o b a q l I a d r i l lc
, 
it
t e r a p e u t a : c m p , a o la do do p a c ie n t e
1 0 t e r a p e u t a p o s i c io n a r ; I a p o l p a do 4 de do de s u a m o h o m o 
l a m r a l à p a lp a ç i i o , s o b r e a E IPS ; 
4
.
 C o m a m o
 co n tr al at er a l ,
 i
rá me d i rd o i s ded os r r i l n s v c r s s ab ; li
x o da E.PS ;
 0
 2g ded o da mi io ho m o l at er a l sc posi ci onar i i me d i at ame n t e
a ba i x o do s d ( : do s d a mi o c o n t r a l a r c r a l c l l l 1 p o u c o la m r a l m c n [ e ;
es t ar s o b r e a EI PI
Fig 1 15 [ho : EIPT (e s p in h a i l la c a pó s t e r o in fe r io , )
1 · PD s s ib ihda de
Fig 1 1 6 lho : EIPI (es pin ha i l ía c a Pö s te r o in f e r io r )
1 · p o ss ib l l, da de p a lp a qäo in d ir e t a
\
J
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
12 / PB lw
(d ) i n c i s u r a i s q u i : i t i c a m a i o r p a l p a ç ä o i n d i r e t a
Pn s i c i u n 1n l c n n ) :Q p a c i e n t e : [-) v c t l l c h i u s o h ( ) t 1u a LÏ r i ]E t e r a p e u t a : c n l p
 0
 r
 cm p c u t wm i ci t ) t1Hr $1
 swl i ni io cc m i ca di l : ; cg u i nr c f om t B\ :
4 ' J J o s o b r e ; 1 E I P I ;2 · t l =t l : a 9 l : ' is o L1 t r es d c . Io s r r ; i n s v c r s o s : 1ba i x o d r ) u n t c r i u r :
c s [ a n i So b r e a e s p i n h a i h l u i ; +t i c a ;3 · J u d o : cni r i e n t r e O s uc . lo s p r c e c J c n [ c s c c s t a n i s o b r e a
t n c is u r a I · 
· 1u i ; i t ic a m a i o r w
c p I n c i 7 t 1p \ i s q u i ; i r i c a n i n i o p I c t l d e p n s s a p c m f l 1n J u m c n t n l p a r a 0 
K
n c r v { 1 i s q u i . i t i c o a c o m l r n n h ; k l t : >=[ l n ú s c u lo p i r i fo n n c ; s l l : 1 p : 
p ; 1ç î i u u c v c r ; I s c r s u a v e c p r u d e n t e
Fig 1 2 3 lsq u io : in c is u r a Is q u ià t : Ca I THI
= PY
Fig 1 2 4 Ïs q u ío : in c is u r a isq . Ià t ica m a ' " " pa :pa ® 0
7 (g ) r a m o i s q u i o p ú b i c o j p a l p a ç i i o d i r e t a
P n s i c i n n a m c n r o :
c p p a c i e n t e : 1-) D c o x o fc m u r a l a b d 1 l z j d a j o e l h o f l c x i o n a d oc p t cmpcut a : s c n r n d o d c Ur c n t c " ; i m 0 p a c i e n t e
 0
 t cr a p c u r a p i l l [
 ·
 ;
 u-
 ì a
 t u h c r o s i LI u.
 Ic i squi t i ca c,
 s e m p c r . l cr
" ' " ' " '
" l l " Un l c l c o s s c n L Ia r e g i o d c s l n c n r ; I o s SC U S L山 ) q c r a n i a l e m c L I i a !m c n r c c 1n d i r c ç iì L ï l : ; í n Ui x c p Li h i c a ;
 C r
 ;
 1ni nl mc n t c
 à tu b i : mA i da d c
 i s
 ·
 1ui ; i[ i ca , nc on t r a r i um a cs t n1 -t u m s s c a t i n a c a c h a r a LIa q u c r c p r e s c n t n a h n r d a 9 Ïo r a m oi s q u i o p ú h i c o
Cp R e fe r i ; n e i n p a l l · : 1 [ t j r i a i n i p o r r a n t c p a r a a p a l p a ç i i o . In m ú s c u l o
u b t u r ; r l or c x r c mo
-
w A
-
T : Þ
. .
F ig 1 2 5 Ra m o is q ' "públ ca
Fi g 1 2 6 Ra m o isq u ia p , Jb ico p a lp a çào d ire t a
门
Scanned by CamScanner
Scanned by CamScanner
14 1 Pe lv e
2 (b) h ia t o do s a e m + p a lp a ção d i r e t a
Po s i c io n a m e n t o :
Q p a c i e n t e : D V
, 
c a lc h ii n s o b u q u a d r i l
t e r a p e u t a : c m p , a o In LIn I Ia p a c ie n t e
 0
 rcr wc u r a 11 ; ll 11mi , ( ) nl H 11 (1l wj t ) 3 · c 2! ' d ed os de sHa n1 %)
cef i l i ca
, 
a pn r ç I o d is t a l Lb c r is t a s a c r a l m (: t l in n a ;
* O s deLt ) s dc s u a n r m c a u lL1 l ; 1c L \ m l , m l ha r i i a 0 r n c s m o a
hn h a 
ï n c n t o v e r t i c a l c i r ii t ) I, r c t : hc r LILIC, a o t c n m n a r ; 1 c r
is t a s a c r a l
ni cLI i 1na
, 
a f u n Ab r ii n n o h i a [ () do 
F ig 1 2 9 Sa c r o : h ia t o do sa a o paBpao
3 (c ) f o r a m e s s a c r a i s p o s t e r i o r e s + p a l p a ç o d i r e t a N
Po s ic in n a m c n r o :
p a c ie n t e : D V
, 
c o lc h o 5 , b 0 q u a d r i l
t e m p e u t a : c m p , a u l a do a o p a c r c n t c
O s Í n r a m e s s a c r a i s p o s t e r io r e s cs t i o s i t u a d o s a u m d e do C r a n s v
s o ta [ c r a hn c n ec à c r is t a s a c r a l ïTuXl i 1na
, 
c l ig c i r a m c n r c a lh l ix o de s c u
p r o c e ss o e s p i n h o s o c o r r c s p o n dc n t c
 0
 tcr ap t : ut a pu s i ci un a r . i a
 po l pa dc l l m de SEU S ded os
 nu m t lbé r c u l n da c r is t a s a c r a l m e d ia n a ;
 A
 . 1u l pa t l o de d dc
 s u a
 ou t r a
 mi i o se r co l oc a d a
 a
 u m de d o
r r a n s v c r s o In r e r a l t+t c n t c a o a n t e r i o r
, 
c l i m PO LI C O a b a i x o ;
 > c r cc b c r ; I L1U= 0 sc u ded o
 i r af un d a r nu ma r e g i i io t l e f on n a t o
a r r e do n da do
, q u e n a da m a i s b e n ii o u 1n fo r a m c s a c r a l p os t e
"
: ; :" 1 p · çi ° d . . . " I . ' " " " , de v ido p r e s e n ç a ( l o s n e r v o s 
至三 一
F ig 1 3 0 Sa c r o : fo r a m e s saa a is poskr or
Fi g 1 3 1 Sa c r o : fa ra m e s sa c r a is po st e r '"
pa lp a çâo d i r e t a
r
Scanned by CamScanner
Scanned by CamScanner
t l i r c t a
5 (h ) A I L S (a n gu lo í n fe r o 1a t c r a l do s a c r o ) + p a lp a ção
I' 0 : i i ci 1n ; 1m c n r w
p a c ie n t e : 1 v
, 
c t ) tc h ìio h u h 0 나 t 1a J r i ]
t e r a p e u t a : c 1n p , a o tu L In t iu p a = ic n t c
b s n p r 1p n ç ii n fe i r a c m Lì i s r c m 11u s p n l lx 1t t ì r i t HT c r c r n o s c { 1m o r cf cr nci n n s EIPS p o r s c :, i t u a r c m , p r u t i c a 1n c n t e ,
n o n l c s m o : 1l i n l l a n i c l l m v c r t i c a l do s ì npul os s : 1c r a is
1 19 t e m p o : 0 [ c m p c u t a w s ic icm a r ; I ( ) s s c t l s p o 1c gJ r e s = m c a da
EI PS ;
 T
 t emp o : 0 49 c l c9 l o,
 d
c c
 ;
 lda n r i Ä
 i r : I su h st i mi r os p [ 1 l cw l r es
p a r a p e r m i t i r q l l c c s r c s s c t lc s lo \ l u c 1n c a u t la l m c n t c , m a n t e n do
0 m c s n l o a1inh : 1n i c n m v c r t i c ó
* D c s s a f [ 1n 11 ; 1
, 
( ) s 1' (1 lw i r c s a lc : 1nçt r m : 1 r c g i ii Æ 1.m i x o 1s A ILS ,
I r i n 11( ) s c u c n c ( ) n r m d c ) s c n t ió 1 c aLI L11p ; 1r a a c c M1i c cl1
¢» A di st i nci a e n t r e o s pal e ; i r e s c o s 4 uct l s d e c : x la m i i o c or r
po n de
, 
n n 1n n ia r iA t lü s i n LI i v íclu o s
, 
à LI is t ; i n c ia c n r r c Ei l t s c E A I LS
- ì, f ; =ËA
æ T Ï j
Fig 1 3 6 Sa c r o : A ILS (â n gu lo in fe r u la te r a l do1 · t e m po * oq
