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Goinometery and Manual Muscle Tests of the Cervical Spine

 

 

  Number 

Grade

 

 

         0

 

 

         1

 

 

         2-

 

 

         2+

 

         2

 

Definition

No motion or palpable contraction

 

 Word 

Grade

 

 

 Trace (Tr)

 

 

 Zero

 

 

 Poor Minus (P-)

 

 

 Poor (P)

 

 

 Poor Plus (P+)

 

Movement up to 1/2 partial ROM against gravity

No motion, but palpable contraction

Movement through partial ROM in gravity-eliminated position 

Movement through complete ROM in gravity-eliminated position 

Flexion

 

  • Patient Position: Supine with shoulders abducted to 90°, elbows flexed to 90°, and dorsal forearms resting on table.

  • Stabilization: Stabilizated the thorax.

  • Palpation: Palpate sternocleidomastoid from mastoid process to attachment on sternum and medial aspect of clavicle, Longus capitis and longus colli on anterolateral surface of cervical certebrae deep to SCM, and anterior scalene above calvicle.

  • Examiner Action: Tuck patient's chin towards chest and flex cervical spine through motion passively.

  • Patient Action: Tuck chin toward's chest, flex head and neck through complete ROM, holding at the end.

  • Resistance: Apply resistance over forehead in direction of neck extension.

 

 

Goniometery and Manual Muscle Testing (MMT) are two methods used to determine range of motion and strength of a muscle or joint. Abnormalities or discrepancies values from normal values can indicate an issue with the muscle or joint. Goniometery and MMT can provide quantitative information to indicate progress or improvement in rehabilitation.

 

  Number 

Grade

 

 

         3-

 

 

         3

 

 

         3+

 

 

         5

 

         4

 

Definition

Movement through complete ROM against gravity and minimum resistance

Movement through complete ROM and moderate resistance

 

 Word 

Grade

 

 

 Fair

 

 

 Fair Minus (F-)

 

 

 Fair Plus (F+)

 

 

 Good

 

 

 Normal (N)

 

Movement through complete ROM and maximum resistance

Movement more than 1/2 partial ROM against gravity

Movement through complete ROM against gravity without resistance

Extension

 

  • Patient Position: Prone with head in neutral rotation, shoulders abducted to 90°, elbows flexed, ventral forearms resting on table.

  • Stabilization: Stabilizated the upper thorax.

  • Palpation: Palpate neck extensor just lateral to the cervical spinous processes.

  • Examiner Action: Extend patient's cervical spine through full ROM passively.

  • Patient Action: Extend head and neck through full ROM with stabilization.

  • Resistance: Apply resistance over occiput in direction of neck flexion.

 

 

Lateral Flexion

 

  • Patient Position: Supine with head turned to contralateral side, shoulders abducted to 90°, elbows flexed to 90°, and dorsal forearms resting on table.

  • Stabilization: Stabilizated the thorax.

  • Palpation: Palpate SCM from mastoid process to attachment on sternum and medial aspect of clavicle.

  • Examiner Action: Laterally flex patient's neck while keeping head turned to side passively.

  • Patient Action: Laterally flex neck to same side while keeping head rotated to opposite side.

  • Resistance: Apply resistance over lateral aspect of the skull toward examining table.

 

 

Manual Muscle Tests

Goniometry

Retrieved Novemeber 14th, 2014 from: http://www.at.uwa.edu

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Flexion

 

  • Testing Position: Sitting with thoracic spine and lumbar spine stabilized by a chair.

  • Testing Motion: Push the patient's head gently on the the back of the head anteriorly. Pull the chin in towards the chest. Stabilize the throrax to prevent thoracic spine invovlment.

