Can you palpate c1 spinous process

Note: Additional figures in this blog post article are courtesy of Joseph E. It should be emphasized that there is a science and an art to muscle myofascial palpation. These guidelines provide a sense of the principles involved in successful muscle palpation. Once a soft tissue has been located, the quality of the tissue is assessed. If the tissue being assessed is a muscle, the qualities to look for are whether it is hard or soft.

Tight overly contracted, locked short — locked long muscles feel hard; loose, relaxed muscles are soft. If the muscle is hard, is the entire muscle hard? Or are there perhaps small knots of tightness or taut bands within the muscle? Small knots may be myofascial trigger points TrPs , whereas taut bands are usually a result of bundles of muscle fibers that are either overly contracted and bunched up, or overly stretched and pulled taut.

Taut bands are usually strummable, similar to twanging a guitar string. Whether muscle tissue, other soft tissues, or bone is being assessed, palpation can provide a great deal of useful information. Palpating for swelling and increased temperature may reveal tissue inflammation; palpating for thickness and increased density within a soft tissue may reveal the buildup of fibrous adhesions within the tissues.

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We also use third-party cookies that help us analyze and understand how you use this website. There are several important soft tissue landmarks in the neck Fig.

The sternocleidomastoid muscle extends from the mastoid process of the skull to the manubrium of the sternum and clavicle, and divides the neck into anterior and posterior triangles.

The muscle is palpable along its entire length. A lymph node chain is situated along the medial border of the sternocleidomastoid muscle. The trapezius muscle extends from the external occipital protuberance to the T12 vertebra and attaches laterally into the clavicle, the acromion, and the spine of the scapula.

The muscle can be palpated along its superior border from its origin to its distal attachment. The trapezius and the sternocleidomastoid share a continuous attachment along the base of the skull to the mastoid process as well as a common nerve supply by way of the accessory nerve CN XI.

The superior border of the trapezius forms the posterior boundary of the posterior triangle of the neck. The thyroid gland lies in the anterior triangle of the neck at the level of the C5-T1 vertebrae.

It consists of right and left lobes located anterolateral to the larynx and trachea. An isthmus connects the lobes across the trachea on the midline of the neck at the level of the second to third tracheal rings. The esophagus, posterior to the trachea, begins at the inferior border of the thyroid cartilage and passes inferiorly through the superior thoracic aperture into the thorax. The carotid sheath is a fascial tube that extends from the base of the skull to the root of the neck deep to the sternocleidomastoid muscle in the anterior triangle of the neck.

It contains the common and internal carotid arteries, internal jugular vein, and vagus nerve CN X. At the level of the superior border of the thyroid cartilage, the common carotid artery divides into the internal and external carotid arteries.

The root of the neck supraclavicular fossa is at the junction between the neck and the superior thoracic aperture. It is bounded anteriorly by the manubrium of the sternum, laterally by the first rib, and posteriorly by the body of the T1 vertebra. The sternocleidomastoid muscle, as it approaches its distal attachment, and covered by the platysma muscle, can be palpated. Temporomandibular joint. The temporomandibular joint TMJ is a synovial joint, anterior to the auricle of the ear, where the head of the condyle of the mandible articulates with the articular tubercle and the mandibular fossa of the temporal bone Fig.

An articular disc divides the joint cavity into superior and inferior compartments each lined by a synovial membrane. The fibrous capsule attaches superiorly to the margins of the articular area on the temporal bone and around the neck of the condyle. The capsule is thickened laterally to form the lateral ligament, which strengthens the TMJ.

Two additional ligaments connect the mandible to the skull but add little strength to the TMJ. The stylomandibular ligament extends from the styloid process of the temporal bone to the posterior aspect of the angle of the mandible.

The sphenomandibular ligament, medial to the TMJ, runs from the spine of the sphenoid bone to the lingula of the mandible. Clemente CD. Essential clinical anatomy. Rosse C, Gaddum-Rosse P. Philadelphia: Lippincott-Raven, London: Churchill Livingstone, Essentials of human anatomy , 9th ed.

New York: Oxford University Press, Note any lacerations, lesions, or swelling. Patterns of bruising should also be noted, although bruising may take up to 24 hours to appear.

Bruising of the eyelids and orbital region is typically associated with an orbital fracture, basilar skull fracture, or fracture of the base of the anterior cranial fossa. Although many people do not have perfectly aligned eyes, pronounced asymmetry may be a sign of a zygomatic bone fracture. If the athlete has significant swelling of the eyelids that prevents him or her from opening the eye, assume the globe is ruptured and get an ophthalmologic referral immediately.

