Cervical Spine joints

Specifically known neck

Name Rachel Mitchell, Katie Kite, Josh Randall,
as
:
Chelsea Lesinger
Joint type
Arthrodial
Close packed position
Extension
Loose packed position
Flexion
Degrees of freedom
3
Bones & specific bony
hyoid
landmarks
Inion
occiput
Cervical
Spinous process
vertebrae
Specific articulating bony Mastoid process, lateral facets, spinous processes, inion, superior
surfaces
nuchal line, thyroid cartilage, first cricoid ring, carotid tubercle,

Movemen
t

Muscles

Agonists
Motion:
Extension
Splenius
Range:
45 degrees cervicis
Plane:
Sagittal
Axis:
Transverse
Splenius
capitis

Erector
spinae:
iliocostalis

Palpation

Goniometry

Proximal
Distal
Innervation
Recommend Sitting, with thoracic &
Attachment
Attachment
ed Testing lumbar spine well
Position supported by the back of
Palpate in the lower
Spinous
Transverse
Posterior lateral
the chair. Tongue
posterior cervical spine processes of the processes of the branches of
depressor can be held
just medial to inferior 3rd through the first three
cervical nerves
between teeth for
levator scapulae with 6th thoracic
cervical
four through
reference
resisted ipsilateral
vertebrae
vertebrae
eight (C4-C8)
rotation
Stabilization Shoulder girdle is
stabilized to prevent
Deep to trapezius
Lower of the Mastoid
Posterior lateral
flexion of thoracic &
inferiorly and
ligamentum
process and
branches of
lumbar spine
sternocleidomastoid
nuchae and the occipital bone cervical nerves
superiorly; with subject spinous
four through
Center Over the external auditory
seated palpate in
processes of the
eight (C4-C8)
meatus
posterior triangle of
7th cervical and
Proximal Perpendicular or parallel
neck between upper
the upper three
Arm
to ground
trapezius and
or four thoracic
Distal Arm With base of nares or
sternocleiodmastoid
vertebrae
parallel to longitudinal
with resisted rotation to
axis of tongue depressor
ipsilateral side
Deep and difficult to Medial iliac
Posterior ribs 1- Posterior
distinguish from other crest,
12 cervical 4-7 branches of the
muscles in the cervical thoracolumbar transverse
spinal nerves
and thoracic regions; aponeurosis

9/1/10

Manual Muscle Testing

Motion
Muscle specific,
or
list
Muscle(s)
Recommen Model is prone with
ded Testing head off the end of
Position table and arms at side.
The examiner stands
next to patients head
Resistance The examiner places
Hand
one hand over the
Placement parieto-occipital for
resistance
Patient Instruct the patient to
Instruction 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

with subject prone,

palpate immediately
lateral to spinous
processes in lumbar
region with active
extension
Erector
spinae:
longissimus

Erector
spinae:
Spinalis

Motion:
Rotation
Range:
60
degrees
Plane:
Transvers
e
Axis:
Vertical

Agonists
Splenius
cervicis

Splenius
capitis

from sacrum,
posterior ribs 312

Medial iliac
Cervical 2-6
Posterior
crest,
spinous
branches of the
Deep and difficult to
thoracolumbar processes
spinal nerves
distinguish from other
from sacrum, thoracic 1-12
muscles in the cervical
lumbar 1-5
transverse
and thoracic regions;
transverse
processes lower
with subject prone,
processes, and 9 ribs, mastoid
palpate immediately
thoracic 1-5
process
lateral to spinous
transverse
processes in lumbar
processes,
region with active
cervical 5-7
extension
articular
processes
Deep and difficult to Ligamentum
2nd cervical
Posterior
distinguish from other nuchae, 7h
spinous
branches of the
muscles in the cervical cervical spinous process,
spinal nerves
and thoracic regions; process,
thoracic 5-12
with subject prone,
thoracic 11-12 spinous
palpate immediately
spinous
processes,
lateral to spinous
processes,
occipital bone
processes in lumbar
andlumbar1-2
region with active
spinous
extension
processes
Palpation
Proximal
Distal
Innervation Recommend Sitting, with thoracic &
Attachment
Attachment
ed Testing lumbar spine well
Palpate in the lower
Spinous
Transverse
Posterior lateral Position supported by the back of
the chair. Cervical spine
posterior cervical spine processes of the processes of the branches of
in 00 of flex, ext, & lat
just medial to inferior 3rd through the first three
cervical nerves
th
flex. Tongue depressor
levator scapulae with 6 thoracic
cervical
four through
can be held between teeth
resisted ipsilateral
vertebrae
vertebrae
eight (C4-C8)
for reference.
rotation
Deep to trapezius
Lower of the Mastoid
Posterior lateral Stabilization Shoulder girdle is
stabilized to prevent
inferiorly and
ligamentum
process and
branches of
rotation of thoracic &
sternocleidomastoid
nuchae and the occipital bone cervical nerves
lumbar spine.
superiorly; with subject spinous
four through
seated palpate in
processes of the
eight (C4-C8)
Center Over center of cranial
posterior triangle of
7th cervical and
aspect of head
neck between upper
the upper three
Proximal Parallel to imaginary line
trapezius and
or four thoracic
Arm
between the two acromial
sternocleiodmastoid
vertebrae
processes

