Head and Cervical Spine

temporal fossa

just posterior to frontal lobe

zygomatic arch

inferior from the temporal fossa and feel the bony contour from ear and follow medially to the nose

inferior to the eye socket

temporomandibular joint

palpate laterally by placing finger over joint just anterior to tragus of the ear

mandible

from TMJ, proceed inferiorly along the mandibular angle to the anterior portion

hyoid bone

inferior to the mandible, first bony prominence in anterior neck

at the level of C3

thyroid cartilage

just inferior to the hyoid bone

feel the superior notch at its midline

at the level of C4-C5

cricoid cartilage of the trachea

inferior to thyroid cartilage

palpate softly

at the level of C6

occipital protuberance

at the center of the occiput

occiput

bony ridge along posterior aspect of cranium

mastoid process

large bony prominence just posterior to the ear

C1 transverse process

between the angle of the mandible and the mastoid process

C2 spinous process

first spinous process palpated inferior to the occipital protuberance

C3-C7 spinous process interspinous space

proceed inferior from C2 spinous process and palpate spinous process and interspinous process

ligamentum nuchae must be slack

C3,4,5 are not easily palpable due to the cervical spine lordosis

the facet joints are one finger off each spinous process

spinous process are in a line inferior to the occipital protuberance

C2 through C5/C6 transverse process

difficult to palpate but realize the transverse levels are at the same level as the spinous process and run in line inferior from the mastoid process

C2-C7 lamina and cervical facet joints

AKA articular pillar

between the spinous process and the transverse process

T1 spinous process

most prominent spinous process inferior to C7

temporalis muscle

over the temporal fossa

have subject clench their teeth to palpate

masseter muscle

inferior to the TMJ joint

have subject clench their teeth to palpate

anterior belly of the digastric muscles

located from the anterior portion of mandible to the hyoid bone

place finger in this region and have subject push tongue down and into teeth

sternohyoid muscle

located from the hyoid bone to the superior portion of the sternum

just lateral to the trachea

difficult to palpate specific muscle so know location

sternocleidomastoid muscle

palpate from mastoid process to the sternum and medial clavicle

two portions

have subject rotate and flex head to palpate SCM to opposite side

scalene muscles

anterior, middle, and posterior

palpate all three muscle posterior to the SCM

carotid artery pulse

lateral to the trachea

medial to the SCM

palpate one side at a time

external jugular vein

runs superficial to the SCM

lymph nodes of the neck

medial and lateral to the SCM

will only be able to feel if there is an infection

thyroid gland

inferior to cricoid cartilage

will only be able to feel if there is a condition that affects the thyroid gland

ligamentum nuchae

very thick ligament over the cervical spinous process

easy to palpate when cervical spine is flexed (subject tucks the chin)

suboccipital muscles

significant amount of muscle in the subocciptal space

unable to differentiate between specific muscles

splenius captius cervicis

muscles on either side of the cervical spine

unable to differentiate between specific muscles

semispinalis capitus

muscles on either side of the cervical spine

unable to differentiate between specific muscles

cervical spine functional movements

cervical rotation with flexion to right and left

cervical rotation with extension to right and left

straight plane gross motion assessment

cervical-thoracic flexion

cervical-thoracic extension

cervical-thoracic rotation to right and left

cervical-thoracic lateral flexion (side-bending) to the right and left

neck flexion/extension with inclinometer

subject position: sitting or standing

inclinometer over the crown of the head in line with tragus of the ear

compensations for neck flexion/extension

flexion through lumbar spine

neck lateral flexion (side bending) with inclinometer

subject position: sitting or standing

inclinometer over the crown of the head in line with occipital protuberance from posterior or nose from anterior

norms for neck lateral flexion

0-45

compensations for neck lateral flexion

side bending the whole trunk

trunk rotation

neck lateral flexion with goniometer

subject position: sitting or standing

axis: C7 spinous process

stationary arm: down the thoracic spine, perpendicular to the floor

moveable arm: occipital protuberance

neck rotation with goniometer

subject position: sitting

axis: center of cranium

stationary arm: in the sagittal plane

moveable arm: tip of the nose

norms for neck rotation

0-60

compensations for neck rotation

whole trunk rotation

cervical spine flexion MMT

grade 3/5-5/5 only

muscles: all neck flexors

subject position: supine with head on table

stablize: none

movement: raise head off table moving chin to chest

resistance: hand over forehead with other hand under the head

deep cervical spine flexors MMT

'alternative test": 3/5-5/5 only

isolates deep neck flexor muscles

patient position: supine with head on table

movement: keep head on table and bring chin to chest

stablize: none

resistance: both hands underneath chin surface

cervical flexion with rotation

grade 3/5-5/5 only

isolates the sternocleidomastoid

patient position: supine with head on table

movement: rotate head to one side and raise head off table

stablize: none

resistance: hand over the temporal region with other hand under the head: applying in direction of muscle

cervical spine extension

grade 3/5-5/5 only

muscles: all neck extensors

patient position: prone with head on table, towel or hands

movement: raise head as if looking at the wall

stablize: none

resistance: hand over the occiput with other hand under the head/chin

deep neck flexor endurance test

subject is supine: therapist passively flexes the upper cervical spine (tucks chin) then lifts head off table approx one inch

therapist asks subject to hold that position as they bring their hand away

test is completed when subject can no longer maintain chin tuck, head drops to table or subject experiences pain

norms for deep flexor endurance test

males: 38 +/- 20 sec

females: 29 +/- 13 sec

cervical extensor endurance test

subject is prone with forehead supported by towel: therapist passively tucks the subjects chin and raises head off table about 1-2 inches

therapist asks to hold that position

test is completed when: subject can no longer maintain chin tuck, head drops to table, extends neck or experiences pain

goal= 20-30 seconds