  • Normal End-Feel: Firm due to streching of the posterior ligaments

 

Goniometer

  • Fulcrum: Over the external auditory meatus

  • Proximal Arm: Perpendicular or parallel to the ground

  • Distal Arm: Base of the nares. (Can use tounge depressor between the teeth for alignment)

  • Normal Values: 40°

 

Tape Measure

  • First Landmark: The middle of the tip of the chin

  • Second Landmark: The lower edge of the sternal notch

  • Take measurement in neutral position. Have patient move through motion. Retake measurement and compare the two.

  • Normal Values: 1.0-4.3cm

 

 

Extension

 

  • Testing Position: Sitting with thoracic spine and lumbar spine stabilized by a chair.

  • Testing Motion: Hold the patient's head gently on the the base of the head posteriorly. Push the chin in upward. 

  • Normal End-Feel: Firm due to streching of the anterior ligaments

 

Goniometer

  • Fulcrum: Over the external auditory meatus

  • Proximal Arm: Perpendicular or parallel to the ground

  • Distal Arm: Base of the nares. (Can use tounge depressor in the mouth for alignment)

  • Normal Values: 50°

 

Tape Measure

  • First Landmark: The middle of the tip of the chin

  • Second Landmark: The lower edge of the sternal notch

  • Take measurement in neutral position. Have patient move through motion. Retake measurement and compare the two.

  • Normal Values: 18.5-22.4cm

 

 

Lateral Flexion

 

  • Testing Position: Sitting in neutral position. Stabilize shoulder girdle to prevent excess movement.

  • Testing Motion: Hold the patient's head at the top and side opposite to the direction of the movement. Pull the head toward the shoulder without additionaly motions.

  • Normal End-Feel: Firm 

 

Goniometer

  • Fulcrum: Spinous process of C7 

  • Proximal Arm: Spinous precess of the thoracic vertebrae, perpendicular to the ground

  • Distal Arm: Dorsal midline of the head, occipital proturberance

  • Normal Values: 22°

 

Tape Measure

  • First Landmark: Mastoid Process

  • Second Landmark: lateral tip of the acromion process 

  • Take measurement in neutral position. Have patient move through motion. Retake measurement and compare the two.

  • Normal Values: 10.7-12.9cm

 

 

Rotation

 

  • Testing Position: Sitting with thoracic spine and lumbar spine stabilized by a chair.

  • Testing Motion: Hold the patient's head gently on the the base of the chin and neck posteriorly. Rotate chin towards the shoulder.

  • Normal End-Feel: Firm due to streching of ligaments.

 

Goniometer

  • Fulcrum: Center of the cranial aspect of the head

  • Proximal Arm: parallel to an imaginary line between the two acrominal processes

  • Distal Arm: Align with the tip of the nose (Can use a tounge depressor between teeth for alignment)

  • Normal Values: 49° for left rotation, 51° for right rotation. Can be between 70°-90° but verterbral artery may be compressed passed 50°

 

Tape Measure

  • First Landmark: The middle of the tip of the chin

  • Second Landmark: Scrominal process

  • Take measurement in neutral position. Have patient move through motion. Retake measurement and compare the two.

  • Normal Values: 11.0-13.2cm

Cercivcal ROM can be measured in a few different ways. Be sure to stay consistent in method when measuring ROM. In addition to goniometers and tape measures, an inclinometer or CROM device can be used for measurement.

Retrieved Novemeber 14th, 2014 from:http://www.youtube/NgvgbK64eIo

Retrieved Novemeber 14th, 2014 from: http://www.youtube/IHvGTckACE4

Retrieved Novemeber 14th, 2014 from: http://www.youtube/lS3fSiVcmTA

All Manual Muscle Testing procedures and numerical values retrieved from:

Reese, N. (2012). Muscle and sensory testing. St. Louis, MO: El Sevier Saunders

All goniometry vaules and procedures retrieved from:

Norkin, C. C., & White, D. J, (2009). Measurement of Joint Motion. Philadelphia, Pa: F.A. Davis Company

Reese, N. (2012).

Reese, N. (2012).

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