Head, Neck, Thoracic, Ribs, and Pelvis Landmarks and Diagnostics

Flashcards covering key anatomical landmarks and diagnostic procedures for the head, neck, thoracic spine, ribs, and pelvis.

C1 Transverse Process

Locate by tracking the mastoid process behind the ear, dropping posterior to the angle of the mandible and anterior to the mastoid process.

C2 Spinous Process

The first palpable spinous process in the supine position.

C2-C7 Articular Pillars

Found by sliding fingers laterally from C2 or C7 into the lamina groove until meeting solid resistance.

C7-T1 Junction

Located by flexing the head and following C7 just below its spinous process.

C7

A large, palpable protuberance on the neck when the head is flexed.

External Auditory Canal

Used for a 10-step screen, viewing alignment of the anterior ear with the acromion.

External Occipital Protuberance

A midline bump centered on the superior nuchal line, palpated at the middle of the occiput.

Mastoid Process

A bony bump located behind the ear where the jaw ends.

Sternocleidomastoid

A muscle that protrudes on the side of the neck when the head is rotated.

Hyoid

A bone superior to the thyroid cartilage, located by sliding inferiorly and posteriorly from the midline of the chin.

Posterior Aspect of First Rib

Located between the posteromedial clavicle and upper trapezius, feeling for bony resistance in an inferior and medial direction.

Tip of the Acromion

The bony protuberance found by sliding slightly down anteriorly from the acromioclavicular joint.

Posterior Scalene

A muscle that protrudes on the side of the neck when the head is rotated, viewed from the posterior side.

Acromioclavicular Joint

A protuberance on the shoulder.

Occipitoatlantal Joint (OA)

Assessed by placing middle fingers posterior to occipital condyles and index fingers posterior to C1 articular pillars, inducing motion in all three planes.

Atlantoaxial Joint (AA)

Assessed by placing middle fingers posterior to C1 articular pillars and index fingers posterior to C2 articular pillars, with lower cervical spine flexed at least 45° for rotation assessment.

C2-C7 Diagnostics

Assessed by placing middle fingers posterior to the involved vertebra's articular pillar and index fingers posterior to the vertebra below, inducing motion in all three planes.

Inferior Angle of Scapula

The downward-pointing triangle on the scapula.

T1 Spinous Process

Found by tracking Rib 1 to its transverse processes.

T2 Spinous Process

Located in the same plane as the superior border of the scapula.

T3 Spinous Process

Located in the same plane as the spine of the scapula.

T8 Transverse Processes, T7 Spinous Processes

Landmarks found by locating the inferior angle of the scapula.

T12

Found by tracking Rib 12 to the vertebra.

T1-T3, T12 Transverse Processes

Located at the same level as their corresponding spinous process.

T4-T6, T11 Transverse Processes

Located ½ level above their corresponding spinous process.

T7-T10 Transverse Processes

Located 1 level above their corresponding spinous process.

Angle of Louis (Sternal Angle)

A bony ridge where the manubrium connects to the sternum body, aligning with T4 and articulating with Rib 2.

Xiphoid Process

A diamond-shaped bone found by following the inferior edge of the anterior ribcage medially.

Sternal Body

Located superior to the xiphoid process.

Rib 2

Found by locating the Angle of Louis and following it until it dives under the shoulder.

Rib 10

The last palpable rib when following the midaxillary line inferiorly.

Rib 11

Located superior to Rib 12 using the intercostal space.

Rib 12

Located by sliding superiorly and medially from the space between the posterior ilium and ribcage.

Rib Angles 2-10

Found by locating Rib 2 and using intercostal spaces to count, or Rib 10 for lower ribs.

T1-T4 Diagnostics

Assessed while sitting, using localized action, to find Type 2 dysfunction primarily, feeling for ease in flexion/extension, sidebending, and rotation at the transverse processes.

Type 1 Dysfunction (Thoracic)

A spinal diagnosis where sidebending and rotation are in opposite directions, and the vertebra is always neutral (TX NSL/rRR/L).

Type 2 Dysfunction (Thoracic)

A spinal diagnosis where sidebending and rotation are in the same direction, and the vertebra is always flexed or extended (TX F/E, SL/rRR/L).

