CERVICAL SPINE AND TMJ

MUSCLE/BONE PALPATION
mastoid process
If the fingers are placed behind the earlobes, the mastoid portion of the temporal bone can be
palpated; its lowest part is the mastoid process.

Link 1 - 0:08 – 0:30 (w/ SCM)

Link 2

occipital bone

If the fingers are moved in a posterior direction from the mastoid process, the occipital bone with its
superior nuchal line is reached

frontal bone

from the temporal bone, move superior and anteriorly until your fingers are in front of
you (basically, noo natin)

temporal bone

From the mastoid process, move superiorly and slightly anterior until you are palpating
just above your ears

External occipital protuberance

At the point where the two superior nuchal lines of the right and the left sides meet at the median
line, there is a small eminence, the external occipital protuberance

condyles of the mandible  Just anterior to the external auditory canals, the condyles of the mandible can be palpated. When
 the subject opens the mouth or deviates the jaw, the condyles can be felt to move on the glenoid
fossa and tubercle of the temporal bones. The mandibular condyles also can be felt by placing the
finger in the ear canal and pressing anteriorly

 To palpate the ramus, begin at the angle of the mandible and palpate superiorly along the
posterior border until the condyle is reached, anterior to the ear. To bring out the condyle, ask the
patient to alternately open and close the mouth. This allows one to feel the movement of the
condyle of the mandible at the temporomandibular joint (TMJ).

spinous process of the axis  If the examiner palpates the occiput of the skull and descends in the midline, the C2 spinous
process will be palpated as the first bump (Magee)

 Begin by finding the external occipital protuberance in the midline of the occiput or the back of
the head. From there, drop interiorly off the occiput onto the cervical spine; the first cervical
spinous process (S that will be palpable will be the spinous process of C2. As with most cervical
SPs, the C2 SP is bifid (i.e., it has two points instead of one)
 Vertebra prominens
Spinous processes of the other cervical
vertebrae
 ask the pt to bow their head and from the spinous process of the axis, move inferiorly until you
feel a bony eminence (which is also seen, that is the vertebra prominens)
 From C2, continue palpating interiorly, feeling for additional cervical SPs. In some individuals, the
next SP that will be readily palpable will be the one on C7 at the inferior end of the cervical spine.
The SP of C7 is clearly larger than the other lower cervical SPs. Move the head anteriorly and
posteriorly to feel the SP of C7.
- the pt should be in supine position to relax the muscles, due to the 3rd and 6th cervical vertebrae
have short and perforated transverse processes and their articular processes protrude laterally, the
palpabale areas of the vertebrae may feel uneven
- From the spinous process of the axis, just move inferiorly while carefully feeling the
spinous processes of the other vertebrae until you reach the vertebra prominens
THORACIC, LUMBAR SPINE, SACRUM, PELVIS
 MUSCLE/BONE PALPATION
Spinous processes of the thoracic and - ask the pt to bend forward, flexing the entire spine, when the pt does this, it somehow seperates the
lumbar spine vertebral column from one another

- to palpate the entire thoracic vertebrae, you start from the vertebra prominens since that is the last of
cervical vertebrae and inferior to that is the T1, T12 is at the level of the 12th ribs.

- to palpate the lumbar vertebrae, you start from the T12 because inferior to that is the L1, the L4 is in the
level of the superior iliac crest

Ribs ask the pt to place the hand on top of their head and stretch to the side so the ribs should somehow
separated, from there, you can palpate from the R12 to R1

To palpate the 1st rib, find the superior border of the upper trapezius muscle and then drop off it
anteriorly and direct your palpatory pressure interiorly against the first rib. Asking the patient to take in a
deep breath will elevate the first rib up against your palpating fingers and make palpation easier

To palpate ribs 2-10: Palpate the anterior rib cage lateral to the sternum. Generally, for ribs two
through ten, it is easiest to identify them by strumming or moving your fingers across them in a
superior to inferior manner. The 2nd rib is located at the level of the angle of Louis. Because of
the contour of the rib cage, it is best to continue palpating ribs 7-10 and their costal cartilages
more laterally in the anterior trunk.

