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Anatomy and
Clinical Evaluation
Orthopedic Assessment III
Head, Spine, and Trunk
with Lab
PET 5609C
Clinical Anatomy
Cervical Spine:
Greatest range
of motion
risk of injury
Vertebral bodies:
Smaller than
other vertebral
sections
7 vertebrae:
1st Atlas
2nd Axis
Clinical Anatomy
Cervical Spine:
Atlas:
No vertebral body
Transverse processes
No true spinous
process
Supports the weight
of the skull through 2
facet surfaces
(atlanto-occipital joint
or C0-C1 articulation)
Clinical Anatomy
Atlanto-occipital joint
dislocation:
Prevertebral soft-tissue
swelling (white arrow)
Malalignment between
the skull and the
cervical spine with
widening of the atlantooccipital joints (black
arrow)
Clinical Anatomy
Cervical Spine:
Axis:
2nd cervical
vertebrae
Small body with a
superior projection
(Dens)
Atlanto-axial joint:
Dens and atlas
articulation
Rotation of the
skull
Clinical Anatomy
Cervical ligaments:
Ligamentum nuchae:
Limits flexion
Interspinous ligaments:
Ligamentum flavum:
Connect laminae
Limits flexion and rotation
Clinical Anatomy
Brachial
Plexus: C5 T1
7 cervical
vertebrae
8 cervical
nerves:
Clinical Anatomy
Muscular Anatomy:
Cervical extension and flexion
bilateral contraction of cervical
muscles
Side bending and rotation unilateral
contraction
Superficial cervical musculature:
Splenius capitis
Splenius cervicis
Upper trapezius
Sternocleidomastoid
Clinical Anatomy
Splenius capitis:
O: Lower half of
ligamentum nuchae
I: Mastoid process
and adjacent occipital
bone
A: Lateral bending
Splenius cervicis:
O: C7 spinous process
through T6
I: Transverse
processes of C2 C4
A: Rotation, extension
Clinical Anatomy
Upper trapezius:
O: Occipital
protuberance, nuchal
line, upper portion of
ligamentum nuchae
I: Lateral 1/3 of
clavicle, acromion
process
A: Cervical extension,
cervical spine
bending, scapular
elevation, upward
scapular rotation
Clinical Anatomy
Levator scapulae:
O: Spinous process
of C7, transverse
processes of C1
through C4
I: Superior medial
border of scapula
A: Extension of
cervical spine,
scapular elevation
and downward
rotation
Clinical Anatomy
Scalenes:
Anterior scalene:
Middle scalene:
Posterior scalene:
Clinical Anatomy
Clinical Anatomy
Sternocleidomast
oid:
O: Medial
clavicular head,
superior sternum
I: Mastoid
process
A: Flexion of
cervical spine,
rotation to
opposite side,
lateral bending
Clinical Evaluation
History:
Location of pain:
Localized pain:
Radiating pain:
Muscle strain,
ligament sprain,
vertebral fracture,
facet syndrome
Trauma to cervical
nerve root or spinal
cord
Onset of pain:
Acute, chronic,
insidious
Clinical Evaluation
History:
Mechanism of Injury:
Insidious onset:
Acute onset:
Clinical Evaluation
History:
Mechanism of Injury:
Acute onset:
Consistency of pain:
History:
Previous injury
Scar tissue formation
Injured disc
Osteophyte within intervertebral foramina
Clinical Evaluation
Inspection:
Cervical
curvature:
Lordotic
curvature
normal
Lateral bending
posture -
pressure on
nerve roots away
from the bend
Clinical Evaluation
Inspection:
Position of head on
the shoulders:
Unilateral spasm
lateral flexion of head
towards involved side
Torticollis: Wry neck
Rotation of chin
opposite the side of
the tilt
Congenital or
acquired spasm of
the SCM
Clinical Evaluation
Inspection:
Position of the
head on the
shoulders:
Torticollis
Clinical Evaluation
Inspection:
Hypertrophy, atrophy
Height of
acromioclavicular joints
Deltoids
Clavicles
Clinical Evaluation
Palpation:
Anterior
Structures:
Hyoid bone:
Thyroid cartilage:
Have patient
swallow noting
superior and
inferior movement
Level of 3rd cervical
vertebrae
Adams apple
Level of 4th and 5th
cervical vertebrae
Cricoid cartilage:
Clinical Evaluation
Palpation:
Anterior structures:
Sternocleidomastoi
d:
Have patient
rotate head
Scalenes:
Posterior to SCM
(C3-C6 level)
Carotid artery
Lymph nodes
Clinical Evaluation
Palpation:
Posterior and
Lateral Structures:
Occiput and
superior nuchal line
Transverse
processes
Spinous processes:
Trapezius
Clinical Evaluation
Range of Motion:
Clinical Evaluation
Range of Motion:
Active rotation:
Test position: patient seated, head held
upward and facing forward
Patient attempts to look over each
shoulder
Motion: Atlanto-axial joint (450)
Clinical Evaluation
Range of Motion:
Passive flexion:
Patient position: supine
ATC: grab patients head (under occiput)
and attempt to bring chin to chest
Passive extension:
Patient position: supine, head off end of
table
ATC: grasp patients head and move into
extension
Clinical Evaluation
Range of Motion:
Passive rotation:
Patient position: supine
ATC: grasp patients forehead and
occiput, rotate head and neck
Clinical Evaluation
Clinical Evaluation
Range of Motion:
Clinical Evaluation
Range of Motion:
Clinical Evaluation
Range of Motion:
Clinical Evaluation
Range of Motion:
Clinical Evaluation
C1-C2
C3
C4
C5
C6
C7
C8
T1
Neck flexion
Neck lateral flexion
Shoulder shrug
Shoulder abduction, ER
Elbow flexion, wrist
extension
Elbow extension, wrist
flexion
Thumb extension
Finger abduction and
Clinical Evaluation
Neurological
Screening:
Nerve root: C5
(Biceps brachii)
Patient: seated
and relaxed
ATC: thumb
placed over biceps
tendon, strike the
thumb nail with
reflex hammer
Clinical Evaluation
Neurological
Screening:
Nerve root: C6
(Brachioradialis)
Patient: seated
and relaxed
ATC: taps the
brachioradialis
with reflex
hammer
Clinical Evaluation
Neurological
Screening:
Nerve root: C7
(Triceps)
Patient: seated
and relaxed
ATC: support arm
in position of
extension and
abduction, tap the
triceps tendon with
reflex hammer
Clinical Evaluation
Babinkski Test:
Clinical Evaluation
Oppenheim Test:
Test: Upper motor neuron lesions
Patient position: supine
ATC: at patients side
Procedure: examiners fingernail is
run along the crest of the
anteromedial tibia
Positive test: great to extends and
the other toes splay