T4-T12 Diagnostics

Assessed while sitting, placing fingers on transverse processes, assisting patient with arm wrap for flexion/extension, sidebending, and rotation to find type 1 or 2 dysfunction.

L1-L5 Diagnostics

Assessed while sitting, placing fingers on transverse processes, assisting patient with arm wrap for flexion/extension, sidebending, and rotation to find type 1 or 2 dysfunction.

Rib 1 Diagnostics

Assessed supine by placing thumb posteriorly and index finger anteriorly on Rib 1, feeling for 'stuck' movement during inhalation/exhalation (inferior motion on inhalation posteriorly).

Rib 2-5 (Pump Handle) Diagnostics

Assessed supine by finding Rib 2 at the Angle of Louis, using 'karate chop hands' on the sternum, checking for dysfunctional side, and diagnosing inhalation/exhalation restriction.

Key Rib (Inhalation Diagnosis)

The first functional rib (moving posterior on exhale) that remains anterior and gets stuck while continuing to palpate ribs down the ribcage during inhalation/exhalation assessment.

Key Rib (Exhalation Diagnosis)

The first functional rib (moving anterior on inhale) that remains posterior and gets stuck while continuing to palpate ribs up the ribcage during inhalation/exhalation assessment.

Rib 6-10 (Bucket Handle) Diagnostics

Assessed supine by finding Rib 10, wrapping hands around ribs to feel for dysfunction, using the same inhalation/exhalation process as pump handle ribs without the sternum landmark.

Rib 11-12 Diagnostics

Assessed prone by finding Rib 12, wrapping hands around Ribs 11 and 12 with thumbs on T11/T12 transverse processes, feeling for posterior movement on inhalation and anterior on exhalation.

Diaphragm Diagnostics

Assessed supine by wrapping hands around ribs 7-12, placing thumbs on costal margin, sinking thumbs posteriorly/superiorly, feeling for which side gets stuck during inhalation/exhalation (inferior on inhale, superior on exhale).

Achilles Tendon

Located on the posterior leg moving upward from the ankle.

ASIS (Anterior Superior Iliac Spine)

Found by following the iliac crest until the first 'hitch'.

AIIS (Anterior Inferior Iliac Spine)

Found by following from the ASIS until feeling the next 'hitch'.

Femoral Greater Trochanter

The bony protuberance below the iliac crests.

Iliac Crest

The superior portion of the ilium, inferior to the costal margin, at the level of L4.

Inguinal Ligament

A firm, rope-like structure originating from the ASIS and attaching to the pubic tubercle bilaterally.

Ischial Tuberosity

The first bony protuberance in the buttock, felt by pushing from the leg up to the buttocks.

Gluteal Crease

The junction where the butt cheeks meet the leg.

Lateral Malleolus

The bony prominence on the lateral side of the ankle.

Medial Malleolus

The bony prominence on the medial side of the ankle.

Patella

The kneecap.

Lateral Condyle of the Knee

A bony prominence on the lateral aspect of the knee.

Popliteal Crease

The crease at the back of the knee.

Piriformis

Originates from the anterior sacrum and ilium, palpable in the center of the gluteal region between the lateral sacrum and greater trochanter.

PSIS (Posterior Superior Iliac Spine)

The first bony protuberance found by pushing against the back and buttocks.

Psoas

Originates from T12-L5 vertebrae and attaches to the lesser trochanter of the femur, found 2/3 of the way from ASIS to midline, moving superiorly.

Pubic Symphysis

A cartilaginous midline structure palpated by moving inferiorly from the umbilicus to a bony ridge superior to the genitals.

Pubic Tubercle

A bony prominence found slightly lateral to the pubic symphysis, on the superior aspect of the pubic ridge.

Tibial Tuberosity

A bony protrusion directly inferior to the patella.

Biceps Femoris

Palpated between the ischial tuberosity and the lateral aspect of the knee, with the long head originating from the ischial tuberosity.

Sacrotuberous Ligament

A firm, rope-like structure attaching to the inferior lateral angle of the sacrum and the ischial tuberosity bilaterally.

Quadratus Lumborum

Originates at the iliac crest and attaches to the transverse processes of L1-4 and the inferior border of rib 12, palpated superiorly and medially from the iliac crest.

ASIS Lateralization Diagnostics

Assessed supine by placing hands on bilateral ASISs, pushing one side posteriorly and inferiorly, and identifying the 'stuck' side (where no movement is felt on the opposite ASIS).