; s w
4 P IE
1
Fig 1 3 7 Sa c r o : A ILS ( n g u lo ínferl ateral do n ero),2 ° t e m po
Fig 1 38 Sa c r o : A ILS (ii n g u lo ín f e r o la t e r a l do 9 0 0)
p a lpa qi i o d ir e ta w t em po
r h
Fig 1 39 Sa c r o : A ILS (ân g u lo ín fe r o la te r a l do H a o)
pa lp a ção d ir e ta 2 · t em
弘
1
Scanned by CamScanner
Pg he / 17
6 (d ) c r i s t a s s a c r a i s i nt cr medi r i as + p a l p n qii o t l i r c t a
>o s ic ia n a m c n t o :
Q pa c i e n t e : D V , col chi u » n b a u m ïu r i l
4 t e r a p e u t a : c m p , a o l a bo du p a c ie n t e
A s c r i : ; r a s s : r c r a is i n t c r m c d i ; i r ia s r c p r c s c n t a m a : u s ii o t .n s 11 r o c c s 
s o s i l r t i c u la r c s d n s v r t c h r a s s a c r a i s
Po r c s : ; c m o t i v o , p a r a a s s i m s p a l pn ç i ì e s , t e r e m o s c o m o r cf cr nci a
o s c o m i 15 da s : l c m
 O s
 pa l cg a r es sc r i in di : ; pt » t os sob r e os ca r n o s do sa c r o, d ( : f o
m a s i m r r i c i l ;
. l r i i o [ le s lo c ; 1r s c , c m n ia hl l c n t c , n n n l c s m o a 1in h zl m c n m v c r t i 
c a l
, pa r a p a l lu r c m o s r l I h r cut t t l a c r i s f a s s a c r a is i n [ c r 1n e d i ; I Fig 1 4 0 Sa c r o : c r
is t a s sa c r a s I. Te , m e d ià r ia s
r i n A
æ Sc I s fn r i m i c s s Bt c r u i s s c s i r u n 1n i l l l m 9lc 9ln r r a n x v c r s o t la c r is t a s a c r a l
m c u i n n a
, 
n s c r is t n s s i t c r zl i s in r c n n c Ll i zi r i a s s i t u a m s c i l m e n a s t lc l i m
dc du t r i l n s v c r M 1 da cr i sm s : 1cr1l m c t ] iH n a
Fi g 1 4 1 Sa c r o : c r is t a l s a c r a is in t e r m e d iár ia s
座
Fig 1 4 2 Sa c r o : = r is t a s s a c r a is in t e r m e d , ár i
p a lpa ç o d ir e ta
Fig 1 4 3 Sa c r o : c r ista s sa c ra is m t e r m e d , à n
pal paça d ir e ta
司
:
羞
Scanned by CamScanner
7 (f ) c r i s t a s s a c r a i s la t e r a i s + p a l p a ç ão d i r e t a
Pm ic i [ 1n ; i m c n r o :
p a c i e n t e : n v
, 
c o l c h o so b 0 q u n t l r i l
t e r a p e u t a : c m p , a u la do u u pa c ic n r c
 0r cr ap c u h l s c w i ni ml l cs n l o
 11 ; Än i cr r ° 11 ; ll [1mD r i u : mt cr i ur ,
p u r m
, 
a p a r t i r do s c o r n o 5 du s a c r o
, 
o s dC LIo s i r iì o s u b i r n a s
t iuo l a r c r a l
, p o s ic io n a n LIo s c a ba i x o Ua s EIPS
t » A s c r is t a s s a c r a i s l a t e r a is c s [ ï+o s i t u a da s l a t c r a lm c n t c a o s fn r a m e s
s : 1c r a i s po w c r io r e s
. 
d
r # B
Fig 1 44 Sa c ro : c r is t a s sa c r a is la t e , a is
Fi g 1 4 5 Sa c r o : c r is ta s sa c r a is la t e r a is
Fig 1 4 6 Sa c r o : c r is ta s sa c r a , s la t e r a is p a lpa ç o direta
. È1e
Fig 1 4 7 Sa c r o : c r ist a s sa c r a is la te r a , 5 pa lpa ç o dire t&
I
/
r
Scanned by CamScanner
Pe lv e 1 19
8 (c ) s u l c o do s a c r
o + pal paçi o i n d i r e t a
Po : ; ic im i a i n c t l r o 
:
0 su lc o do s a c r o r c p r c s c n t a i l u
n i iio da s lâm i n a s da s v r t c b r a s 
c r "
 r ii t l s i r u a d n s a c a u a la da d a c r is t a sa c r a
l m u j ja n a
. 
A s pn lpB1s du 5 dc 9lo s s c r ii o pn s ic io n a d a s 
la t c r a lm c n t c à c r is t a
sa c r a l m e d ia n a ; i r ãu p a lpa r 0 s u lc o clo sa c r o
c r A s l ii ln i n a s Alc 5 5 n i i n s c u n c [n c fo r m u m 0 h ia r n do sa c K )
Fig 1 4 8 Sa c r o : s u lco do sa c r o
一 一 匦
Fig 1 4 9 Sa c r o : SU tc o d o s a c ro pal paço in d i r e ta
1 3 c ó c c l x
E L EM E N T O S ÓSSE O S
P a l pa ç iio D i r e t a e t n d i r e M
/ 0 . . I , w r o I. d , c a a n r Jc l . Dc p · lp, Ç .
1 (a ) ba s e + p a lp a ç ii o i n di r e t a
A bm = LIu c d c c i x s i t u a s c n o i n íc i o da p r e ga i n r e r g lú t e a , a c r ês
0 c óc c ix a p r e s c n t a d .fc r c n t c : s fo n n i r t o s c po s içö e s v a r ia da s , s e gdo a i n 山 v idu a l idn d t :
Po s i c io n a m c n m :
Q p a c i e n t e : D V
, 
c o l c h n so b 0 q u a d r i .
r
t e r a p e u t a : c m p , a o l a do do p a c i e n t e
 0
 t c r ap e u [ a pa l pu r ; I a r eg i i io sac r oc o c c í ge a ,
 q u e sc s i tua n o
Uu p r e ss ii o , c m n se n t ido t r a n s v c r s o , q u e r c : p r e s c n r a a a r t ic u la w 
Ção s a c r o c o c c íg e a
c p A p a 1p a ç ii o do áp ic e do c ó c c i x é fe i t a p o r v i a a n a l = n il o s e r á 
Fig 1 50 Có c c i ba se pa lpa çâ o in d tr e ta
m o s t r a da
w 0 c ó c c i x fa c i l m e n cc p a lp ; i v e l p e lo r o q u e r c r a l , c c o n l e s sa p
& 1Çii o c o n M : g u e s c p e r c c hc r a s u a m o l l i ] iLL1de
臣
Scanned by CamScanner
Scanned by CamScanner
Pe lw 1 n
Re g iã o A n t e r io r
1 1 O SSO IN O M IN A D O O SSO D o QU A D RIL
E L E M EN T O S ÓSSEO S
P a lpa ç ii o D i r e t a c I n d i r e t a
-
n c r is t a i l í i 1c n (j : I t le s c r i t : 1)
/ O s n : I . Cr o s I . J lc . - . N r clu n , I. p . Ipa ç n 国
1 (b) E I A S + p a l p a ç ii o d i r e t a
I F pu s s i b i l i t L u l e
 0
 :
 ; d e j a s . l t cmpcut a ser i i de s l oc a d os v c n t r a ï mc n t e ;
 i r i ìn ·
 :,
a c o m p a n h a r a c r i s r a i l ía c a n t e n c o n t r a r e m u m a p r a c m in
一 1
ヒ
c ia q u c c t w r c s p o n d c à EIA S p
 5 c
 05 de t l os
 co n t i nu a r em a pa l pa ç i ìa,
 S( : nt i r i io qu e ,
 s ob a EI AS ,
h á u n i a i n c i s u r a
Fi g 1 53 hio : EIA S (e s p in ha i lía c a n t e r o su pe r io r)
pa lpa ç o d ir e t a w po s s ib i l id a d e
'
'
,
,
Scanned by CamScanner
i B
p n Tp n cû o d rr p rn ? · p o s :, , b , r, d 1, ïe
Q pa v i c t , r c : 0 0 1 1111
l c r u p c u t . : ° r n 1'
( } t l r l r r cw B, I, " ï. . I : Ï l ì t u · rn , : t l i . . c . f ; I s i ï 1r RLA, \ I ; 1r c r n l v 1" wt cr i ur i n
 c ,
 110 I I i rnl iu : Hl ur 1wï ïx1 r i î n EI AS ;
 I '
,
 al un pc r vc l , Cr , : 1n, B : ; I. cn r . s SC1 I S. InB . s UI U I "n o i nf e ri o
m c n [ c
, 
c m , l i r c ç ii . . n . . 1 : ì l , iu c x r c > n , " B : \ c r is r i 1 i l í . c : 1, ' ï11C c : : s c
r u l , L : r c u l . bc m c s l ' c h s "
& s c I u . · r c u lu s c n Uc r e ícr n c in D 11 l l l , a ç I o . Iu t m ì s c u lu g lú r c u
1n , Bin = da a p t n r c l i r o s c g Bu r c u
Fig 1 56 II, 0 : 1l rb ¢1c u lo d o g lú 10 0 m ¢d , 0
飞
 d i
Flg 1 5 7 II, 0 : t u b r c u [o d o g lú te o n 1èd , 0 pa lp a qi \ 0 d j, e ta
T Q
