Cervical Spine joints
|Cervical Spine joints |Specifically known as |
|Movement |Muscles |Goniometry |Manual Muscle Testing |
| | | | |
|Motion: |Agonists |Recommended Testing Position | |
| |Palpation |Sitting, with thoracic & lumbar spine well |Motion or |
|Extension |Proximal Attachment |supported by the back of the chair. Tongue | |
| |Distal Attachment |depressor can be held between teeth for |Muscle specific, list ↓ |
|Range: |Innervation |reference | |
| | | |Muscle(s) |
|45 degrees |Splenius cervicis |Stabilization | |
| |Palpate in the lower posterior cervical spine just medial to inferior levator scapulae with resisted |Shoulder girdle is stabilized to prevent | |
|Plane: |ipsilateral rotation |flexion of thoracic & lumbar spine |Recommended Testing Position |
| |Spinous processes of the 3rd through the 6th thoracic vertebrae | |Model is prone with head off the end of table|
|Sagittal |Transverse processes of the first three cervical vertebrae |Center |and arms at side. The examiner stands next |
| |Posterior lateral branches of cervical nerves four through eight (C4-C8) |Over the external auditory meatus |to patients head |
|Axis: | | | |
| |Splenius capitis |Proximal Arm |Resistance Hand Placement |
|Transverse |Deep to trapezius inferiorly and sternocleidomastoid superiorly; with subject seated palpate in posterior |Perpendicular or parallel to ground |The examiner places one hand over the |
| |triangle of neck between upper trapezius and sternocleiodmastoid with resisted rotation to ipsilateral | |parieto-occipital for resistance |
| |side |Distal Arm | |
| |Lower ½ of the ligamentum nuchae and the spinous processes of the 7th cervical and the upper three or four|With base of nares or parallel to longitudinal |Patient Instruction |
| |thoracic vertebrae |axis of tongue depressor |Instruct the patient to nod their head |
| |Mastoid process and occipital bone | |forward in a yes movement. He should be able |
| |Posterior lateral branches of cervical nerves four through eight (C4-C8) | |to touch his/her chin to the chest and to |
| | | |directly to the ceiling above him/her. |
| |Erector spinae: iliocostalis | | |
| |Deep and difficult to distinguish from other muscles in the cervical and thoracic regions; with subject | |Special notes |
| |prone, palpate immediately lateral to spinous processes in lumbar region with active extension | | |
| |Medial iliac crest, thoracolumbar aponeurosis from sacrum, posterior ribs 3-12 | | |
| |Posterior ribs 1-12 cervical 4-7 transverse | | |
| |Posterior branches of the spinal nerves | | |
| | | | |
| |Erector spinae: longissimus | | |
| |Deep and difficult to distinguish from other muscles in the cervical and thoracic regions; with subject | | |
| |prone, palpate immediately lateral to spinous processes in lumbar region with active extension | | |
| |Medial iliac crest, thoracolumbar from sacrum, lumbar 1-5 transverse processes, and thoracic 1-5 | | |
| |transverse processes, cervical 5-7 articular processes | | |
| |Cervical 2-6 spinous processes thoracic 1-12 transverse processes lower 9 ribs, mastoid process | | |
| |Posterior branches of the spinal nerves | | |
| | | | |
| |Erector spinae: Spinalis | | |
| |Deep and difficult to distinguish from other muscles in the cervical and thoracic regions; with subject | | |
| |prone, palpate immediately lateral to spinous processes in lumbar region with active extension | | |
| |Ligamentum nuchae, 7h cervical spinous process, thoracic 11-12 spinous processes, andlumbar1-2 spinous | | |
| |processes | | |
| |2nd cervical spinous process, thoracic 5-12 spinous processes, occipital bone | | |
| |Posterior branches of the spinal nerves | | |
| | | | |
|Motion: |Agonists |Recommended Testing Position | |
| |Palpation |Sitting, with thoracic & lumbar spine well |Motion or |
|Rotation |Proximal Attachment |supported by the back of the chair. Cervical | |
| |Distal Attachment |spine in 00 of flex, ext, & lat flex. Tongue |Muscle specific, list ↓ |
|Range: |Innervation |depressor can be held between teeth for | |
| | |reference. |Muscle(s) |
|60 degrees |Splenius cervicis | | |
| |Palpate in the lower posterior cervical spine just medial to inferior levator scapulae with resisted |Stabilization | |
|Plane: |ipsilateral rotation |Shoulder girdle is stabilized to prevent |Recommended Testing Position |
| |Spinous processes of the 3rd through the 6th thoracic vertebrae |rotation of thoracic & lumbar spine. |Patient is supine with head supported on |
