Spine Goniometry Flashcards
Cervical flexion
Chin tuck
End feel should be firm.
Expected AROM: 45º
Position: seated with head at neutral, shoulders are stable and back is supported as needed
Goniometry
fulcrum - external auditory meatus (ear hole)
stationary arm - perpendicular or parallel to floor
moveable arm - base of nares (nose holes)
Cervical extension
Expected AROM: 45º
Position: seated with head at neutral, shoulders are stable and back is supported as needed
Goniometry
fulcrum - external auditory meatus (ear hole)
stationary arm - perpendicular or parallel to floor
moveable arm - base of nares (nose holes)
Cervical lateral flexion
Expected AROM: 45º, consistency for left and right
Firm end feel
Position: head in neutral
Goniometer
fulcrum - spinous process of C7
stationary arm - along spinous process of thoracic region, perpendicular to the floor
moveable arm- midline of back of head, occipital protuberance
Cervical rotation
Expected ROM: 50º - 70º
Firm end feel
Position: seated, head at neutral
Goniometer:
fulcrum - imaginary line over the center of the head
stationary arm - parallel between the two acromion processes, or over the nose
Cervical motion
Alternative methods for cervical flexion
Tape measure, 1-4cm (book says 3 cm) is normal
Tip of chin to sternal notch
Inclinometers
Crom device
Arthrodial protractor
Alternative methods for cervical extension
Tape measure, same norm is 18-22 cm (book says 20)
Others
- Inclinometers
- Crom device
- Arthrodial protactor
Alternative methods for cervical lateral flexion
Measuring tape (13 cm), tip of mastoid process to acromion process
Inclinometers, CROM device
Alternative methods for cervical rotation
Tape measure-11-12 cm, tip of chin to acromion process
Inclinometer, CROM device and Arthrodial protractor
Cervical flexion muscles
Sternocleidomastoid
- Palpate bilateral anterior lateral aspect during flexion
- Assess one side (contralateral) by turning head
Anterior, middle and posterior scalene
- Palpate in the triangle of the clavicle and sternocleidomastoid, force inspiration
Logus colli
- Too deep
Longus capitus
- Too deep
The Scalene, colli and capitus work unilaterally to rotate and laterally flex.
MMT for cervical extension
Palpation:
- Deep to the upper trapezieus
- Start at angle of jaw and slide around or find edge of trapezius and slide toward jaw
Position:
Pt in prone with head off table
5-full range (lift head up) with resistance to the occipital bone(back of head)
3-full range, no resistance
2-partial range
1-trace
MMT of rotation and lateral flexion
Rotation is the act of contralateral flexors
Lateral flexion-ipsilateral flexors and extensors
So you actually assess this when looking at flexion and extension
Spinal test
Compression Test (Spruling) or Axial Loading
- Used to assess disc protrusion or irritation of facet joints (probably arthritis)
- Pt is seated with head and neck in neutral
- Compress force downward (don’t bend)
- For cervical and upper thoracic
Positive:
- Symptoms will increase
Shoulder depression test
Suspected cases of nerve root or nerve compression
Subject is supine or seated
Examiner depresses the shoulder being tested while side bending the neck
Positive: reproduction or exacerbation of symptoms
- If it is a nerve problem, the pain will follow the dermatome. If it hurts in a certain spot, it is either a bone problem or a soft tissue problem.
Thoracic and lumbar flexion assessment
Thoracic and Lumbar Flexion
- Tape measure=normally 4 inches
- Pt sits or stands erect
- Tape measure-C7 and S1
- Have patient bend over and touch toes
* Allow tape to slide
Watch for hip flexion, cervical flexion, and anterior pelvic tilt
Thorocolumbar lateral flexion
Expected AROM = 35º
Subject is standing
Goniometer:
- Fulcrum: posterior over s2
- Stationary arm: perpendicular to the floor (down the butt crack)
- Movable arm: in line with the spinous processes of lumbar and thoracic
Ask pt to slide the arm down the leg
Alternative method
- Measure from fingertip to ground
- Measure distance slid on thigh
MMT Rectus abdominis
O – pubic symphysis and pubic crest
I – Xiphoid process and 5th-7th costal cartilages
A –trunk flexion, abdominal viscera compression, stabilizes pelvis
N – Thoraco-abdominal and subcostal nerves (anterior rami of T7-T12 spinal nerves)
Flexion of the upper trunk
Palpate
- Both sides of the midline between the xiphoid process and belly button
Pt is in supine
Scale is a bit different
5 = pt places hands on top of head and inferior angle of scapula clears table
4 = arms across chest, inferior angle clears
3 = arms by side, inferior angle clears
2 = arms by side, contractions with full depression of thorax; some movement but scapula don’t clear
1= trace
MMT Lower rectus abdominis
Palpation is below the umbilicus
Position
Supine with hips and knees flexed
5=lifts sacrum off mat 8-10 x
4=lifts sacrum off mat 4-6 x
3=lifts sacrum off mat 1x
2=complete pelvic tilt, but sacrum doesn’t lift
1=trace
Erector spinae, transversospinalis, interspinalis MMT
These are the back extensors, cervical, thoracic and lumbar
Interspinales:
O - superior surfaces of spinous processes of cervical and lumbar vertebrae
I- inferior surfaces of spinous processes of vertebrae superior to vertebrae of origin
A - aid in extension and rotation
N - posterior rami of spinal nerves
Erector spinae
O – posterior part of iliac crest and sacrum, sacro-iliac ligaments, sacral and inferior lumbar spinous processes and supraspinous ligament
I: Iliocostalis – superior angles of lower ribs and transverse processes
Longissimus – superior to ribs between tubercles and angles to transverse processes in thoracic and cervical regions and mastoid process
Spinalis: superior to spinous process in upper thoracic region and cranium
A: bilateral extension of vertebral column and head, and controlled back flexion; unilateral lateral flexion
N: posterior rami of spinal nerves
Transversospinalis:
Semispinalis
O – transverse processes of C4-T10
I – superiormedial to occipital bone and spinous processes in upper thoracic and cervical region
A - head, thoracic, and cervical extension, contralateral rotation
N – posterior rami of spinal nerves
Multifidus
O - posterior sacrum, posterior iliac spine, aponeurosis of erector spinae, sacro-iliac ligaments, mammillary processes of lumbar vertebrae, transverse processes of thoracic vertebrae, and articular processes of C4-C7
I - spinous processes of vertebrae located in 2-4 segments superior to origin
A - stabilizes the vertebrae, unilateral contraction rotates to contralateral side
N - posterior rami of the spinal nerves
Rotatores
O - transverse processes of vertebrae
I - lamina and transverse process or spinous process of vertebra immediately above or 2 segments superior to vertebra of origin
A - proprioception, stabilize, extends, and rotates the spine
N - posterior rami of the spinal nerve
Palpation: either side of the thoracic and lumbar vertebra
Position: prone with pillows under tummy (slight flexion) or with chest off mat
- Subject lifts (pass or fail) - nipple line should clear table
- If they can’t do above, you test with gravity minimized
* sit backward in chair, with back arched, sit up