Fi g 1 58 ít, 0 : t u bér c u lo d o g 1L t e o m éd , 0 p a lp a çäo d i ' " ta
Scanned by CamScanner
p e :v e 1 2 3
3 ( t l ) t u b r c u l o p ú b i c o j p a lp a ç ii o d i r e t a
p a r a 1 w w h & 1 ç 5 e 1 D t m u Ä r c u a 0 w m t D a c u
, 
0 t c r n p c u t a w 1 ó r a h w w s k d h" !r r4> ; 1r ; 1 11 : 1l& 1Çii c l 00 M : xm11wcul i t l o , 0 t c r ; l p c u r ; 1 D : v c r ; I 1mi ci o n a r s c v n 1h l d t ) i t a r : \ o s p s do p : \ c ic n r c , p a r ; 1 n ñ o c o r r c r 0 r i s c ( )
, 
clc
fo m n n c u u i v o c a d a , dc p a lp a r , p r i m c i r ; 1 0 0 1 c
, 
O x dr gi os Re n i t a is m H s 
c u l i n o s
1 e po s s i b i l idm l e
Po s ic io n ; l i n c n t o :
pa c i e n t e : c m D D
Q t e r a p e u t a : c m p
 C o m a p o l pa do s t l cd os de s u a s mi Ds ,
 0 t cr up c u r a i r i i pa 1 pa r ,
i n i c ia 1m c n t ( :
, 
a r e t o ; ì n t c r io r do a h I o r n e ; 9lc s c c r ; ì o s d e d o s c 1n
t l i r c ç ii lj à s ín f i s c 1ì hi ca, a r e n c o n t r a r l i m i t s u lr c r í íc i c r íg ida , d c
fo r m a t o a c h a t : 1u n c h n r i z n n t a l : e s t a r ; I s o b r e H ha r u n s u p e r io r da
s ín f i s e p ú b i c a
1 D e s la c ; 1r ; I o s SC LI^ dc J o s l a t c r i ì l m c n t c
, 
a t t l u c p o s s a p c r c c bc r
u m a m u u a n ç a de Ui r c ç ii a l a p ; i r l o ei s s c a , q u c p a s s a r á a i nc
n a r s c p a r a 0 a l t o ; n e s s : 1 r c g i ii o , p a lp n r ; ì H : : s n l i n c i a s Uo s t u h
c u lo s p úb ic o s : t m u m fa n n a r o ar r ct l nduLI Ï c p o n t ia g u do
F ig 1 59 Pú b is : t u bér c u lo p ú b ic o 1 · p o ss ib i l id a de
ケ
Fig 1 6 0 Púb is : t u bé r c u lo úbi co pa lp a q o di re
1 ' po ss ib ilid a de
Ã* . I $
F lg 1 6 1 Púb is : t u bé r c u lo p úb ic o pa lp a çào di r e
1 · p o ss ib ilida d e
Scanned by CamScanner
Scanned by CamScanner
26 / Ou 4 d . . 1 ( 0 , J
í (a ) r r 【a n t c r m n i u r + pa lpa qii o d i r c l n
> I l u M i h i l i { ; 1dc
I ' [ · h i= i . . n 1r 1l n1 \ "
c pa c i r n 1c : c m : , 
Q t e r a pe u t ; 1 : ; l f r I ( m : 1. Iu , !. . In p : i c n t c 
1 0 1c r l 11UM [ lc v c r : + v in i r l iz Rr l l 1n n t ïc r, r s : $n 
f
.
. N n : 1t J : 1 pl . ' " 
lc v n . I, b r n , ì . C u l , wpl l i l t I n , l io c [ n l n in n · (c x f t ì ï t i r n o , n : 1 p r '
"
rl l n , BBJ k lc ) ' l11c c w I s i r u ; n in p r i r ie : n n c r l r c H l r ûs t l c , 
I
. 
\ i n i
w w w m , 1, j l t r in n i1i. « n ; c · q l , lc p r c w ; I , l . ic l i n l i r : 1 h 
1h t n l n s i l f 
di , r c : · . Iì · ; i n ) n ï, n Jr. i n , [n r H 11 1 l lx rç i iu , :, c n r i r ; + l i n i n r e
s is t e n c i a
r :p i . I ; 1 t l t 1v c ¢ i r r c: 11. . n : l = h In 1r L I : 1 A m , cr i 1 t l, J r r . c
n n r c f r nui f
 I ' nr . hc
 ce r r i : i cn r \ l a 1
 ·
 ;
 1l ïx : çi l. . , r ' " ï i r : I m) l xl ci cn r c t l ,
 1= t : lev e Jo
c h I t J t l 1, t ln r ï r c m l , r u i n fu r it l r h , n n , 1l ; l r c r ; 1t \ p u
lp ï' ç : i 9 r c ; 
l
: ; i n , B. . u s l * U ) v i rn c n f 1 n dc n J r u ç I n 1 : i r c r : l t i n [ : d ia l t
l= C F : 1l [ c Fig 2 1 te r
r 1ï ' c 1l r 1 1' u r c c ï, = r ; I t ) m . v i r n c n n ] J t ) [ r c , c l l n f c r n 1 ; 1
i t r r Qu e d e r, m
娴 潮
h il
Fi g 2 2 Fëm u r : t r o ca n i¬ r r n a I" : pa lpa(ào d. Eb
,1 · po H ib ilida de
八
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
g u a d r i l Co . a 1 2 9
3 ' po s s ib i l ida de a tn ì r da gc m p o s t e r io r
P{ x i i c io n ; 1m c n r w
ü p a c ie n t e : 【] L , C F c j o e lh o s n c x in n a do s
d t e m pe u t a : c m pé , a t r ás da p a c i c n r c
 0 ter ap e u t a po h i ci un a r á II sc u p- ) 1cp a r ar r z A ; c nh a i xn do t r ac a n
* 0 q u M r i l d e v c r á sc r mot l j 1i adc ) , pa s s i v a m c n r c
, 
c n l M u ç o c
[ c r m zï io r ; de v c r : I p c n c t r zr r n a m u s s a l L\ rca J u r c H i ii c J
m t a ç o m c t l ia l , fa ze n t Jn c o m q u c a p u r ç ii u p o s t e r io r da c a be ç a
fe m o r a l 5 c d e s lo q u e p a r a f ; ) r a c p a r a t r ; i x
c r N a a bo n Jn p c m a n t e r io r , ] ; 1 p a lp a ç ìi o dH c a hc qn fc m o m l , p o de s c
p c r c c hc r ( , p u l s o fe m u r n l (a r t r i a f c m o r a l )
æ I1c v c : ; c t e n t a r p a l p a r a c a hc ç a fc m u r a l , n a pmí undi dndc
, 
me
a lIm c n t c ii a r t r i a :e m o r a l
. AL -W&+I
-
Fig 2 8 Ca be ça fe m o r a l 3 · po ss ib i lid a de :
a bo r da g e m po s t e r io r
E L E M E N T O S M U SC U L A R E S
Se r ii o d i v id ida s de n c n r Llo c o m a s r c g i( i e s d o q u n d r i l c da c o
x
A m ú s c u l o s da r e g i ii o p o s t e r io r r e g ião g1ú t e a 
Fi g 2 9 Ca be qa fe m o ra l pa lpa q o i ndi re
a g l ú r c o m : i x i m o 3
' p o ss ib il ida d e : a bo r da g e m po s te r io r
h g l ú t c o m d io
c gl t co m ín i m o
d p i r i f o r m c
c g i ; n i c o s w e r io r
- u b t u r i l L]m i n t c m o
g 9 6n l e [ 1 i n fe r i o r
h o b t u r u do r c x r c mo
I q u a d r a dn :e m o r a l
i s q u i o t ib i a is ( r e g iã o g lú t c a i n fe r i o r )
B m ú s c u l o s da r e g iã o ân t e r o l a t e r a l r e g i i i o i n gu i n a l la t e r a l
a Lc n so r da f sci a la t a
b S1 r t ( i r i o
c r e t o f e m n r n l
c m ú s c u l o s da r e gi ii o a n t e r i o r r e g i o i n g u i n a l a n t e r i o r
a PS 1S n l a io r
b i l ía c ü
D r n ú s c u lo s da r e g i ii o ân t e r o m e d i a l r e g i ão i n g u i n a l m e d i a l
a p e c t í n c o
b a J u t o r l [ m go
c g r : i c i l
t B n du r o r c u r u )
e a d u t u r m a g n o
物
Scanned by CamScanner
了f
30 / Qu a d r i l Co x a
A M Ús c u LO S D A REG IÃo PO ST ERIO R REG IÃ O G LÚT EA
a 9 lú t e o m á x i m oE ( , m tì s c u lo m a is s u p e r f ic i a l c n i a is v a l u 1n o 5o d a regi i o g lú t e aRe c o h r c r o LIa a r c 只消 0 g l tì t c a
, 
e s t e n d e n do s c o b l iq u i u n c n t e d e s u a O r 1gu n
, e rn Se n ,
o r iq = m :
 P o r ção po s t er i or
 da
 cr i st a
 i l íac a c na
 l i nh a
 gl út ca po s t er i or do
 f l i d
 ; p o r ç i io po s t er i or
 t l a f äs c i a
 l om b os s ac r a e
 po r sc u i nt er ml cdi o
 ; p
 ; ir t e i nb r i or
 do
 sac r o,
 c m su a su p e r f í ci e po s t cn o r ,
,
 n a
 bor c j a
 l at «
 : ral do
 Cd c c i x,
 e m su a po r ç i io po s ter i or .