|Transverse |Transverse processes of the first three cervical vertebrae | |table and turned to the right to test the |
| |Posterior lateral branches of cervical nerves four through eight (C4-C8) |Center |left sternocleidomastoid. |
|Axis: | |Over center of cranial aspect of head | |
| |Splenius capitis | |Resistance Hand Placement |
|Vertical |Deep to trapezius inferiorly and sternocleidomastoid superiorly; with subject seated palpate in posterior |Proximal Arm |Therapist faces the patient with one hand |
| |triangle of neck between upper trapezius and sternocleiodmastoid with resisted rotation to ipsilateral |Parallel to imaginary line between the two |placed on the temporal area above the ear for|
| |side |acromial processes |resistance. |
| |Lower ½ of the ligamentum nuchae and the spinous processes of the 7th cervical and the upper three or four| | |
| |thoracic vertebrae |Distal Arm |Patient Instruction |
| |Mastoid process and occipital bone |With the tip of the nose. If using tongue |To rotate his/her head in a “no” motion |
| |Posterior lateral branches of cervical nerves four through eight (C4-C8) |depressor, parallel to longitudinal axis of |toward the open palm of the resisting hand. |
| | |tongue depressor | |
| |Sternocleidomastoid (both sides) | |Special notes |
| |Anterrolateral neck, diagonally between the origin and insertion, particularly with rotation to | | |
| |contralateral side | | |
| |Manubrium of sternum, anterior superior surface medial clavicle | | |
| |Mastoid process | | |
| |Spinal accessory (Cr 11, C2-C3) | | |
| | | | |
| |Erector spinae: iliocostalis | | |
| |Deep and difficult to distinguish from other muscles in the cervical and thoracic regions; with subject | | |
| |prone, palpate immediately lateral to spinous processes in lumbar region with active extension | | |
| |Medial iliac crest, thoracolumbar aponeurosis from sacrum, posterior ribs 3-12 | | |
| |Posterior ribs 1-12 cervical 4-7 transverse | | |
| |Posterior branches of the spinal nerves | | |
| | | | |
| |Erector spinae: longissimus | | |
| |Deep and difficult to distinguish from other muscles in the cervical and thoracic regions; with subject | | |
| |prone, palpate immediately lateral to spinous processes in lumbar region with active extension | | |
| |Medial iliac crest, thoracolumbar from sacrum, lumbar 1-5 transverse processes, and thoracic 1-5 | | |
| |transverse processes, cervical 5-7 articular processes | | |
| |Cervical 2-6 spinous processes thoracic 1-12 transverse processes lower 9 ribs, mastoid process | | |
| |Posterior branches of the spinal nerves | | |
| | | | |
| |Erector spinae: Spinalis | | |
| |Deep and difficult to distinguish from other muscles in the cervical and thoracic regions; with subject | | |
| |prone, palpate immediately lateral to spinous processes in lumbar region with active extension | | |
| |Ligamentum nuchae, 7h cervical spinous process, thoracic 11-12 spinous processes, andlumbar1-2 spinous | | |
| |processes | | |
| |2nd cervical spinous process, thoracic 5-12 spinous processes, occipital bone | | |
| |Posterior branches of the spinal nerves | | |
| | | | |
|Motion: |Agonists |Recommended Testing Position | |
| |Palpation |Sitting, with thoracic & lumbar spine well |Motion or |
|Lateral |Proximal Attachment |supported by the back of the chair. Cervical | |
|flexion |Distal Attachment |spine in 00 of flex, ext, & rot. Tongue |Muscle specific, list ↓ |
| |Innervation |depressor can be held between teeth for | |
|Range: | |reference. |Muscle(s) |
| |Splenius cervicis | |Sternocleidomastoid |
|45 degrees |Palpate in the lower posterior cervical spine just medial to inferior levator scapulae with resisted |Stabilization | |
| |ipsilateral rotation |Shoulder girdle is stabilized to prevent |Recommended Testing Position |
| |Spinous processes of the 3rd through the 6th thoracic vertebrae |lateral flexion of thoracic & lumbar spine | |
|Plane: |Transverse processes of the first three cervical vertebrae | | |
| |Posterior lateral branches of cervical nerves four through eight (C4-C8) |Center |Resistance Hand Placement |
|Frontal | |Over spinous process of C7 |Resistant range of motion |
| |Splenius capitis | | |
|Axis: |Deep to trapezius inferiorly and sternocleidomastoid superiorly; with subject seated palpate in posterior |Proximal Arm |Patient Instruction |
| |triangle of neck between upper trapezius and sternocleiodmastoid with resisted rotation to ipsilateral |Spinous processes of thoracic vertebrae so that|Have the patient to try to touch his/her ear |
