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Overview Examination Palpation Special tests Neurological exam Circulatory exam

Examination AROM AROM AROM with overpressure Flexion (80 to 90 o ) Extension (70 o ) Lateral flexion (L & R) (20 to 45 o ) Rotation (L & R) (70 to 90 o ) Shoulder elevation & depression PROM Tissue stretch end feel for all

Examination Manual muscle testing/isometric break testing Don t let me move you Bull your neck Flexion Extension Lateral flexion Rotation Shoulder elevation

Examination MMT Flexion Scalenes Longus coli Extension Levator scapulae Trapezius Splenius, semispinalis, & longissimus cervicis

Examination MMT Lateral flexion Trapezius Longus capitus Sternocleidomastoid Rotation Levator scapulae Sternocleidomastoid Shoulder elevation

Examination Peripheral joint scanning TMJ Shoulder girdle Elbow Wrist and hand

Palpation Bone Spinous process Transverse process Hyoid Cricoid Ring Inion Scapula

Palpation Soft tissue Thyroid Nodes Sternocleidomastoid O: Manubrium & medial clavicle I: Lateral mastoid process A: Unilateral rotation to opposite side, bilateral head flexion

Palpation Soft tissue Levator scapulae O: Transverse processes of C1-C4 I: Superior vertebral border of scapula A: Elevation, downward rotation, & adduction of the scapula Latissimus dorsi O: Spinous processes of T7-L5, lower 3 or 4 ribs, inferior angle of scapula I: Intertubercular groove (just anterior to the pectoralis major insertion) A: Extension, adduction, & internal rotation of the humerus; depression, adduction, & downward rotation of the scapula.

Palpation Soft tissue Serratus anterior O: Upper 8 or 9 ribs I: Vertebral border of the scapula A: Upward rotation & abduction of the scapula; elevates ribs Teres minor O: Superior 2/3 of axillary border of scapula I: Greater tubercle of the humerus A: External rotation, extension, & adduction of the humerus

Palpation Soft tissue Infraspinatus O: Infraspinous fossa of scapula I: Greater tubercle of the humerus A: External rotation & adduction of the humerus Subscapularis O: Subscapular fossa of anterior scapula I: Lesser tubercle of the humerus A: Internal rotation of the humerus

Palpation Soft tissue Rhomboideus Minor: O: Spinous processes of C7-T1 I: Vertebral border of scapula above spine A: Scapular adduction & downward rotation Major: O: Spinous processes of T2-T5 I: Vertebral border of the scapula below spine A: Scapular adduction & downward rotation

Palpation Soft tissue Trapezius Superior (I): O: Spinous process of C7 & up I: Lateral 1/3 of clavicle and acromion A: Elevation, adduction, and upward rotation of the scapula Medial (II): O: Spinous processes of T1-T5 I: Superior border of scapular spine A: Elevation and adduction of the scapula Inferior (III): O: Spinous processes of T6-T12 I: Medial 1/3 of scapular spine A: Depression, upward rotation, and adduction of the scapula

Palpation Soft tissue Scalenes Posterior: O: Transverse processes of C4-C6 I: Rib 2 A: Neck flexion & rotation; rib elevation Medius: O: Transverse processes of C2-C7 I: Rib 1 A: Neck flexion & rotation; rib elevation Anterior: O: Transverse processes of C3-C6 I: Rib 1 A: Neck flexion & rotation; rib elevation

Special Tests Vertebral Artery Test Distraction Compression Valsalva Test Swallowing/cough Adson Test Spurling s Sign (Foraminal Compression) Grip Strength Wiggle Fingers and Toes Pinch/Reaction to Pain

Vertebral Artery Test With patient supine, examiner supports pt s head c both hands Examiner slowly extends, rotates, & laterally flexes pt s head to the L then R. Hold each position for 30 Dizziness, blurred vision or slurred speech indicates complete or partial occlusion of vertebral artery Utilize prior to traction or other manual therapy techniques

Distraction Test Examiner begins by placing the open palm of one hand under the pt s chin with the other hand on the occipital bone at the base of the skull Gentle, linear, traction-like pressure is then exerted to lift pt s head Positive test yields a relief of pain May be indicative of nerve root compression

Compression Test Examiner presses down on the crown of the pt s head, looking for apprehension or signs of pain Pt should be either seated or supine Positive test yields pain upon compression and may be indicative of narrowed neural foramen causing nerve root compression

Valsalva Maneuver The examiner should instruct the pt to bear down as if performing a bowel movement This movement increases interthecal pressure and is positive if pain is felt upon performance May be indicative of a herniated disc

Swallowing/Cough Pain upon swallowing or coughing is considered a positive test that may be indicative of cervical spine pathology or soft tissue swelling

Adson Test Examiner begins by palpating the pt s radial pulse Pt s arm is then abducted, extended, and externally rotated while the examiner continues to palpate the pulse Pt is instructed to take a deep breath and turn the head toward the arm (look AD me) being tested A disappearance of the radial pulse is a positive test that indicates a compression of the subclavian artery by the medial scalene muscle

Spurling s Sign Examiner begins by placing the seated pt s head in moderate lateral flexion & rotation Examiner then pushes straight down on the top of the pt s head Sharp, shooting pain is a positive test for stinger / burner syndrome Pain on the same side as the head is flexed toward is probably indicative of cervical sprain while pain on the opposite side probably indicates muscle strain

Grip Strength The patient is instructed to grasp examiner s index and middle fingers of both hands and squeeze maximally The examiner should check for obvious bilateral or unilateral strength deficiencies, possibly indicating motor nerve involvement

Wiggle Fingers & Toes The examiner instructs the patient to quickly flex and extend the fingers and toes. Test is positive if athlete is unable to perform task and may indicate motor nerve involvement

Pinch & React to Pain The examiner pinches the patient at the triceps, gastrocnemius, and elsewhere to look for sensory nerve response

Neurologic Exam: Sensory Sensory dermatomes C2-C3: Occipital area and angle of jaw C4: Supraclavicular area Axillary Nerve Patch: Lateral aspect of shoulder C5: Lateral upper arm C6: Lateral forearm, thumb, and index finger C7: Middle finger and palmar aspect of hand C8: Small finger, ring finger, and medial portion of palmar surface T1: Medial side of forearm and elbow T2: Medial aspect of upper arm T3: Medial aspect of upper arm

Neurologic Exam: Motor C1-C2: Neck flexion C1-C2: Neck extension C3: Neck lateral flexion C4: Shoulder elevation C5: Shoulder abduction and external rotation C6: Elbow flexion and wrist extension C7: Elbow extension and wrist flexion C8: Thumb abduction and ulnar deviation T1: Finger approximation

Neurologic Exam: Reflexes Biceps (C5-C6) Supinator (C5-C6) Triceps (C7-C8)

DTR: Biceps (C5-C6)

DTR: Supinator/Brachioradiali s (C5-C6)

DTR: Triceps (C7-C8)

Circulatory Carotid Brachial Radial