Motion
Muscle specific,
or
list
Muscle(s)
Recommen Patient is supine with
ded Testing head supported on table
Position and turned to the right
to test the left
sternocleidomastoid.
Resistance Therapist faces the
Hand
patient with one hand
Placement placed on the temporal
area above the ear for
resistance.
Patient To rotate his/her head in
Instruction a no motion toward
the open palm of the
resisting hand.

Motion:
Lateral
flexion
Range:
45

with resisted rotation to

Distal Arm With the tip of the nose. If Special
ipsilateral side
using tongue depressor,
notes
parallel to longitudinal
Sternocleidom Anterrolateral neck,
Manubrium of Mastoid
Spinal
axis of tongue depressor
astoid (both
diagonally between the sternum,
process
accessory (Cr
sides)
origin and insertion,
anterior
11, C2-C3)
particularly with
superior surface
rotation to contralateral medial clavicle
side
Erector spinae: Deep and difficult to Medial iliac
Posterior ribs 1- Posterior
iliocostalis
distinguish from other crest,
12 cervical 4-7 branches of the
muscles in the cervical thoracolumbar transverse
spinal nerves
and thoracic regions; aponeurosis
with subject prone,
from sacrum,
palpate immediately
posterior ribs 3lateral to spinous
12
processes in lumbar
region with active
extension
Erector spinae:
Medial iliac
Cervical 2-6
Posterior
longissimus
crest,
spinous
branches of the
Deep and difficult to
thoracolumbar processes
spinal nerves
distinguish from other
from sacrum, thoracic 1-12
muscles in the cervical
lumbar 1-5
transverse
and thoracic regions;
transverse
processes lower
with subject prone,
processes, and 9 ribs, mastoid
palpate immediately
thoracic 1-5
process
lateral to spinous
transverse
processes in lumbar
processes,
region with active
cervical 5-7
extension
articular
processes
Erector spinae: Deep and difficult to Ligamentum
2nd cervical
Posterior
Spinalis
distinguish from other nuchae, 7h
spinous
branches of the
muscles in the cervical cervical spinous process,
spinal nerves
and thoracic regions; process,
thoracic 5-12
with subject prone,
thoracic 11-12 spinous
palpate immediately
spinous
processes,
lateral to spinous
processes,
occipital bone
processes in lumbar
andlumbar1-2
region with active
spinous
extension
processes
Agonists
Palpation
Proximal
Distal
Innervation Recommend Sitting, with thoracic &
Motion
Muscle specific,
Attachment
Attachment
ed Testing lumbar spine well
or
list
Splenius cervicis Palpate in the lower Spinous
Transverse
Posterior lateral Position supported by the back of Muscle(s) Sternocleidomastoid
the chair. Cervical spine Recommend
posterior cervical
processes of the processes of the branches of
in 00 of flex, ext, & rot.
spine just medial to 3rd through the first three
cervical nerves
ed Testing