To palpate ribs 11-12: They must be palpated at the bottom of the rib cage, superior to the iliac crest, in
the lateral and/or posterolateral trunk. It is often easiest to palpate the eleventh and twelfth ribs by
pressing directly into and feeling for their pointy ends. (Note: This pressure should be firm but gentle
because you are pressing soft tissue into the hard pointy end of a bone.)

Sternum

Sacrum From the PSIS, palpate the midline of the sacrum, by feeling for the sacral tubercles. Once a sacral tubercle
 is located, continue palpating superiorly and inferiorly for the other sacral tubercles.

Place the patient in a prone position, then place your fingers on the iliac crest. The iliac crest is mostly
around the “dimples” on the lower back.

Iliac crest

The PSIS is located approximately 2 inches (5 cm) from the midline of the superior aspect (the base) of the
sacrum. Locate the iliac crest and follow it posteriorly until you reach the bony prominence.

PSIS

ASIS Palpate again for iliac crest again, and move anteriorly until you reach the bony prominence. Usually it can
be palpated from the front.
 The ischial tuberosity is located deep to the gluteal fold, slightly medial to the midpoint of the buttock. It is
best to palpate it from the inferior perspective so that the palpating fingers do not have to palpate through
the gluteus maximus. Moderate to deep pressure is necessary to palpate the ischial tuberosity; however, it
is not difficult to feel and is usually not tender for the patient. Once located, palpate across the ischial
tuberosity both horizontally and vertically to palpate it in its entirety

Ischial tuberosity

Anterior inferior iliac spine (AIIS) Because of the thickness of musculature that overlies the anterior inferior iliac spine (AIIS), it can be
difficult to palpate. Drop interiorly from the ASIS and feel for the AIIS deeper into the tissue
 To locate the pubic bone, begin by palpating more superiorly on the anterior abdominal wall, then carefully
and gradually palpate farther interiorly, pressing gently into the abdominal wall until the pubic bone is felt.
It is important that the abdominal wall muscles are relaxed so that when the pubic bone is reached, it will
be readily felt.

Pubic bone

MUSCLES OF THE NECK

MUSCLE/BONE ORIGIN INSERTION INNERVATION ACTION PALPATION
Longus capitis Anterior tubercles of Basilar part of C1 – C3 Bilaterally, the They cover the rectus capitis. The
the transverse occipital bone / Muscles produce longus capitis is palpated with the
processes of C3-C5 occiput head and neck longus colli; see below for palpation
flexion. description

Unilaterally, they
produce lateral
bending and
 rotation. Because
they are close to the
axis of motion, they
provide significant
joint compression.
Longus colli Bodies of C5 Anterior tubercle C2 – C6 Cervical flexion. Place your fingers medially and deep
through T3, of C1, bodies of to the sternocleidomastoid (SCM)
transverse C1–C3, and It works with the muscle near the anterolateral surface
processes of C3–C5. Transverse longus capitis to of the cervical vertebrae. Have the
processes of C3–C6 stabilize the head, subject rotate the head to the same
especially when the side to relax the SCM and then resist
upper trapezius neck flexion with the other hand so
moves the scapula. that the muscle contraction can be
felt by the palpating fingers.

Longus capitis and colli palpation

Scalenes Anterior: Anterior and Anterior: C4,5,6 Elevates first rib; Anterior scalene: Palpate just above
Transverse medius: 1st rib laterally flexes and the clavicle and behind the SCM.
processes of 3rd, 4th Medius & Posterior: rotates cervical part
5th and 6th cervical Posterior: 2nd rib Anterior rami of of vertebral column Medial scalene: Palpated
vertebrae cervical nerves immediately lateral to anterior
scalene, just above the clavicle.
Medius:
Transverse
processes of upper
six cervical
vertebrae
 Posterior:
Link for pic:
Transverse process
https://bit.ly/39F8R4E
of lower cervical
vertebrae
Sternocleidomastoid - rotate the head of the pt to the left
and resistance is given to lateral
flexion of the head, it will pop out

Two muscles acting - Easily observed when the subject

Manubrium sterni Mastoid process of Spinal part of together extend rotates the head to the opposite side;
and medial third of temporal bone and accessory nerve and head and flex neck; it becomes the most prominent
the clavicle occipital bone C2 and C3 one muscle rotates muscle of the anterior neck.
head to opposite
side