PSIS Lateralization Diagnostics

Assessed standing by having the patient bend over, with the dysfunctional side moving first and furthest.

Midline Assessment (Pelvis)

Assessed supine by placing thumbs on bilateral ASISs and a pointer finger to the bellybutton, with the higher finger indicating the superior (inflared) side.

Pubic Tubercle Diagnostics (Pelvis)

Assessed supine by placing thumbs bilaterally on the superior edge of the pubic rami lateral to the pubic symphysis, visually inspecting which thumb is higher (superior/inferior).

PSIS Diagnostics (Pelvis)

Assessed prone by placing thumbs on bilateral ASISs and hooking under, visually inspecting which thumb is higher (superior/inferior).

Ischial Tuberosities Diagnostics (Pelvis)

Assessed prone by hooking under bony protuberances from the thigh upward with thumbs, visually inspecting which thumb is higher (superior/inferior).

Medial Malleoli Diagnostics (Pelvis)

Assessed prone by hooking underneath with thumbs, visually inspecting which thumb is higher (superior/inferior).

Posterior Rotation (Pelvis)

A somatic dysfunction indicated by superior ASIS, inferior PSIS, and usually a superior medial malleolus.

Anterior Rotation (Pelvis)

A somatic dysfunction indicated by inferior ASIS, superior PSIS, and usually an inferior medial malleolus.

Superior Shear (Pelvis)

A somatic dysfunction indicated by superior ASIS and PSIS, and both medial malleoli being superior.

Inferior Shear (Pelvis)

A somatic dysfunction indicated by inferior ASIS and PSIS, and both medial malleoli being inferior.

Inflare (Pelvis)

A somatic dysfunction where the ASIS to midline is more medial.

Outflare (Pelvis)

A somatic dysfunction where the ASIS to midline is more lateral.

Superior Pubic Shear

A somatic dysfunction indicated by superior pubic ramus/pubic tubercles.

Inferior Pubic Shear

A somatic dysfunction indicated by inferior pubic ramus/pubic tubercles.

Pubic Compression

Tenderness over the pubic symphysis with no other pubic dysfunction.

How does hypertonicity of the Rectus Abdominis affect the pelvis?

It can pull the pubis superiorly, contributing to a superior pubic shear dysfunction.

Which muscles, when tight, can contribute to an anteriorly rotated innominate?

Quadratus lumborum, rectus femoris, and psoas.

What muscle's tension is associated with an innominate inflare dysfunction?

Sartorius, by pulling on the ASIS.

How do tight Adductor muscles affect the pubic bone?

They exert a strong downward pull, contributing to an inferior pubic shear.

Which muscle group, when hypertonic, can lead to a posterior innominate dysfunction?

Hamstrings, as they pull the ischial tuberosity posterior/inferiorly.

What muscle/structure's tension can cause an innominate outflare dysfunction?

Tensor fascia lata/IT band (TFL/ITB), which pulls the ilium laterally.

What is the articulation between the tubercle of a rib and a vertebra?

The tubercle of a rib articulates with the transverse process of its corresponding vertebra.

Describe an Inhaled Rib Dysfunction.

The anterior end of the rib moves up, and the posterior end moves down. The rib is restricted in exhalation.

Describe an Exhaled Rib Dysfunction.

The anterior end of the rib moves down, and the posterior end up. The rib is restricted in inhalation.

What are the typical ribs and their palpable parts?

Typical ribs are 3-9, and all parts (tubercle, head, neck, angle, shaft) are palpable landmarks for diagnosis.

What are the unique characteristics of Rib 1?

It attaches only to T1, has no angle, is the most curved, and is flat.

What are the unique characteristics of Rib 10?

It only has one facet.

What are the unique characteristics of Ribs 11 & 12?

They are floating ribs, tapered, have no tubercle, and a single facet.

When diagnosing pelvic/innominate dysfunctions, what are the primary considerations?

Identifying the muscular contributors and targeting them during treatment (e.g., muscle energy, counterstrain).

When diagnosing rib dysfunctions, why is knowing typical vs. atypical ribs important?

It affects palpation and proper hand placement during diagnosis and treatment (e.g., pump-handle, bucket-handle, caliper motions).