Q i n s c r ç i i n :
* n o t r a t a i l io t i h ia l d a H s c ia Ia t a ; n u
 t ub c r os i LI ad c
 gl t ìt ea da
 c l iáf i se
 do
 f m
: r LIu t u r m a g n o
U r
, 
e m s u a f a c e p o s t e r io r
, 
e n t r e u v a st o
a ç ii o :
1 P r i n c i p a l :
c x t e n s o r u c C F ;
r o t a do r l a t e r a l d e C F1 s e c u n 【lzì Fi a :
m a n t m 0 j o e lh o e s r e n cì id o a t r a v és d o t r a t o i l io t i b i a l (s e 0 j o e lh o e s t iv e r ro t a lma s f i br a s SLrp c r io r e s p a r t i c ip a m d a abd\ l çi o 9lc C F
, 
c o n t r a r e s i s
a t u a n a r c t r o v c r s ii o Uo q u a d r i l
a s f i b r a s i n fe r i o r e s a j L1z c m a c o x a
, 
c o n t r a r e s i s t ê n c ia ; 
t nci a
, 
e s ra n do a c l
i n c r v a ç o :
 n e r v o
 Rl út eo
 i nf er i or - o n t ém
 f i br a s
 do
 5g n e r vo
 l om b a r
 e
 do
 1 g e
 F. n e r v o s sa c rai
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Qu a d r BB ( o x a 1 3 3
Pa lpa çii o D i r e t a
r pm Æ M dUd C
>osi ci ona1nct rm :
t 9 p a c ic n t c : C l l l 116
¢ t e r a p e u t a : c m p , a o la t In da p n c ic n t c
0 t u b r c u hl 1 :M r c o m d in c 0 [ r o c a n t c r m a io r sc r M ] u t
i l i z a d , 1S
c o m o re: ernci \ l s p n l ï' " 9\ r i as
. 0 r c r w : m ; 1 1w ic i n n ; 1r l s u ; 1 nì i cl d : 1 s c g u i n r c n i a
n c i r i \ :
pl cgur , so l, r c n t u h r c u ln dn Hl i tctl m d i o
5 9 Uc Ju
, 
s o h r c a hn r , In s t i i · c í i H f d >r c) c n n f c r m a i u r ;
. 0 4
, 
3 9 c 2 " , l c LIt ) s s c n t i r ii u H c m ì r m ç ii u Un g lú [ c o ï n 
山 0
æ É p n ss :v c l dc l im i r n r n s hm da s a n [ c r in r c p t l s r c r iu r t \o g lú t c u m é
d ia
» .
Fig 2 13 Glú t e o m d lo p a lpa ( ' " di re
1 · po s s ib i l id a d e
a s
益
Fig 2 14 Glú t e o m éd io p a lpa q o d ir e t a : de íim it a q o da s
bo rd a s a n t e n o r e po s te r io r » po s s ib i lida d e
2 9 p o s s i b i l ida de
Po s i c io n a m e n t o :
p a c ie n t e : e m D L
Q t e r a p e u t a : e m p é , à f n : n t c do p a c ie n t e
. ü t e r a pe u t a i m a g i n a r : I u m a l in h a v e r t ic a l u n i n , lo a c r is t a i
l ía c n
(n a r e g i ii ü d t ì t u b r c u lu do g lú t c o m LI iu ) a o t r o c a n t c r m a i o r
 C o m a sua mE in ca u d al pu s i ci on a d a no t er ço di st al da co x a do
p a c i e n f e , r e s is t i r á ì l a bd u ç ii t ) d(: C F
 C o m as po l l"h dos ded os J( : su a mi o ce f ál i ca pu s i ci on a u a s c
t r c a s du a s r c fc r n c ia s já c i t a da s , s e n t i r : I a c o n t r a ç o do g l ú t c
m d io
æ N o m o v im e n t o de a bcl u ç ii o da c o x a , a a n i c u ln ç ii o C F de v e r á c s Fig 2 15 Glú l eo m éd io pa lpa ção d ire t a 2° POSS, b l ltda de
t a r e m posi ço n c u t m ; sc a abduçi i fo r fe i t a c o m a C F f le x io n a 
da
, 
0 m ú s c u lo T FL í ic a r ; I t e n s o
w 0 m ( ) v i m e m o t ]c a M LIÇ t ) dc C F p o de s c r c o m b in a clo c o m a r o t a 
ç ii o l a r c r a l O u c ü m a r t açi i o m c l ia <, p a r a t cnt ar di f r enci nr a 
t
s o da p o r ç o a n t c r i u r e m r e \a ç ii o à p o r ç ii o p o s t e r i o r 
do g1ú t e o
m Éd io
Scanned by CamScanner
招 国国
3 4 1 Ou a dn l Co . a
É n n t n is I · r n Uu n J n , I I 1n a is zm cc r in r c 0 n l
c n o r u n s 
m ú s c u l t ì sg lú r c o s
S i r u u h c s h t ) Rlú Fc t ì m J io ; s t r H 
U : 1c c p n ì f l 1 n d u r cl ci ona
c c o m a c ; i ps u la dn I I r h c q
c o x o l t m u r a l = c o n l 0 r c n t ïj n r c nc t iL
Ï, ] Ut ) r c h ) fc nn t t m l
 U n
 : · u1 1c r í :=i c cx f c ma d
n
 f l i d,
 °
n r r ° ; H l
i nh i 1s gl út ca s an f cr i or c i nf
er i or ;
.
, lH i n c is u r B1 ih q \ 1i ; i t i c . ï m n io f
a po n c u r n s c t e r m i n a c m I i m t
c n u i i o c u r r , q u e r c
f r , r ça a c Dp s u la da a n I c ulaçi " J ì qq
d açi i
 p r i nc i l · ; ïl :
n m 1LIu r m c J ia] dc C F
 a c e s h t ìr i n :
Fihn 1s n n i c r iu r c s : Re x iu n n m c r o da n r m e J i a
l1n c n t c C F ;
l i lr r ; H p , w f = r iu r L : ; : c s t c n LIc m : c r o d a m 
la t e r a lm c n t c C F
Q i n c r v a ç i i u :
 n e r v o gl út c su p e r i or ( co n t m í i hr as do 49
 c
 5 ·
 n
e r v o s l om b ar es c do 1 g ne r vo sac r dj ,
Scanned by CamScanner
Scanned by CamScanner
36 / Qu a d r il Co x a
Pa l p a çã o d o N e r v o C iá t ic o
P a l p a ç o I n t l i r c t a
Pu s i c iu n a m c n r o :
Q p a c i e n t c : c n l D L
, 
c 1 1 C F c j t ) c [ll m ; n c x i t ) n : 1L%v ;
t e r a p e u t a : e m p , n t r : i s o u f r e n t e d a p u c i c n t c
1 0 t c r : w : l m 11t l s i c i t ) m r : ì ; 1 11o lp a A : s c u i ndi c1ór t l o t1{ 1m it n l i ) dc u m a 1i n 11 : 1 i n i w i n Dr i : 1
, q u c s c s i [ u n c n t r c a l l o r d : 1 1 1 ; 
t c r iLt r u A) t r u c n n t c r m At i u r c 21 r t lhc r o s i9l : r dc i s q u i ; i t i c u , p a r a de l i m i t a r 0 l t ) c ; I I cl c p ; l s wc n l (] o n c r v o c i i i [ ic o
 N e s s a
 r cgi i o ten t ar ;
 I pa i pá - o : po s i ci on a r á os se l l s ded os t m n
v c r s a hn c n t e à l i n h a im n g i n : i r ia
, p a r a , n e s s n r c g i ii o , p r o c u r a r L)
n e r v o c i Ai t ic o : a u e n c o n t r : I l0
, 
r c r D a s e n s ; l ç ñ o d c e s t a r pn l pdo u m c o r d i i u c s p c s s o
, 11 lc 11 t l
æ 0 n e r v o c i : i t ic o he i n e s p e ss o ; t c l n
, 
a p r o x im n da m c n t e
, 
1 5 C TL1l c l a r g u r a ; s u a l] a lp a ç ão p o d e r : I s c r do lo r o s a p a r a 0 p a c ie n t e
 
A
Fi g 2 17 N e r v o c iá t ic o : po n t o m éd io e n t r e a t u be rn s ;.
is q u iâ t ic a e a bo r da p o st e r io r d o t r o c a n t
Fi g 2 18 N e rv o c iát ic o p a lp a q o in d ir e t a
月
月
Scanned by CamScanner
Qu a d r i l Co x a 1 31
d p i r if o r m e
E u m m ú s c u l o t r i ; 1n g u ln r , c 1n fo r m : 1 de p r a ( l a t i tT1 PITU Æ : p ê r a )
o r ige m :
 u
 ;
 1 st 1pc r ííci c v c n r r . l dn sa e m ,
 c n t r c 0 l g,
 2
 °
,
 3
9 e
 49 f or am c s sa c r a i s an t er i or es ;
1 Aln fo r a m c i s q u i ; i t i c o 1n a io F ;
* do l ip ; 1m c n t t ) sacrocspi nh1l
, 
c 1n s u a s u p c r « c ic a n t c r i«1 r
i nscrçi n :
= n a bo r da s u p e r i o r u u t r o c a n t c r m a io r
a ç ìi o :
1 r n t a do r l a t e r a l dc C F ;
1 a h , Iu t o r de C F c
, 
c m c e r t o g r a u , c x t c n s o r
i ncrvaçi o :
 r amo
 do pr i ïnc i rn c/ ou do se g u n d o ne r v o s sa c r a i s.