Palpate and inspect the rest of the skull, noting any hematoma, deformity, and areas of pain to palpation. While examining the oral cavity, ask the athlete to close the teeth together and examine the bite, noting alignment and pain with biting. Malaligned teeth are common, so that is not necessarily diagnostic for a fracture. Check to see if there are any teeth missing, and tap them to see if they are loose or if there is any pain. Evaluate the integrity of the gingiva, buccal mucosa, and tongue.

Crepitus or pain over the TMJ is a sign of degeneration or significant injury of the joint 1. The TMJ is often the cause of severe headaches or earaches, so examine it carefully, particularly when you find evidence of mandibular trauma. An otoscopic examination can visualize the ear canals and tympanic membranes. Evaluate for both clear and bloody discharge. As with the nose, clear discharge may be the sign of a cerebrospinal fluid CSF leak and skull fracture.

Also, the ear tips should align with the corner of the eyes, so any discrepancy should be evaluated further. Neck, lateral view. Inspection of the cervical spine should reveal sufficient cervical lordosis, or a backward curve Fig. Loss of this curve may be a clue to the source of pain, such as degenerative disc disease or spondylosis. The head should sit between the shoulders, not in front of them. Note any abnormal rotation or side bending. When inspecting the athlete from the front, the nose should be in line with the sternum.

From the side, the earlobe should be in line with the acromion process. The thyroid gland is just inferior and lateral to the thyroid cartilage Fig.

Palpate these structures, noting pain or deformity. At the base of the neck anteriorly, palpate the sternoclavicular SC joints and the length of the clavicles bilaterally, noting position, joint play, and motion. The position of the SC joints can be gauged by resting the index finger on the anterior and superior surfaces and comparing position. The sternocleidomastoid inserts here as well, so palpate its enthesis for pain or disruption. The cervical spine examination can be done with the athlete supine to allow the neck muscles to relax, although the examination can also be done with the athlete seated.

The examiner should palpate the suboccipital fossae and note tenderness and somatic dysfunction. Traveling superolaterally from the fossae are the greater occipital nerves, which may be tender in athletes with chronic headaches and in those with atlantoaxial and occipitoatlantal dysfunctions. Palpating the thyroid gland, with the athlete sitting up.

The skull should be examined for tenderness, depressions, or bony movement, particularly with any evidence of blunt trauma. An athlete with an obvious open skull fracture should be immediately transported to emergency services.

Prominent posterior landmarks to examine include the occiput, mastoid processes, inion, and superior nuchal line. Anteriorly, palpate the orbital rim and zygomatic bone for crepitus, pain, or a stepoff, which can be associated with a fracture.

Care must be taken to palpate gently throughout this examination in case an unstable fracture exists, lest the examiner displaces any fracture into a disadvantageous position. Plug one nostril by pressing on the side of the naris and ask the athlete to gently blow out through his or her nose, noting the ease and amount of air flow. If the athlete does have discharge, determine if the discharge is CSF secondary to an ethmoid fracture. If the discharge is bloody, use a piece of white gauze to soak up the discharge.

If there is a yellowishorange halo surrounding the central bloody discharge, then a CSF leak is likely. Athletes often complain of a salty taste in the mouth when they have a CSF leak; also ask the athlete if his or her sense of smell has changed, because fracture of the frontobasal or nasoethmoid bones can result in an altered sensation of smell.

The first palpable vertebral structure below the occiput is the spinous process of C2. Palpate along the spinous processes of C2 through C7, noting pain, swelling, stepoffs, and any differences in interspinous distance Fig. Note the superior nuchal ligament and the interspinous ligaments during palpation, especially in injuries involving sudden hyperflexion of the neck. Palpate with the neck flexed as well. Palpating the C2 spinous process just below the occiput.

The spinous processes of C6 and C7 should be more prominent than those of C3-C5, but the C6 prominence disappears when the neck is in extension. Any cervical spine with spinous processes that show either a stepoff or a significant difference in interspinous distance needs radiographs taken to rule out instability or fracture.

The transverse process of C1 can be palpated inferior and anterior to the mastoid process. Move laterally and palpate along the facet joints, noting any prominent pillars or tender points Fig. Note whether one facet is more prominent than the one on the contralateral side, for this can help identify a somatic dysfunction.

Finally, continue to move laterally and palpate the musculature in the posterior neck. Palpating the cervical pillars with the athlete supine. Bring the chin to the chest. Look over the left and right shoulders.