MUSCLES OF THE TRUNK

MUSCLE/BONE ORIGIN INSERTION INNERVATION ACTION PALPATION
erector Sacrum, spinous the dorsal rami of 1.) the pt is in supine position, ask the patient to raise their
spinae process of lumbar the first cervical feet and then you will see the lower part fibers of the erector
and lower two nerve (C1) through spinae
Angles of the lower
Iliocostalis thoracic vertebrae the fifth lumbar 2.) pt is in supine, ask the pt to arch the back and you will see
6 or 7 ribs
lumborum and their nerve (L5) the fibers of the erector spinae
supraspinous 3.) pt is in supine, palpate the spinous processes of the
ligaments and the (galing lang sa thoracic and lumbar vertebrae because beside those spinous
iliac crest internet to so yes) processes are the erector spinae muscles
Iliocostalis
Angles of the lower 6 Angles of the upper 6 4.) the pt is in erect position, sway forward and backwards
ribs ribs and the transverse while placing your hand behind you, you can feel the
thoracis process of C7 muscles tensing when moving forward and the muscles
Iliocostalis Angles of ribs 3 to 6 Transverse processes relaxing when moving backward
cervicis of C4 to C6
Longissimus Blends with iliocostalis Transverse processes OR
thoracis in lumbar region and is of all thoracic
attached to transverse vertebrae and just
Action of the erector spinae as a
processes of lumbar lateral to the tubercles
 of the lower 9 or 10 group may be observed best in the lumbar and lower
vertebrae
ribs thoracic regions when the subject, in the prone position,
Transverse processes Transverse processes raises the upper part of the body off the floor.
Longissimus
of upper 4 or 5 of C2 to C6
cervicis thoracic vertebrae
Transverse processes
OR
of upper 4 or 5
Posterior margin of
Longissimus thoracic vertebrae and
the mastoid process The patient must be in a prone position. Ask the patient to
capitis articular processes of
lower three or four extend the trunk, neck, and head, and feel for the
cervical vertebrae contraction of the erector spinae musculature in the lumbar
Spinous processes of Spinous processes of region. Palpate to the inferior attachment on the pelvis and
Spinalis
T10 or T11 to L2 T1 to T8 (varies) then toward the superior attachment as far as possible by
thoracis
strumming perpendicular to the fibers.
Lower part of
ligamentum nuchae Spinous process of C2
Spinalis
and spinous processes (axis)
cervicis of C7 (sometimes T1
to T2)

Spinalis Usually blends with With semispinalis

capitis semispinalis capitis capitis

*** for spinalis capitis

With the subject prone, the palpating
Iliocolumbar Fixes 12th rib during
fingers are positioned above the iliac
Quadratus inspiration; depresses
ligament, iliac crest,
12tjh rib during forced crest just lateral to the erector spinae
lumborum tips of transverse 12th rib Lumbar plexus attachments. The subject “hikes” the
expiration; laterally
processes of lower flexes vertebral hip to activate the muscle.
lumbar vertebrae column same side

Rectus abdominis Symphysis pubis and 5th 6th 7th costal Lower 6 thoracic Compresses - pt is in supine position, ask the
pubic crest cartilages and nerves abdominal contents patient to raised their shoulders and
xiphoid process and flexes vertebral head so that the spine flexes, you will
column; accessory see/feel the muscles tense up
muscle of expiration
- or ask the pt to crunch for the
 muscles to contract

The patient must be in supine

position, with a small roll under the
knees. Ask the patient to
slightly flex the trunk at the spinal
joints (slightly curl the trunk upward)
and feel for the
contraction of the rectus abdominis.
With the rectus abdominis
contracted, strum laterally
(perpendicularly) across its fibers to
locate its medial and lateral borders.