Scanned by CamScanner
缸
角
七
38 1 Qu a d r il Co x a
可Pa lp a ç ii o I n i l i r e t : 1
1 F þ o s s ib i l ida d e : r u n ì p : i 1p a ç il o
Pc ) s i c io n : i n l : n r u :
Q p a c ie n t e : s i l l p
t e r a p e u t a : C l 11 P , n o In LIu t lo p a c ie n t e
* 0 p u c ic n r c c o lu c a f î a p o l p a dc s u l l dc LIo a t r : is d o t n ) c a n t e r
n i n i o , c i n fc r iu r m c n t c M i H1ú t t 0 m LI io ; ! 
l i
* I r i c lc v a r ( 1 s c u p , r c a l i z ; m Llm l r o t a ç ii c ) 1 : i r c r a l dc C F ;
* / \ p m $ i n ó 1r Bi : 1 & 1lp a ç i i ( ) , p n r : 1 [ c n m r s c t 1 [ i r a c t ) n [ r : l çi t l dc ) 1l i 
r i fu r 1n c s o b 0 g i \ì t c o m ; i x i m o
Fig 2 19 Pi r i fo r m e
1a p o ss ib il id a de : a u to pa l .
p a lpa qâ o in d ir e t a Paçäo
" p o s s i b i l i da d e
Po s i c i o n a m e n t o :
° 
= ;" n t ' " m IW , c o m a j o e lho h u n i o l a t e r a l ;, p ; l l pl çi o n e x is
c » t e r a p e u t a : c m P , a a la do d o p a c ie n t e
 0
 rc r a p c L 1t a co l oc a r
 :
 I a
 Po l pa 【l05 ded o s
 dc
 51 . a
 mi io
 cc f : il i c1 das e g u i n t e t ì r a n e i r a :
n j p o n t o m d io d e u m a l i n h a i m a g i n á r i a LI LI C u n c a r c : gi i o
1 Su1 m ãa c a u da l s e r á Po s i c io n a d a 11 0 t o r n o z e lo d o p a c i e n t e er e s i s t i r á i\ r o t ; l ç ii o l a t e r a l d e C F
, 
O u s e j a ; 1 p c r na d o p a c l c n t e s c
* O s de do s d a 1T1i o c e fá l i c a i r ii o ; 1p r o fu n d a r d 1ì n ip a ç i i o , p a r a xt i r e m a t e n s o d o I T1ú s c u lo p i r i fr ì r m c
Fig 2 2 0 Pir ifo r m e 2 - p o ss ib i l id a de pa lp a ç o in d I reh
Scanned by CamScanner
Qu a d r i l c 1 39
/ U:
d c St 1J n 1 ïi Lì c c : : i l i c H u u r h u l m c n t c H c
l = n i 1 LIprcssi cJ q l l c S = r
n l a : 1 l r ; I : ; Lh : s s c n 1ú : ; c u
lo
. 
A s u a m il t ) c u t K la l i r ; I s c g l i n l r
"
c m h c r ç a 0 m c m bm in te r io r da
. 
0 p a c ie n t e i r : I c m ll u r r a
r 0 SC LL p n ì p r io j o e lh o c o n t r a 0 t r o n c o bo r da po s t e r io r do g lú t e o m d , 0 ) 3
' p m s , b , l lda de
d o r c r a pc u f n , PA TA p a L
Ie r r c ; 1l iz a r a r o t a çã o la t e r a l d c C F
 O s dc L I o5 da mi io cc f
l ica sc n t i ri ìo a t cn x i io Uo pi ri f t ) rmc ,
t e 0 n e r v o c i : ì t ic o , n o r m n
l m c n r c
, 
s i t u a s c i m H Bia t u m c n t c a t r : is , O l l
回国叼 石舀 匦
scj 1, n 1H i s p r [ 1fu n : IM 11c n r c i l 0 \ 11ús : u h pi ri 
; w m c
Ar cnçi ì o : a c f LIc v c r ; i c s t n r l it : c i r a m c n t c
f l= x i : m u LÏa c : J x o c o n t r á
. 
p .
r i
, 
s c u tl c x ii t t L In q LI i \ Ur i l e s t i v e r m u i r u a c e n
r u n t la
, 
0 p i r i lb r i n c p ; 
s a a s c r l l m m
f a : l t ) r m e d i a l J c C F
Fig 2 2 2 Pi r if o r m e p a lp a q o i ndet a 3 · p o s s , b rl ida d e
Scanned by CamScanner
I l c e s s t \ r Iz- :
Scanned by CamScanner
Q. Ad r i l Co . a 1 111
g g ê m e o i n f e r io r
F o r ig c m :
* u d fa c e p u s t c r in r d n t u bc r o s id ; rd c is q u i i i t i c a
i n s e r ção :
* n a in c e m c l i a i do t mc a nt c r 1n a io r
, 
j u n t a tn c n t c c o m 0 a b t u r a do r i n t c r no
açi o :
1 p r in c ip a l :
r o t a d o r l a t e r a l de C F
* a c c s s Dr ia :
u LIu t o r d c C F
Q i ncrvaçi o :
 n e r vo
 do
 F
 :
 
mc o
 i ní cr i ar ( pl ex o sa c r a l : I . ,
 L
5 ou 51 ).
P a l p a ç ão I n d i r e t a (s e r ; I m o s t r a da c o n j u n t a m e n t e a o g m c o s u p e r io r c a o o b r u r a do r i nr er no)
Scanned by CamScanner
4 1 I Ou a d r jj Co x a
Pa lp a ç o Glo b a l d o s M ú s c u lo s G ê m e o Su p e r io r , O b t u r a d o r
In t e r n o e Gê m e o I n f e r io r
Pal paçi o I n d i r e t a
I F þo s s ih i l ida d c
Pn : : ic io n a mc n t t ) :
Q pa c i c n t c : c i n n v
, 
c 1 1 ( 1 j \ 1c nl n ncxi [ 1n : u ]c l a 90 °
t e r a p e u t a : c m p
1 n l C f H p c u [ H i r ; I In c a l i zn r
, 
i n ic i n 1m c n t c
, 
H e s p i n h a is t l u i : l e ic a ,
p H TH H s = g u i r , t r 19 : \ r 11111 ; \ l i n ha i r n H Hi n ; i r ia q u c t i n e a l\ r d p r i a
c : 1l i n l1H iM 1u i ; i t im : \ 41 t mc i n 1 c r n i d io r
, 
i s[ 1 
, 
U [ 11 0 1i n l l : 1 n o SC I 1 
r iJ n m c t l iH l lm r i l L1r c m l ;
 C n i nc n n ì H p t ì l pn \ b 4.
.
r c
 z dc t ] us
 dc
 s l i d mE ia c c f ;
 il i cH n a F i g
.