degrees
Plane:
Frontal
Axis:
sagittal

inferior levator
6th thoracic
cervical
four through
Tongue depressor can be
Position
scapulae with resisted vertebrae
vertebrae
eight (C4-C8)
held between teeth for
Resistance
ipsilateral rotation
reference.
Hand
Splenius capitis Deep to trapezius
Lower of the Mastoid
Posterior lateral Stabilization Shoulder girdle is
Placement
inferiorly and
ligamentum
process and
branches of
stabilized to prevent
Patient
sternocleidomastoid nuchae and the occipital bone cervical nerves
lateral flexion of thoracic Instruction
superiorly; with
spinous
four through
& lumbar spine
subject seated palpate processes of the
eight (C4-C8)
Center Over spinous process of
in posterior triangle 7th cervical and
C7
of neck between
the upper three
Proximal Spinous processes of
Special notes
upper trapezius and or four thoracic
Arm
thoracic vertebrae so that
sternocleiodmastoid vertebrae
arm is perpendicular to
with resisted rotation
ground
to ipsilateral side
Distal Arm Dorsal midline of head.
Erector spinae: Deep and difficult to Medial iliac
Posterior ribs 1- Posterior
Reference occipital
iliocostalis
distinguish from other crest,
12 cervical 4-7 branches of the
protuberance.
muscles in the
thoracolumbar transverse
spinal nerves
cervical and thoracic aponeurosis
regions; with subject from sacrum,
prone, palpate
posterior ribs 3immediately lateral to 12
spinous processes in
lumbar region with
active extension
Erector spinae:
Medial iliac
Cervical 2-6
Posterior
longissimus
crest,
spinous
branches of the
Deep and difficult to
thoracolumbar processes
spinal nerves
distinguish from other
from sacrum, thoracic 1-12
muscles in the
lumbar 1-5
transverse
cervical and thoracic
transverse
processes lower
regions; with subject
processes, and 9 ribs, mastoid
prone, palpate
thoracic 1-5
process
immediately lateral to
transverse
spinous processes in
processes,
lumbar region with
cervical 5-7
active extension
articular
processes
Erector spinae: Deep and difficult to Ligamentum
2nd cervical
Posterior
Spinalis
distinguish from other nuchae, 7h
spinous
branches of the
muscles in the
cervical spinous process,
spinal nerves
cervical and thoracic process,
thoracic 5-12
regions; with subject thoracic 11-12 spinous
prone, palpate
spinous
processes,
immediately lateral to processes,
occipital bone
spinous processes in andlumbar1-2
lumbar region with spinous

Resistant range of
motion
Have the patient to try
to touch his/her ear to
the shoulder making
sure he does not lift the
shoulder.
Larger cervical lymph
nodes may cause
limited motion.

processes
Posterior inner Approximately Branches of
lip of the iliac on half the
T12, L1 nerves
crest
length of the
lower border of
the 12th rib and
the transverse
process of the
upper four
lumbar
vertebrae
Sternocleidomast Anterrolateral neck, Manubrium of Mastoid
Spinal
oid (both sides) diagonally between sternum,
process
accessory (Cr
the origin and
anterior
11, C2-C3)
insertion, particularly superior surface
with rotation to
medial clavicle
contralateral side
Agonists
Palpation
Proximal
Distal
Innervation Recommend Sitting, with thoracic &
Motion:
Attachment
Attachment
ed Testing lumbar spine well
Flexion
Position supported by the back of
Sternocleidomast Anterrolateral neck, Manubrium of Mastoid
Spinal
Range:
the chair. Tongue
process
accessory (Cr
45 degrees oid (both sides) diagonally between sternum,
depressor can be held
the origin and
anterior
11, C2-C3)
Plane:
between teeth for
insertion, particularly superior surface
Sagittal
reference
with rotation to
medial clavicle
Axis:
contralateral
side
Stabilization
Shoulder girdle is
Transverse
stabilized to prevent
flexion of thoracic &
lumbar spine
Center Over the external auditory
meatus
Proximal Perpendicular or parallel
Arm
to ground
Distal Arm With base of nares or
parallel to longitudinal
axis of tongue depressor
Quadratus
lumborum

active extension
With subject prone
just superior to iliac
crest and lateral to
lumbar erector spinae
with isometric lateral
flexion

Motion
Muscle specific,
or
list
Muscle
(s)
Recommen Model is supine with
ded Testing arms at their side, and
Position head on table. The
examiner stands next to
patients head.
Resistance The examiner places
Hand
one hand on the model's
Placement forehead for resistance
Patient Instruct the patient
Instruction 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.