Cervical and Thoracic Region Practical Skills

Mastoid process palpation

Sitting on edge of plinth with feet supported on stool
Apply appropriate counter pressure on opposite side of face - the models head should be inclined away from you slightly
Identify the bony prominence immediately behind the model’s ear and palpate the roughly u shaped border

External occipital protuberance palpation

Sitting on end of plinth with feet supported on a stool
Use one hand for counter pressure over the model’s forehead
Slide hand up the midline of the posterior neck until you feel a bony prominence roughly in the centre of the occiput bone

Cervicothoracic region spinous process palpation

Prone lying with nose hold with cervical spine in neutral with no pillows and arms by sides
Stand at top end of the plinth by the model’s head facing their feet
Begin by finding the external occipital protuberance and then slide your fingers in a caudad direction, first bony point will be C2
Continue down to C7 and palpate C7 and C6 and get model to extend their head slightly, C6 should disappear
After C7 palpate down to T12

Flexion

Sitting on edge of plinth with feet supporting on a stool
Measure distance between the sternal notch and the point of the model’s chin
Close your jaw and bend your head down as far as it can go

Flexion limiting factors

Posterior longitudinal ligament, ligamentum flavum, interspinous ligament and nuchal ligament
Intervertebral disc - stretched posteriorly, compressed anteriorly
Tension in extensor muscles such as erector spinae and UFT

Extension

Sitting on edge of plinth with feet supporting on a stool
Measure the distance between the sternal notch and the point of the model’s chin
Close your jaw and look up to the ceiling as far as you can

Extension limiting factors

Anterior longitudinal ligament
IVD stretched anteriorly and compressed posteriorly
Approximation of spinous processes

Lateral flexion

Sitting on edge of plinth with feet supporting on a stool
Measure distance between the anterior acromion process (dimple between middle and anterior deltoid fibres) and the lowest part of the ear lobe
Without lifting your shoulder, tilt your head to the right/left being your ear lobe as close as possible to your shoulder

Lateral flexion limiting factors

On opposite side; intertransverse ligament and ligamentum flavum
IVD stretched on opposite side and compressed on same side
Approximation of facet joint surfaces on same side

Rotation

Sitting on edge of plinth with feet supporting on a stool
Measure the distance between the anterior acromion process (dimple between middle and anterior deltoid fibres) to the point of the model’s chin
Close your jaw and turn your head to the left/right as far as you can

Rotation limiting factors

Tortional strain in IVD
Some tension present in all ligaments but ligamentum flavum and alar ligament in particular

General palpation of cervothoracic region

Prone lying on plinth with face hole - cervical spine in neutral position with no pillows and arms by side
Examine region as necessary and palpate soft and skeletal tissues of spine considering;
Temperature of area (may indicate local inflammation), evidence of localised increased skin moisture (may indicate autonomic disturbance), the prescence of any oedema or effusion (glossy or tight appearance of skin), mobility of superficial soft tissues, the presence of elicitation of muscle spasm, increased or decreased prominence of spinous processes

Central PA

Patient prone lying on plinth with face hole with cervical spine in neutral position with no pillows and arms by sides
Stand at the top end of the plinth by the model’s head facing towards the model’s feet - plinth should be approx. mid thigh height
Using thumb tips back to back, pressure applied to selected spinous process - shoulders should be directly above segment to be mobilised with wrists and elbow extended but relaxed
Force transmitted through arms to vertebral column with gentle oscillatory movements

Unilateral PA

Patient prone lying on plinth with face hole with cervical spine in neutral position with no pillows and arms by sides
Stand at the top end of the plinth by the model’s head facing towards the model’s feet - plinth should be approx. mid thigh height
Same as central but to lateral aspect