. 3 Pal paç äo gl ob a l do s mú s cu l os g me o
 Slp t ) n m m 9ï in u c s x a l i n h a
, 
l l m s o h n a u t r o
, 
[ r n n s v c r s u l m c n t e c o b t u r a d o r i n t e r n o e gëm e o in t e r ; Or Pe rul i ci p 1m c n l c a ïì n i x o Uc la ;
* C m 11 : 1 n1i ( ) c : I LMH ] 11 m ic i n n ; 1J i l n n l o m ( 1z c l ( ) t ]o p : 1c ic n t c
, 
r c 
s i s r i r ; I 1 r u f a ç ìi n l a r c r n l dc C F :
* A : ; p t 1l11 ; \ : I t ]u M Bc [ 1n : ; L! ; 1 m $ 1 cemi c1 apr [ 1 f u n 1r i t Hl p l l lp a ç ii o ,
p n r ; 1 t c n [ a r c m s e n t i r H t c n s f i o m u s c u l i l r
团团团自由自 一
2 g Po s s ib i l ida de
Po s ic io n a m e n t o : 1L
p a c i e n t e : e m D L
, 
c o n t r á r io iB pal paçi o C F e j o e lho s n c x in n a d o st e r a p e u t a : c m Pé , a t r ; i s o u à f r e n t e do p a c ie n t e
 0
 tcr ap ( : ut a pa l pa r : I a es p i nh a i squ i ; it i ca co m
 D
 Jg ded o
 de
 su am ão ;
* D e s lo c a r : I 0 dc do l a t c r a 1m e n [ c
, w r o x i m a da m c n t c do is de do st r a n s v (: r s a s
, 
e Ln n p o l l c o in fe r io r m e n t c a e l a
, p a r a t e n t a r st i r
, 
j u n t a m e n t e c o m o s F e 4g de do s
, 
a t e ns o do s m ú s c u lo sg mc o s u p e r io r
, 
u bt u r a LIo r i n t e r n o e g 1n c o i n fe r io r
, 
a s s i m 国回ド芦de n a do s
, 
n o s e n t i 山) c fa la c a u t l a l ; s u a m o c a u 9la l uever i 
t a r p o s i c io n a cj a n o t o m o z (: l0 do pa c ie n t e
, p a r a po de r r e s is t i r 
r n t a ç i i o la u : r a l de C F
Fig 2 25 Pa lpa ç o g lo ba l d o s m úsc u lo s qêm e o su penoro b t u r a d o r in t e r n o e gêm e o in fe r io r pa lp a qâo i ndi r
2 · Po ss ib i lid a de
姑
Scanned by CamScanner
Scanned by CamScanner
44 1 q u a d r i l c o m
Pa lpa çãn I n d i r e t a
Pt v ; ic i m i : 1 mc n t o :
Q p a c ie n t e : c l n D D , c m p , w iç ii t ) r e c o s t a Ja , c o i n i l C
F a bd u z iJ a , j t v
t c r i 1p c u t a : s c m a J n n n 1111 0 i l , Ue l r c n t c p iJ r a n r c g
i ii t ì i n g u i n ; 1l J o
p a c ic n r c
 0
 rcr wl cu m c[ 1] uc a r : + as SL H1S Ï 11M) s t ï : \ swl i n[ ( : ó
n l a :
m it o c i 1LiJ n l : n n fa c e l J ï e r a l u j u c [h n J o I' " i cr 1t c , m a n t e n
da H C F n ht l u z ida ;
a mi + ceì l i cal i r ; I pa lp a r a t L【h : rosi LInLI is q u i i r
ic a c a n i 0
1, n lc g a r ; s c m I, c r . Ic r Cd n t i t l o c m n c ln , dc a
lo c a n i ( , Ue du c m
di r ci o = c fn ic ; 1 , c LI M p ' " C[ 1 n l c , ] iJ hl l c n n : 4 1 a r J c n c o
n l r a r
n r ; 10 10 I : ; : 1u iw 1ú h ic t \ : 1 ; : ; c n c í H 1 [ r D lu , Lh : s h) c a r
I ( ) w ic p r ,
c 1n s c n r iJ n I nt cm] , p n r n 1' " c t r a r n a r°Hi i , J s o lr o s m ms c u
ln &
: t LI uï r lu n g , 】 c w ; t e i l ;
 c ,
 ml i l nr i it l ca H J : 1l res i sr i rm rml l çi io br cr al de CF ; 0 sc u po
t e ·
g ; i r I · cr cl ' " r zi a t c n s n d t ) n bt u r m lBJ r c x r c r n o
厚 召目
r
B i
p
Fig 2 2 6 Ob t u r a do r e x t e r n o pa lpaçào mdnw
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Qu a d r iB Co x a 1 47
I is q u i o t ib ia is (r e g i ii o g l i i t c a in fe r io r )
Pa J e sc t l i v iu i r s u a s or i cns c m , l o is p la n o s : s u p e r f i c i a l c p n Jf u n d o
F o r igc n i :
P la n o Su p e r f i c i a l
b f c c p s f c m o r a l : p o r ç ii o lo n ga :
 n Ä i rca di sh 1 Ï da
 wr ç o pmx i ni al cl a [ uhc r os i dml c i squ i : it i ca .
s e m i t c n d í n e o :
 n M r c1 1 t l i : i[ ul c] a wr çi it l pmx i ni al da [ ub er os i t]ad e i squ i : it i ca , me d i al mc n [ c à po r ção l on ·
81 do h :c c N fcn 1(1r Æ
P l a n o P r o f u n do
b íc c p s f ( : m o r a l : p o r ção c u r t a :
 n o 1 ;
 thi n I ar cr al t l n l i nh a ; isp c r a do f mu r , P « ) xi ma l mc n t c à i nscr çi o do gl út eo mx i r n o ,
e n t r e 0 H , l u t o r m a n o c 0 v a s t o Ia t c r u \ ;
 d
 pr Lì l on g n mc n r a 1 : rt c r a l da l i nh a ; isp c r a do f Êmu r .
s c m i m c m b r a n o s o :
 n a
 t ub c r os i uad c : i sq u i ; it i ca ,
 n
a
 rc a pr ox i ma l dc su a por çi o pr ox i ma l .
F i l l s c r ç o :
b í c e p s f e m o r a l : p o r ç ii o l o n g a :
 n a ca b eç a da : í bu l a, c m sua sup e r f íci e l at er al ;
 n o
 cndi l o Lat er al da t i bi a,
 p o r me i o dc um pe q u e n o í as c í cu l o.
p o r çã o c u r t a :
 j un t a- c às f i br as da po r çì io l on g a .
s e m i t e n d i n c o :
 n a f ac e me d i al do co r po da t i bi a,
 e m su a por çi o pr ox i ma l .
s e m i m e m b r a n o s o :
 1 m c, )nd i l o me d i al dn t i bi a,
 c m sua fac e pós t er o- e d i al .
açi o :
b íc e p s f e m o r a l : p o r ç ii o l o n ga :
 p r i nc i pa l :
c x t c n s o r de C F ;
f l = x o r c r o t a J o r la t e r a l do jo e l h o ;
fa z a r c [ r o v c r s íi a d a p e l v e
 a c e s sór i a :
r o t a ç o la t e r a l de C F
b íc e p s f e m o r a l : p o r ç ìi o c u r t a :
* fl e x o r c r o t a do r la t e r a l do j o e lh o
s e m i t e n dín e o :
1 p r in c i p a l :
e x t c n s o r de C F ;
f le x o r c r o t a do r tT1c d ia l do j o e lho ;
f a z a r c er o v (: r s ii o da p e l v c
 a c e s s ór i a :
r o t a do r m e d ia l de C F
Scanned by CamScanner
48 1 Ou r} dn t ( o m
s c m i n 1> m l 1r i \ n o h u :
0 x l 1 M1 > J c C F ;
11= x o r c h r r ; k l, 1r m c LI iu l dt ì j t 1= lh t )
m r m h) r n l c LI in l dc C F
i n c r v n ç i i , r
1 : 1n M 1s n { ì n c r v t ) c iDt ic t )
Pa l p a ç o d o T e n d i i o Co m u m d e O r ig e m d o B ic e p s Fe m o r a l e aael
Se m i t e n d l n e o
A 1' " r ç ; ì lu n H ; 1 LI h l c c ps f cwf 1\ l c u { t s c m i t c n LI ín c a u r ig i n u s c
n ; 1 [ u h = r , 1 ; I, LI , h : i5t l u i : +r i c : 1, p t , r n l c i ° dc H n l [ c n LIi i n c t n l u n i , 0 1W 1 : l [ 1 [ o
n r i p : n 1 t lo s c m i m c 1n h r u n o s o , r u 1 m e s m u n : g i ii . , m a i s p r t ) f u n LIa
=
Pa 1p i \ ç ii o D i r c [ a
一
聊P{ w i c i [ 1n n n i c n m :
p a c ie n t e : c m >) v
t e r a p e u t a : c n 1 p , ; m la LIo t Jt ) p n c i c n r c
 0
 r cr up c u t ; 1 c u l nc ; 1r ; I u p n [ pa t l s t l cd os Jc s u a m, o c e f : ì1i ca
i n í ° r io r m c n r c ï l t uh=nxi t l uLI c i s L Iu I ; i r i c a ; c s : ; a t u bc n ) 5 i u n d c 
m i s c
, 
n ( ) r m a l n i c n r c
, 
n o ni csnl ml i nh1ni cl l r ( ) M r im n [ a 1 ó Fig 2 30 Te n d oc o m u m de o rige m do bíc e ps fem m a l
se m it e n d ïn e o p a lpa iio d rre tap r c p a Hlú r c n , s u b a hu r LIn i n fe r i o r do gl i cco m : ì x i n r 11 ;
 A
 nl a mi t ) ca u L I al sc r ; I p, ici unuLI n na r cgi i n pAwr cr i or Ja co x a
do p u c ic n t c , c 1n SC LI [ c r ço Uix t a l , c r e s i s t i r ; I i i ex t c ns i o d c C F ;
 A
 ;
 wi &l s t ] us t h : dos di l n i i io c c m i c ; 1 pcr cch : ri o a
 t c n i o 00
r c n LIii [ 1 d t ) s :s q u io s t ih i a is
Scanned by CamScanner
Scanned by CamScanner
l
Scanned by CamScanner
Ou a d r il Co x a 1 5 1
9
Pa lp a ção d a Po r t ão Lo n g a d o B ic e p s Fe m o r a l
Pa lp a ção D i r e t a
1
. 
