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Client Supine:
suprahyoid group. The client is supine; you are seated at
the head of the table. To palpate the infrahyoids, place
1.
2.
Sternocleidomastoid (SCM): The client is supine with
your palpating fingers immediately inferior to the hyoid
the head and neck contralaterally rotated; you are seated
bone and just off center and feel for their contraction as
at the head of the table. Before palpating, first visualize the
the client is resisted from depressing the mandible at the
contraction of the SCM as the client lifts the head from the
temporomandibular joints (TM)s). Once felt, palpate these
table. Then palpate the contraction of the SCM just supe-
muscles toward their inferior attachments on the sternum
rior to the sternoclavicular joint as the client again lifts the
by strumming perpendicular to the fibers as the client
head from the table. Once felt, continue palpating the SCM
alternately contracts and relaxes them. The inferior belly
to the mastoid process of the temporal bone and the supe-
of the omohyoid can be palpated in the posterior triangle
rior nuchal line of the occipital bone by strumming per-
of the neck by strumming perpendicular to it as the cli -
pendicular to the fibers as the client alternately contracts
ent is resisted from depressing the mandible at the TMJs .
and relaxes the muscle. Note: Look and palpate carefully
To palpate the suprahyoids, place your palpating fingers
for the clavicular head; it is usually less obvious than the
immediately inferior to the mandible and again feel for
sternal head.
their contraction as the client is resisted from depressing
Scalene group: The client is supine; you are seated at the
the mandible at the TMJs. Once felt, palpate these muscles
head of the table. Locate the lateral border of the clavicu -
toward the hyoid bone by strumming perpendicular to the
lar head of the SCM (be sure that it is the lateral border
fibers as the client alternately contracts and relaxes them.
of the clavicular head, not the sternal head that you have
Palpate the stylohyoid and superior belly of the digastric
located). Place palpating fingers just lateral to the lateral
by strumming perpendicular to their fibers from the hyoid
border of the clavicular head of the SCM and just superior
bone toward the mastoid process of the temporal bone as
to the clavicle, and feel for the contraction of the scalenes
the client alternately contracts and relaxes them.
as the client takes in short, quick breaths through the nose.
Once felt, palpate as much of the scalenes as possible in
the posterior triangle of the neck by strumming perpen-
Client Seated:
dicular to the fibers. The transverse processes attachment
of the scalenes can usually be palpated by pressing in deep
to the SCM if it is first slackened by passively flexing and
5.
neck contralaterally rotated; you are standing to the side of
ipsilaterally laterally flexing the client's head and neck.
the client. Feel for the contraction of the upper trapezius
Note: It can be challenging to discern the anterior, middle,
at the top of the shoulder as the client is resisted from
and posterior scalenes from each other. The best way to
extending the head and neck against the resistance of your
achieve this is to try to feel for the different direction of
support hand on the back of their head (Note: The contrac-
fibers that each one has. Remember: the anterior scalene
tion of the upper trapezius is often visible and palpable; be
goes to C3-C6; the middle scalene goes to C2-C7; and the
sure to look for it as well). Continue palpating the upper
posterior scalene goes to C5-C7. Also, keep in mind that
trapezius toward its medial attachment on the head and
the posterior scalene is located in the posterior triangle of
neck and its lateral attachment on the lateral clavicle and
the neck immediately anterior to the upper trapezius and
acromion process by strumming perpendicular to its fibers
levator scapulae.
3.
as the client alternately contracts and relaxes it. Note: The
Longus colli/longus capitis: The client is supine; you are
superior aspect of the upper trapezius is actually quite
seated at the head of the table. Locate the medial border
narrow and only attaches to the medial V 3 of the superior
of the sternal head of the SCM, and then drop off it and
place palpating fingers immediately medial to that. Sink in
toward the anterior surface of the vertebral bodies slowly
and gently, but firmly. If you feel a pulse under your fingers,
move your fingers to one side or the other and continue
palpating for the vertebral bodies. Once you have reached
the vertebral bodies, confirm that you are on the longus
colli by asking the client to flex the head and neck by lifting
the head up off the table. Palpate as much of the longus
colli and capitis as possible superiorly and inferiorly by
strumming perpendicular to the fibers. Note: The carotid
tubercle on the transverse process of C6 (see page 100) is a
good landmark for determining the segmental level of the
palpating fingers.
4.
Hyoid group: For the purpose of palpation, the hyoid
group can be divided into the infrahyoid group and the
Upper trapezius: The client is seated with the head and
nuchal line of the occipital bone.
6.