Bring each ear to each shoulder. Normal range of motion of the cervical spine is 60 to 90 degrees in flexion, 70 degrees in extension, 20 to 45 degrees in side bending, and 70 to 90 degrees in rotation. Cervical flexion primarily occurs at the occipitoatlantal joint and centers on the C5 and C6 vertebrae, while cervical extension centers around the C6 and C7 vertebrae. Rotation occurs primarily at the atlantoaxial joint, and normal range of motion is between 70 and 90 degrees.

Side bending occurs primarily at the occipitoatlantal and atlantoaxial joints. Vertebrae C3 through C7 move in flexion and extension as one continuous group. While the athlete is flexing, pay close attention to the spinous processes and note if any vertebral body is more prominent than the others 3.

By placing the athlete in a supine position, the cervical postural muscles relax, and PROM can be more accurately assessed. Painful barriers, muscle guarding, and anatomic restrictions should be noted.

Intersegmental Motion Testing Occipitoatlantal Motion The athlete lies supine with the examiner sitting at the head of the table. The examiner introduces lateral translation to the left and right, noting ease of motion or restriction Fig. Testing is repeated in flexion and extension of the head. Note any motion restriction or palpable dysfunction in the occipital articulation. Atlantoaxial Motion With the athlete supine, the examiner flexes the head while monitoring the lateral masses of the atlas with the index finger pads flexion locks out the C2-C7 vertebrae.

The head is rotated left and right, while the examiner notes any restriction or pain Fig. C2 through C7 Vertebrae Intersegmental motion is more difficult to assess in the C2-C7 vertebrae, and the examiner will have more success palpating for joint play and tissue spring in each level. The fingers introduce side bending into that segment, translating it left and right.

Note spring, tenderness, and amount of play. This helps to identify whether a segmental lesion is restricted in left or right side bending Fig. Upper cervical motion with athlete supine: occipitoatlantal motion A ; atlantoaxial motion B. The examiner then moves the index finger pads to touch the posterior aspect of the facets and introduces anterior translation, noting spring, tenderness, and amount of play. This helps to identify whether a segmental lesion is restricted moving in extension.

The vertebrae follow type II mechanics, so side bending and rotation are on the same side. Therefore, if a segment resists flexion and side bending to the left, it is classified as a vertebral segment that is positionally extended, and side-bent and rotated to the right. C4 vertebral motion testing. This is usually done with minimal spine motion in order to minimize any opportunity for injury 1 , 4.

This motion should be smooth, and there should be no deviation of the jaw to the left or right. Movements of the TMJ include opening of the mouth; closing of the mouth; and protrusion, retrusion, and lateral deviation of the mandible. Normal range of motion on opening of the mandible is from 35 to 50 mm. Functionally, only 25 to 35 mm of opening is needed for activities of daily living. To assess normal range of opening, have the athlete place two or three flexed proximal interphalangeal PIP joints into the mouth.

To palpate the TMJ, place your fingers either anterior to the tragus over the mandibular condyles or directly over the external auditory meatus. Ask the athlete to open and close his or her mouth while you palpate for clicking, grinding, or popping, noting any pain with this movement Fig. Normal range of motion on protrusion of the mandible is from 3 to 6 mm and on retrusion it is from 3 to 4 mm; however, this may vary greatly for the athlete with a significant overbite or underbite.

Normal lateral deviation is from 10 to 15 mm to each side. Test TMJ strength by resisting mandibular movement. While testing these movements, note strength and any pain that is referred to the TMJ itself. Make sure you tell the athlete that you are testing strength and that full closing of the jaw is not necessary so that he or she does not bite your fingers.

Jaw Reflex. This tests cranial nerve V, which is important in TMJ motion. The examiner uses a reflex hammer to tap the thumb. A normal reflex response is closing of the mouth 4. Temporomandibular joint palpation with jaw opened. Positive test: Absence or hyperreactivtity is considered loss of the jaw reflex. Indicates: Fifth cranial nerve injury. This test evaluates for seventh cranial nerve facial pathology.

Irritation to the seventh cranial nerve will often refer pain to the area of the TMJ. The examiner taps on the parotid gland and observes for a reaction 4. Positive test: The facial muscles twitch as a result of the tapping. Indicates: Seventh cranial nerve palsy or injury. Head and Neck. The skull is the skeleton of the head, which encloses the brain and its coverings as well as the 12 cranial nerves connected to the brain; houses the organs of special senses sight, hearing, taste, and smell ; and surrounds the openings into the digestive and respiratory tracts.

The erector spinae muscles in the neck include the following from superficial to deep:. The multifidus muscles, lying deep to the semispinalis muscles, are thin in the cervical region.