J =
Po s ic i t m a n ì c r r r u :
pa c i e n t e : 1-) 
Q t e r a p e u t a : c m " , n u l H LIn t ln p n c ic n t e Y
. 0 t c r ; l p c u f J pc LI i r ; ì i m p n c ic n r c q l r e a l i z e a fl c x ii o do jo e lh o
c o m h i n a da c o i n a r ( 1n 1Çi ia lM '" r : 11 tL1 pc r n a 呜 刀
. V i : ; ual i ar ; t u n l rcnLI i i 1, ( w : f i c : 1r /i p m c n r i n c n t c , n o l a do la t c 
m] d a Tc p i i i \ w 1 M c r in r LL1 Ct 1X H
 /
 \ St hl mi in cl UJ ; 1l : ; cr i + pmi ci {1n ; ì1a no t or nn z c t L1 LI () &1 c i cn t c c
r c : ; iM i r ; ì m ) n i o v i n i c n [ n ( lc n = x ii [ 1 t lu j ) c thm Fig 2 3 4 Bic e ps f e m o r a l po r çã o lo n g a (t e n d o )
. I n i c ia l l l l c n t c
, " u
l lm n + t ) r cnLI o t in PUrÇ*t ) i nga do b :c c p s f c p a lpa qäo d i r e t a
t c
, pa n i p n lp n t a p t l r ç ii o lo r 1j :a t Bo h íc c p s f = m u r a l n o t c r ç m Y
u iu ( 1 ; 1 r c p i ii o p t n r c r io r u a c o x a
: JPa l p a ç o d a Po r çã o Cu r t a d o B ic e p s Fe m o r a l
Pa ïp a qii o D i r e t a
Po s i c io n a m c n m :
Q p a c ie n t e : c lm D V , c o m 0 j o e lh o f lc x io n a do a 45 ° ; t :b i a c m r o
Q t e r a p e u t a : c 1n pé , a o l a do do p a c i e n t e
 C o m I I po s i ci on ; 1mc n t o ad o t ad o pe l o pa c i en t e,
 0 t c r ap ( : LI Hl i r ; I F i g. . 5 Bi cep s fem or al - o r q o l on g a ( ve $ t re mu s cu l ar ) -
o bs e r v a r u m s u lc o c x ix r e n t c e n t r e a h n r d a la t e r a l t l o t c n d o d u p a l pa q o di r e
h :c e p s Ucmnml c a bo r J a p o s t e r io r do t r a t o i l io r i b i a l ; e s s e s u lc o
t c m u n l fo r m a r a t r ia n g u l a r , c o m huh c e f á l i c a c Ai pi c c a u da l ;
 0
 ter ap c u M pus i ci un u r z i as po < pa s dos dCL I o5 dc su n mi lo ccf l
c a n e s s e s u lc o e r e s i s r i r ; I
, 
c o m a s i l a m il o c a u da l
, 
à fl e x i+o d o
jo e lh o c ( ) n r l) i n1t ] a c o m a r o m ç ii û l awr 1L 1l ; 1 r íh i a ;
 P c r c\ : be r ; I a r ensi t )
 Ja pür ço cu r t a do bí ce p s f em o r al .
Fjg 2 3 6 Bíc e p s fe m o r a l p o r ç o c u r t a (v is u a l iz a çâo do
s u lc o e n t r e 0 t e n d i<o do b ic e ps fe m o r a l e 0 t ra t o , r, o t , b ra l)
Fig 2 37 B, ce p s fe m o r a l p o ' çao CU ' " (w n [ r e m u sc u la r)
pa lpa qào d【r e M
n j
I
Scanned by CamScanner
52 / Qu a dr il Cbx a
B M ÚSCULO S DA REGIÃO ÁN T ERO LA T ERA L REG IÃO IN G U IN A L LA T ERA L
D i v i, Hn 1[ v i a r c g im i i 1wi 11 ; 1l c n l t r s r (: : i$ : : ; : r w i i i o i n & J i n a n r r (: r
a 1
, r c : iM i n g u in ; ] l a n rq
e regi i n i n p u i n a l m c t Jiu t , dc a c o rda c o m Hs n r ip c n s m u s c l l la r e s , 1
Y I r a í n c i l i r a r a nl ïpçå°
A r c g i ii ( ) i n gu i n a l ó c r : I I : 1prchc11 : ! o s : ; c w i n r c : I ï i 1Tl
i H : s : Jnar nr i cm ; :
 m c J i aï m( : nt e,
 0 i nl i sc u i u su r r ör i o ;
1 l l t u a lm c n [ c
, 
0 m l is c u ln r c n s o r L] M : ; c ia la t a
Es s e s m Lisc u lo s fu H n a m u m a r c Hi£i o J e {u r m a r a [ r i a n p u ln r , c
o m ; i p i c e c r a n ia l , c o m 0 ma
1o r e t o fc n x ) r a l
, q l l c s c o r ig in a da EIA ! , c o n t i 9
ln n e s s e tri i i njula ; e lc Ín n n u i m l : I bi ct r i z, já
d i v ide 0 v r t ic c t lo ii n g u lo fo r m a da p e la s or i cn£ d u 
T FL c s a r r d r i ü e m di s ii n g u l t w i Hua
a t e n s o r d a f ás c ia la t a
o r iRc m :
.
, ! EIA S
, 
c r n s i l a s u p c r f íc ic c x r c ma ;
* , lH c r is t a i l íz1c : I , n a pH r r c : t r i r c r i t 】r d c s c u Ï i i b i n c x t c mo ;
* ó i n c i : i u r ; 1 In c a l i z ; r LL1 a h ; l i x ° ó E. A S , c n r r c ( ) g 1ú r c a ï n
M iu c 0 s a r Ä r io ;
 L b f i sci a l ar a,
 c
r n ST Ï H su p e r f í ci e 11r . íun L ! i1.
Q i n s t : r ç i i u :
 n o t r at o i l i ot i hi al ,
 p r Lì xi m îl j unn. 9 l n t er ço n1 di o co i n 0 t er ç o pmx i ma l da co x a , qu
!' " r s m l v c z , i r >i in s e r i r s c n a l u c e u n r c r ia r d o cnJi l t ) Ja r e r a ï d a t
h i a
, p m x i m a lm c n te
o r ige m u u m t ì s c u ln t i b i a . a n t e r io r c n t ) n í v e l d o t u b r c u lu d t : G c r d y ;
 a l gu n s f as c í cu l os sc i ns e r em so b r e H hon l a l at er al 山 pu tel a.
a ç iio :
 p r i nc i ["I :
r n n ïJ o r m (: d i a l LÏc C F
a c e s s d r ia :
n c x ( ) r cic C F ;
a bdu m r dc C F
i n e r v a ç ã o :
 l i m r amo
 do
 ne r vo gl t i t co su p e r i or ( co n t ém f i br as do qu a r t o c qu i nt o ne r v o s l om b ar es
, lu í1r i m c i r o n c r v ( ) s a c r a l )
Scanned by CamScanner
g u a d , ií Co x a 1 53
Pa lpa qii n D i r e t a
r w s s ib i l idm1e
>n s ic io n n m c n r o : /
Q pa c i e n t e : c m 
D L
, 
c o m a C F l igc i r a m c n t c f le x in n a da
c > t e r a pe u t a : c m r , n r n i s u o p a c ie n t e
. 
0 t c r a p c u t i r r r a q n r zi l i n i a l i n h a i m u p i n : i r ia e n t r e a EIA S c n
ho r , l a a n t e r io r , [o t r t ) c n n t c r m a in r ;
. 
C o lo c a r ; I i l 1, o lpn L1n 5
"
, 
4 "
, 
3 1 c 29 d c t ln s dc s i l a m iio cc: l i ca
n o p t ) n m ï 11 J i t ) LI c ; 9 1 l i n ll a ;
. A s u a n l ii o c a ULB : 1] iM : ; c gu r a r , ° c m bc r ço " , 0 n l c m h r o i n k r io r
A , Ndc nc , N n H c s h M a m mo v h n n ms s h n u Mn o s J n
. 