Levator scapulae: Note: The palpation of the levator scapulae can be divided into three parts: when it is deep to the upper trapezius near its scapular attachment, when it is superficial in the posterior triangle of the neck, and when it is deep
to the SCM near its spinal attachment. The client is seated
with the hand in the small of the back; you are standing behind or to the side of the client. Locate the superior angle of
the scapula and place your palpating hand immediately superior and medial to it. Feel for the contraction of the levator
scapulae deep to the upper trapezius as the client performs
a gentle, short range of motion of elevation of the scapula
at the scapulocostal joint. Once felt, continue palpating it
until it enters the posterior triangle of the neck (i.e., until
it is no longer deep to the upper trapezius) by strumming
perpendicular to its fibers as the client alternately gently
contracts and relaxes the muscle. Once the levator scapulae
that the upper trapezius is relaxed and slackened; it can be
is located in the posterior triangle, it is superficial and eas -
slackened by passively moving the client's head and neck
ily palpable, and sometimes visible as well. It is no longer
into extension, contralateral rotation, and/or ipsilateral
necessary for the client to have the hand in the small of the
lateral flexion.
back, and the client can be asked to perform a more forceful
contraction (against resistance if desired) of elevation of the
scapula. Continue palpating it superiorly by strumming per-
Client Supine:
pendicular to its fibers as the client alternately con tracts and
relaxes the muscle. As it approaches its spinal attachment
8.
in the small of the back, and/or the head and neck rotated
deep to the SCM. To palpate it all the way to its spinal at-
to the same side (ipsilaterally rotated); you are seated at
tachments deep to the SCM, the SCM must be slackened by
the head of the table. Ask the client to extend the head and
passively moving the client's head and neck into flexion and
neck at the spinal joints by gently pressing the head into
ipsilateral lateral flexion. Note: When following the levator
the table and feel for the contraction of the semispinalis
scapulae superiorly, be sure that you follow it toward the
capitis deep to the upper trapezius, just below the occiput
transverse process of Cl, which is located more anteriorly
and just lateral to the spine. Once felt, continue palpating
than most people realize; the transverse process of Cl is
the semispinalis capitis inferiorly as far as possible as the
located immediately inferior to the ear.
7.
Semispinalis capitis: The client is supine with the hand
(transverse processes of C1-C4), the levator scapulae will go
Splenius capitis: The client is seated with the head and
client alternately contracts and relaxes the muscle.
9.
Suboccipital group (rectus capitis posterior major
neck ipsilaterally rotated; you are standing behind the
[RCPMaj], rectus capitis posterior minor [RCPMin],
client. Palpate in the uppermost aspect of the posterior tri -
obliquus capitis inferior [OCI], obliquus capitis supe-
angle of the neck, just inferior to the occiput and posterior
rior [OCS]) : The client is supine; you are seated at the head
to the SCM. Now feel for the contraction of the splenius
of the table. Begin by palpating the RCPMaj; palpate just su-
capitis as the client is resisted from extending the head and
perior and slightly lateral to the spinous process of C2 and
neck at the spinal joints. Once felt, strum perpendicular to
strum perpendicular to it fibers. Once felt, continue palpat-
its fibers and try to follow it inferiorly as the client alter-
ing the RCPMaj to the occiput by strumming perpendicular
nately contracts and relaxes the muscle. Once you are no
to its fibers. Palpate the RCPMin in the same manner by
longer in the posterior triangle of the neck, the splenius
strumming perpendicular to it, beginning just superolateral
capitis can be palpated two ways: (1) feel for it through
to the posterior tubercle of Cl. Once felt, continue palpat-
the upper trapezius by asking the client to extend the head
ing the RCPMin to the occiput by strumming perpendicular
and neck against gentle resistance; once felt, try to follow it
to it. To palpate the OCI, palpate between the spinous
as far inferiorly as possible; or (2) feel for it directly: this
process of C2 and the transverse process of Cl, strumming
requires you to palpate deep (anterior) to the border of
perpendicular to the fibers. It may be helpful to have the
the upper trapezius and press anteriorly toward the upper
OCI contract by gently resisting the client from ipsilaterall y
thoracic spinous processes by reaching with your palpating
rotating the head. The OCS is extremely challenging to pal -
fingers between the upper trapezius and the splenius capi -
pate and discern from adjacent musculature. To attempt its
tis. To accomplish this, it is best to stand more to the front
palpation, feel for it just lateral to the superior attachment
of the client so that your finger pads are oriented anterio rly
of the RCPMaj; if felt, try to continue palpating it inferiorly
toward the splenius capitis. Furthermore, it is important
by strumming perpendicular to it.