|sagittal |side |arm is perpendicular to ground |to the shoulder making sure he does not lift |
| |Lower ½ of the ligamentum nuchae and the spinous processes of the 7th cervical and the upper three or four| |the shoulder. |
| |thoracic vertebrae |Distal Arm | |
| |Mastoid process and occipital bone |Dorsal midline of head. Reference occipital |Special notes |
| |Posterior lateral branches of cervical nerves four through eight (C4-C8) |protuberance. |Larger cervical lymph nodes may cause limited|
| | | |motion. |
| |Erector spinae: iliocostalis | | |
| |Deep and difficult to distinguish from other muscles in the cervical and thoracic regions; with subject | | |
| |prone, palpate immediately lateral to spinous processes in lumbar region with active extension | | |
| |Medial iliac crest, thoracolumbar aponeurosis from sacrum, posterior ribs 3-12 | | |
| |Posterior ribs 1-12 cervical 4-7 transverse | | |
| |Posterior branches of the spinal nerves | | |
| | | | |
| |Erector spinae: longissimus | | |
| |Deep and difficult to distinguish from other muscles in the cervical and thoracic regions; with subject | | |
| |prone, palpate immediately lateral to spinous processes in lumbar region with active extension | | |
| |Medial iliac crest, thoracolumbar from sacrum, lumbar 1-5 transverse processes, and thoracic 1-5 | | |
| |transverse processes, cervical 5-7 articular processes | | |
| |Cervical 2-6 spinous processes thoracic 1-12 transverse processes lower 9 ribs, mastoid process | | |
| |Posterior branches of the spinal nerves | | |
| | | | |
| |Erector spinae: Spinalis | | |
| |Deep and difficult to distinguish from other muscles in the cervical and thoracic regions; with subject | | |
| |prone, palpate immediately lateral to spinous processes in lumbar region with active extension | | |
| |Ligamentum nuchae, 7h cervical spinous process, thoracic 11-12 spinous processes, andlumbar1-2 spinous | | |
| |processes | | |
| |2nd cervical spinous process, thoracic 5-12 spinous processes, occipital bone | | |
| |Posterior branches of the spinal nerves | | |
| | | | |
| |Quadratus lumborum | | |
| |With subject prone just superior to iliac crest and lateral to lumbar erector spinae with isometric | | |
| |lateral flexion | | |
| |Posterior inner lip of the iliac crest | | |
| |Approximately on half the length of the lower border of the 12th rib and the transverse process of the | | |
| |upper four lumbar vertebrae | | |
| |Branches of T12, L1 nerves | | |
| | | | |
| |Sternocleidomastoid (both sides) | | |
| |Anterrolateral neck, diagonally between the origin and insertion, particularly with rotation to | | |
| |contralateral side | | |
| |Manubrium of sternum, anterior superior surface medial clavicle | | |
| |Mastoid process | | |
| |Spinal accessory (Cr 11, C2-C3) | | |
| | | | |
|Motion: |Agonists |Recommended Testing Position | |
| |Palpation |Sitting, with thoracic & lumbar spine well |Motion or |
|Flexion |Proximal Attachment |supported by the back of the chair. Tongue | |
| |Distal Attachment |depressor can be held between teeth for |Muscle specific, list ↓ |
|Range: |Innervation |reference | |
| | | |Muscle(s) |
|45 degrees |Sternocleidomastoid (both sides) |Stabilization | |
| |Anterrolateral neck, diagonally between the origin and insertion, particularly with rotation to |Shoulder girdle is stabilized to prevent | |
|Plane: |contralateral side |flexion of thoracic & lumbar spine |Recommended Testing Position |
| |Manubrium of sternum, anterior superior surface medial clavicle | |Model is supine with arms at their side, and |
|Sagittal |Mastoid process |Center |head on table. The examiner stands next to |
| |Spinal accessory (Cr 11, C2-C3) |Over the external auditory meatus |patients’ head. |
|Axis: | | | |
| | |Proximal Arm |Resistance Hand Placement |
|Transverse | |Perpendicular or parallel to ground |The examiner places one hand on the model's |
| | | |forehead for resistance |
| | |Distal Arm | |
| | |With base of nares or parallel to longitudinal |Patient Instruction |
| | |axis of tongue depressor |Instruct the patient to nod their head |
| | | |forward in a yes movement. He should be able |
| | | |to touch his/her chin to the chest and to |
| | | |directly to the ceiling above him/her. |
| | | | |
| | | |Special notes |
| | | |As he moves his head, watch to see if the arc|
| | | |of motion is smooth rather halting. |
| | | | |
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