The pulse is the rhythmic expansion and recoil of an artery wall resulting from the surge of blood ejected by the heart with each contraction. This palpable wave travels through the arteries and serves as a direct indicator of heart function and circulatory status. A pulse point is a specific location on the body where an artery runs close enough to the skin surface to allow this pulsation to be felt and counted. Locating these points provides a quick, non-invasive method for measuring the heart rate or assessing the adequacy of blood flow.
Pulse Points of the Head and Neck
Two accessible pulse points are located above the shoulders, providing a direct measurement of central circulation. The Carotid pulse is felt along the neck where the carotid artery ascends to supply the head and brain with oxygenated blood. To locate this pulse, place fingers gently between the windpipe (trachea) and the large neck muscle (sternocleidomastoid muscle) about halfway up the neck.
This central location makes the carotid pulse a reliable site for circulation assessment, particularly in emergency scenarios when peripheral pulses may be weak. It is important to press very lightly and to palpate only one side of the neck at a time, as pressing both simultaneously can compromise blood flow to the brain. Excessive pressure can also stimulate the carotid sinus, potentially causing an unintended drop in heart rate and blood pressure.
The Temporal pulse involves the superficial temporal artery and is felt on the side of the head, directly in front of the ear. Locating it requires placing a finger on the temple where the artery passes over the temporal bone. Only light pressure is necessary to detect the pulsation. While less frequently used for routine heart rate monitoring, the Temporal pulse is a common site for comprehensive physical examinations of the head.
Pulse Points of the Upper Limbs
The upper limbs contain three primary pulse points, with the wrist being the most common site for routine checks. The Radial pulse is located on the thumb side of the wrist, where the radial artery passes over the bone. This is the most frequently used site for measuring heart rate due to the artery’s superficial position and accessibility.
To measure the Radial pulse, the pads of the index and middle fingers are placed in the groove between the tendon and the radial bone. The Ulnar pulse is found on the opposite side of the wrist, closer to the little finger. Although often harder to feel, the Ulnar pulse is used when assessing circulation to the hand before certain medical procedures.
The Brachial pulse is found on the inner side of the arm, near the elbow crease, in the antecubital fossa. This artery continues from the axillary artery and branches into the radial and ulnar arteries. The Brachial pulse is regularly used to measure blood pressure and is important for assessing circulation in infants.
Pulse Points of the Trunk and Lower Limbs
The lower half of the body provides several pulse points useful for assessing peripheral circulation (blood flow to the extremities). The Femoral pulse is found in the groin area, where the femoral artery passes deep into the tissue. To locate it, palpate along the crease where the thigh meets the abdomen, midway between the pubic bone and the hip bone (anterior superior iliac spine).
The Popliteal pulse is situated behind the knee, in a hollow area known as the popliteal fossa. Since the artery runs deep beneath the muscles and fat, this pulse is often challenging to detect and may require the knee to be slightly bent for successful palpation.
The two final major pulse points are found in the foot, providing the most distal checks of circulation. The Posterior Tibial pulse is located on the inner side of the ankle, just behind and slightly below the prominent bony protrusion, known as the medial malleolus. This pulse is commonly assessed to check for adequate blood flow to the foot.
The Dorsalis Pedis pulse is found on the top surface of the foot, running down the center, lateral to the tendon of the big toe. Feeling for this pulse is done by applying gentle pressure over the foot bones in the center of the arch. Both the Dorsalis Pedis and Posterior Tibial pulses are essential indicators of lower limb vascular health.