Supports abdominal The patient must be in a supine position.

contents; With palpating hand on the anterolateral
compresses abdominal wall between the iliac crest
abdominal contents; and the lower ribs (be sure that you are
lateral to the rectus abdominis), ask the
Lower 6 thoracic Assists in flexion and
Xiphoid process, patient to rotate the trunk to the
nerves and rotation of the
External oblique linea alba, pubic opposite side of the body (contralateral
Lower 8 ribs iliohypogastric and trunk; rotation) and feel for the contraction of
crest, pubic
ilioinguinal nerves Assists in forced the external abdominal oblique. Try to
tubercle, iliac crest
(L1) expiration, feel for the diagonal orientation of the
micturition, external abdominal oblique fibers by
defecation, strumming perpendicular to them
parturition, and
vomiting
Internal oblique Lumbar fascia, iliac Lower 3 ribs and Lower 6 thoracic Same as external
crest, lateral 2/3 of costal cartilages, nerves and oblique
inguinal ligament xiphoid process, iliohypogastric and
linea alba, ilioinguinal nerves
symphysis pubis (L1) A. palpation of the right external abdominal
oblique as the client flexes and
contralaterally rotates the trunk against
gravity
 B. Palpation of the right internal oblique ass
the client flexes and ipsilaterally rotates the
trunk against gravity
 In forced expiration, a tightening of the
abdominal wall is felt anterolaterally
between the lower ribs and the crest of
the ilium. It is palpated directly by
placing the fingertips just under the
anterior surface of the rib cage on
either side.
Lower 6 costal Lower 6 thoracic
Transverse cartilages, lumbar Xiphoid process, nerves and  Palpate the patient’s anterolateral
Compresses
abdominis fascia, iliac crest, linea alba, iliohypogastric and abdominal wall , and ask the patient to
abdominal contents
lateral third of symphysis pubis ilioinguinal nerves compress the abdominal content by
inguinal ligament (L1) forcefully breathing out; feel for the
contraction of the transversus
abdominis. The transversus abdominis
is deep to the external and internal
abdominal obliques and extremely
difficult to discern from these muscles,
because they also contract when
compressing the abdominal contents

MUSCLES OF RESPIRATION
MUSCLE/BONE ORIGIN INSERTION INNERVATION ACTION PALPATION
Most active during ask the pt to raise their right arm
External intercostals Inferior margin of rib Superior surface of Intercostal nerves; inspiration; supports overhead and flex the trunk to the
above rib below T1-T11 intercostals space;
left, in between the ribs are the
moves ribs superiorly
external intercostals, the internal
Superior surface of
Most active during intercostals are between the ribs
Lateral edge of rib below deep to Intercostal nerves;
expiration; supports near the sternum
Internal intercostals costal groove of rib the attachment of T1-T11
intercostals space;
above the related external moves ribs inferiorly
intercostal
Diaphragm Xiphoid process; Central tendon Phrenic Nerve Very important muscle pt in supine position, place the
lower six costal of inspiration; fingertips to the anterior surface of
cartilages, first three increases vertical
the rib cage and place the thumb to
lumbar vertebrae diameter of thorax by
pulling central tendon
the opposite side. Ask the pt to
downward; assists in breathe using the diaphragm, the
raising lower ribs. Also central portion descends and puts
used in abdominal pressure to the abdominal contents
 causing the abdomen to rise
straining and weight
lifting

MUSCLES OF THE idk HAHA

MUSCLE/BONE ORIGIN INSERTION INNERVATION ACTION PALPATION
Gluteus maximus Outer surface of Iliotibial tract and Inferior gluteal Extends and laterally Place the patient in a prone position. Ask
ilium, sacrum, gluteal tuberosity of nerve rotates hip joint; them to extend and laterally rotate the thigh
at the hip joint, and feel for the contraction of
coccyx, femur through iliotibial tract, it the gluteus maximus. With the muscle
sacrotuberous extends the knee joint contracted, strum perpendicular to the fibers
ligament to discern the borders of the muscle. you may
add resistance to the patient's thigh extension
to better engage the gluteus maximus.

Gluteus medius Outer surface of Lateral surface of Superior gluteal Abducts thigh at hip Palpating just distal to the middle of the
ilium greater trochanter nerve joint; tilts pelvis when iliac crest, ask the patient to abduct the
walking to permit thigh at the hip joint and feel for the
of femur opposite leg to clear the
contraction of the middle fibers of the
ground
gluteus medius. resistance can be added
to the patient's thigh abduction with the
support hand.

Piriformis Anterior surface of Upper border of First and second Lateral rotator of Place the patient in a prone position.
sacrum greater trochanter sacral nerve thigh at hip joint Palpate for the greater trochanter, by
of femur medially rotating the thigh at the hip joint,
and feel for the bony prominence. Then,
laterally rotate the thigh, and move the
fingers medially, you will be able to
palpate the piriformis