: 5 : ì : 5 · c 4 Uc LI[ H AB : mt i n cci l i cn , I, · - · . · - : LIe n " ' 38 Te n so r da fàsd a lM a p a lpa çäo dr re
t i: ic d r i i t l t ) f ; , r l c m 1LIÑ, 1 L Ic ( 1r iw n l Jn T FL ; l s ï, ( 1a s L]n 39 c p
" pm s ib ilid a de
d c J t l s : ; c n r i r i i t l u n : >14i 1 c lc M m &1r çi n c a r n m \ l l
cr I' n Je s c p u l l ' " T c m :. ' " ; 1 , B r i n çn a pu r ç : i o c n r n o s ; 1 do T FL
æ 0 T FL d ; I t c n : ; i i a ï · o n c l i mì s c g l l i r c a , q l l c , l : ; = I H I, \ : n h a u m p a p e l
i m p o r t n n ï c n a m : 1r c h n , cst uhi l i ni nLI H t l l l n LI r i l c . . j , n lh u 艮。
Fig 2 39 Te n so r d a ¢à sc , a la t a : pal paçi o e m :o r m a de
p i, qa p a lpa ç o d , r e ta N POSS, b il, da de
2 9 Þo s s ib i t ida dc
Po s i c io n a m e n t o :
pa c ie n t e : c m D D
¢ t e r a p e u t a : c m p , a o la do do p a c ic n n :
 0
 Cnwu [ l l pa ]pl l r D co m os dNns de sua nr i o ce f ál i cA 1, : 1 r c ·
g ião c o m p r c e n J it ]a c nr r c a EIA S c a ba n ta a n t e r io r d o r r o c
[ e r m a io r ;
l aço e n t r e 0 T FL c 0 g lú t c o m d i , e s t e ú l t i m o s i r u a do do r . A '
Fig 2 4 0 Te n so · da fás c ia lH a « v e n t r e m u sc u la r ) p a lp a cào
m e n t e a o a n r c r i t J1 d , r e ta (e m fo . N a de p ïn ça ) 2 · POSS, b , lid a de
l
Scanned by CamScanner
54 1 Qu a d r il Co x a
Pa lp a çã o d o T r a t o 1l io t i b ia l
O s %1s c íc u k ) 5 1nHscuar es provcrùcn[ cs do F : hi [ co nüi x n i o c do
t c n so r d a f : ì s c ia In r a s c Lm c m
, 
a o n :v c l do t r o c n n t c r m a io r do f m u r ,
p a r a ío n n n r 1 1 t c n d o la r g o , ] c n o m i n a do t r a t o i l io t i b i i 1l , q t r c s e
e n v o l v e c o m a f sci a la r ; 1
0 t r ; 1t o i l im ib ia 1 c s t c n dc s c 1 í l io à Ä ia c s i t u a s c n a %1c c 1 ; l [ c 
r ; 11 da c o x a ; m m a s c t c n s o p o r 111c ic) d ; 1 a ç o L]o : I tk c o nr i x i mc ) c LI )
t e n s o r da :ásc ia ln r ; 1
, 
c t a m b m q u a n do s c r c : al i zB t ì ho c = j o l a t e r a l da
art i cul açi o d o j o e lh o
P a l p a ç o D i r e t a
Po s ic io n a m e n t o :
p a c i e n t e : c m D L O u D D
¢ t e r a p e u t a : c m p
* 0 t c Fa p e u t a resi st i r i
, 
c o m a s u a mi o c U1u t la l lo c a l i z a d a n o t o r
n ( ) z c lo t ]L) w c ic 11 >c
, 
i l f l cxi [ 1
, 1bdtl ç cl c r m i ç o n i c d i a l d c C F
1 C m 11 ° & ) lc g a r c 0 i ml i c1dor ó s u a m Uio c c $ l i m p a ]:1 ; 1r 9i abo r d a a n t e r io r c a p o s t e r i o r Uu t r a t o i l io t i b i ; \ l
, 
n a f a c e l a t e r a lda c o x a do p a c i e n t e
Fi g 2 4 1 T r a t o iïio t ib ia l p a [p a ç o dire ta
Scanned by CamScanner
Ou a d r iB Co x a 1 55
b s a r t ó r io
É n m ú s c u lo n i a is lo n ga do c o r p o h u m a n o
t e m a fo r m a t o de f i t a e a p r e se n t a u m t r a j e t o o hl iq u o p a r a h a ix o
, 
a p a r t i r da e i a s
. 
c o m
w n t idc) 1 : i t c r o m c d i ; I I
F o r igc m :
1 Ua E IA S ;
1 u c n i n a i n c is u r a
, 
lo go a ba i x o da EIA S
i nscr ço :
 p n r t « : pr ox i ma l , In su p e r f íci e me d i al do co F po ua t : bi a.
Q a ç ii u :
 p r i nc i pa l :
fl c x o r Uc C F
1 a c e s s d r i a :
1hJumr dc C F
 r ot aA j or I nt c r al dc CF :
a t i v iJ a t l c le v e
, 
e m D D ;
l e v e a m n J c r a da
, 
s c 0 i n d iv ídu o e s t i v e r s e n t a do
 $ c x o r do j oe l ho .
* r o [ a do r n i e d ia l d a [ í l l i ; 1
Q in c r v a ç o :
 n e r v o f em a r al (pl cx n l om h a r . 2 e 1- ) .
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
5 8 I Ou a d n l Co l a
Pa lp a ç ii o D i r e t a
1 e 1} n s s i b i l ida d e
Pm ; i c i [ 1n ; i n l c n t o :
Q p a c i e n t e : e m D D
t e r a p e u t a : c m p , a a l a u o do p a c ic n r c
P r i m = i r n 1n c n r c
, 
0 t cmpcur a dever v is u a l i z a r a fo s s n c m r a l : c s t :
l t 1c a l iz a t ln c 11t r c a s u r ip c n s dn r c n s o r t Ja f : I : ; c i : 1 la r a c da s a r t t ì r io
, a p m 
x i m a t lm n c n r c n t r ês t lc do s r r a n s v c r s o s a ba i x o d a E IA S
 9 ) n
 :
 rnp c u t n p c d i r : ì ua pa c i cn r c qu t : r ea l ize um a pe q u e n a n
x ii o Uc C F
, 
c o m . . Jo e lho s c m i n c x io n a t l a
 ( : nm
 u
 nmv i r n c n m t l c &c x i in uc
 CF ,
 a f os s a c r ur al pl x l cr : I sc r
v is H ; 1Ï iz ; kB ; 1 lt w t l nh ; 1j x c) ( LI E1A S
 F
 l cr i l í , cu r ; I c t l h) c ; \r ; I wl l p a d( ) p c 3 ] c{ ] os de su a mi io ce ·
fi ì l i c n : ; o b r e n Ín ss a c m r n l
, p i 1r a pu _ Ïc r s e n t i r 0 t e n d i i o r c r i l ín c o
r c t [ 1 $ : m c l r iÆi ì
 C c nn H
 : ; tm m
 : ìo
 cn m . nl ,
 p o s i ci un u L I a na r c : gi i io an t er i or do [ or -
i g
-
. 5
 Re t o
 femo r ar (vi sua h za ç o
 da
 f os s a cr ur al )
-
n o z c ln l lo p i rc i c n t c
, 
r : ; I : ; t i r ; I à f le x : ì o t lc C F c o m b in a t la c o i n a 
» Po ss ib i l id a d e
 (
- vc n l r c
 nm
 : ; cu l nr
 da
 r e t o
 f cmo r al íi ca r ; I hcm
 pmnunci ado na
r c p i : i n n n 1c r io r d a c u x n ; 1' t ) t ie r ; I s c r p ; I I I' " do p c l ; 1s p o lp a s Uo sdc du s d a m il o c c í ; i l ic H
, 
( l l l = h c 9l =sl cur : i t l c a u d a l m ( : n t c
, 
a p a r t i rda f o s s a c m r u l
æ A fo s s a c r u r a l c u r r e s p o n dc
, 
n a p r o fu n d iLIa d c
, 
à p o r ç ñ o s u p e r io r d o
c o lo da f m u r
l h
F i g 2 4 6 Re t o f e m o r a l p a +p a : : o di re
1 · Po s s ib nid a de
、
曝
Fig 2 4 7 Re t o f ' " " : : 
, = : " p a lpa qäo di re
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Scanned by CamScanner
Qu a d r il Co x a 1 6 9
c g r á c i l
N a fa c e m e d i a l d a c o x a
, 
0 g r ác i l é 0 m ú s c u lo m a is s u p c r : ic i a l
o r ige m :
1 n a bo n Jn m e d i a l da fa c e c x t c ma do r a m o in f e r io r do p úb i s , p o r i n t c n n éd in t l c u m a del
d a a p o n c u r o s c
Q i n s e r ç îïo :
1 n a fa c e m e d i a l do t e r ço p r u x i m a [ u o c o r po Un t :b i : 1
u ç ïi o :
1 p r i n c ipa l :
a uu t a r Un c o x a
 :
 1ce s s t ; ri a :
f lc x o r dc C F
, 
s c 0 j o e lh o e s t i v e r e s t e n d ido ;
r o t a do r m c LI i ; 1l de C F ;
$ c x a r dc j o e lh o ;
r o r a do r mcl i al da t :b ia
in c r v a ç ii o : u m r a m o d a d i v isão a n t e r io r do n e r v o o b t u r a do r (c n n t ém f i br a s do t e r c e i r o e
q u a r t o n e r v o s lo m ba r e s )
Scanned by CamScanner
70 1 Ou a d r jt Co x a
Pa lp a çii o D i r e t a
1 F ]) o s s ib i l i t lu d e
Po s ic io n : u n c n t o : 
Q p a c i e n t e : c m D D
, 
c o m a C F l iRc i r a m c n t c a hdu z ida , j o e lh o n c
o n a d()
Q t e r a p e u t a : s e n t a do n a w a c a
, 
dc f r e n t e p a r a a r e g ião i n g u i n a l do
p a c i e n t e
 0
 【cr ap c u t a dcs l izar : I a su a mi lo ccf i 1i ca pe l a fac e me c l ial da co x a
dn p a c ic n r c c m d i r e ção c r a n ia l ;
* P r Dx in m I s ín f is c p úh i c a , pal par , c o rn a p o lp a dc s c u 2 9 de J o , J
( 1 r e n d ; i a 1n a ix e s pe s s o e s a l ie n t e
, q u c c o r r e s po n d e a o t e n dão
dc) a du [ o r l 1nwl ;
 A
 pa l i
 ·
 :
 1 dc
 SCL L. e ded o pa l pa r : I,
 a
b a i xo Un t en d o an t er i or , u
q u = L1c lHn d n ; : ï pul pnçïo
, 
i ì s s c m c lha s c a u m t c n dii o ; 
g r ác i l ,
' :" '
-
 c
.
.
 m
 H
 s u a
 1ni ìt ) cn u L I nl ,
 p t l hi ci un a J a na \ ce me d i al dn t or no - i g- . 2 Gr ác i l- a l pa ç o di r et
z e lo ,-In p a c ic n r c
, 
r e s i s r i r zi à a LIu ç ii u Ua c o x a e n e x o d o j c H po s s ib ilida de
111 n cenl l hi n1h1 c ( ) [n a r ( )[;1Çi t ) m c J ia l da [ íb i ; 1 ;
 S o E 1o 3 · L]c] [1 do
 rcr H&
 : u[