Cervical+Spine+Palp%2C+ROM%2C+MMT%2C+Derms%2C+Myos%2C+Reflexes copy

Cervical & Thoracic Spine Overview

• Key areas of assessment:

  • Palpation

  • Range of Motion (ROM)

  • Manual Muscle Testing (MMT)

  • Dermatomes

  • Myotomes

  • Reflexes

Page 2: Palpation – Anterior Structures

• Hyoid Bone

• Thyroid Cartilage

• Cricoid Cartilage

• Carotid Artery

• Lymph Nodes

• Sternocleidomastoid (SCM) muscles

• Scalene Muscles

• Clavicle

• Sternum Components:

  • Manubrium

  • Body

  • Xiphoid Process

• Ribs & Costal Cartilage

• Erb’s Compression Point:

  • Superficial point of brachial plexus, located near Rib 1.

Page 3: Palpation – Posterior Structures

• Occiput & Superior Nuchal Line

• Spinous Processes: C2 to T12

• Transverse Processes:

  • Located a thumb's width lateral to the spinous processes

• Supraspinous Ligaments

• Muscles:

  • Trapezius

  • Levator Scapulae

• Supraclavicular Fossa

• Scapular Muscles

• Costovertebral Junction

• Paraspinal Muscles

Page 4: Spinous Processes of the Cervical Vertebrae

• C2: First palpable spinous process.

• C7: Most prominent spinous process, moves with neck flexion.

• T1: Stationary, important for comparative movements.

Page 5: Transverse Processes of the Cervical Vertebrae

• C1: Positioned distal and anterior to the tip of the mastoid bone.

• Distinction of transverse processes is critical; many are deep to SCM.

Page 6: First Rib

• Positioned beneath the clavicle.

• Brachial plexus and subclavian artery traverse between the first rib and clavicle.

• Scalenes insert on the 1st and 2nd ribs, crucial for muscle evaluation.

Page 7: Dermatomes

• C2: Head, face

• C3: Occipital region, lateral neck

• C4: Mid-lateral neck, clavicular area

• C5: Deltoid region, lateral upper arm

• C6: Lateral forearm, thumb, index finger

• C7: Middle finger

• C8: Medial distal half of the forearm, 4th & 5th digits

• T1: Medial cubital fossa; mid-forearm to mid-upper arm.

Page 8: Myotomes

• C1/C2: Neck Flexion

• C3: Lateral Neck Flexion

• C4: Shoulder Elevation

• C5: Shoulder Abduction

• C6: Elbow Flexion or Wrist Extension

• C7: Elbow Extension or Wrist Flexion

• C8: Ulnar Deviation or Thumb Extension

• T1: Finger Spreading

Page 9: Reflexes

• C5: Biceps reflex (Musculocutaneous Nerve)

• C6: Brachioradialis reflex (Musculocutaneous Nerve)

• C7: Triceps reflex (Radial Nerve)

Page 10: Cervical ROM - Flexion and Extension

• Flexion: Approximately 45˚

  • Fulcrum: Earlobe

  • Stationary Arm: Perpendicular/parallel to the ground

  • Distal Arm: Base of nostrils,

  • Inclinometer: T1 Spinous Process and vertex of skull

• Extension: Approximately 60˚

  • Goniometer and inclinometer setup remains same as flexion.

Page 11: Cervical ROM - Lateral Flexion and Rotation

• Lateral Flexion: Approximately 45˚

  • Fulcrum: C7

  • Stationary Arm: Perpendicular to floor

  • Distal Arm: Midline of head

  • Inclinometer: T1 Spinous Process and vertex of skull

• Rotation: Approximately 80˚

  • Fulcrum: Center of cranial aspect of the head

  • Stationary Arm: Parallel to line between acromions

  • Distal Arm: Tip of nose or tongue depressor

  • Inclinometer: Placed on forehead when supine.

Page 12: Thoracic ROM Assessment

• Thoracic Flexion:

  • Patient sits, hand behind neck, flex forward while keeping elbows in.

• Thoracic Extension:

  • Hands behind neck, extend back with elbows towards ceiling.

• Thoracic Rotation:

  • Rotate to look behind.

Page 13: Cervical Muscle Assessment

• Perform a break test to assess manual muscle testing (MMT) score.

• Conduct resisted motions through available ROM (concentric & eccentric) to evaluate muscular injury.

• Motions to Assess Include:

  • Cervical Flexion: Capital, cervical & combined

  • Cervical Extension: Capital, cervical & combined

  • Cervical Lateral Flexion

  • Cervical Rotation