Week 6: Cervical and Cranial

This week we will be exploring the following structures of the head and neck:

a. External occipital protuberance- tape

b. Mastoid process- MP

c. C1 transverse processes- C1

d. C2 spinous process- C2

e. Spinous processes of C3-6 & C7

f. Upper trap

g. Scalenes- anterior, middle and posterior- attachments noted with dots and intended ribs designated.

h. Sternocleidomastoid- SCM

i. Sternal notch- SN

Clinical Ap/Critical thinking –

a. The differentiation of tissue types:

bone- Hard structures with the least amount to palpable give

muscle- soft sinking in feeling. You can feel direction of muscle fibers to help you tell which muscle you are working with.

tendon- at the end of the muscles, where they attach to bones. Ropey feel.

bursa- is a fluid filled sac for cushioning and reduce friction between structures (commonly found in joints). You can feel a sinking in and rebound within the joint.

ligament- you can test the tension or laxity of these structures by pulling joints apart and noticing the feel of the give and the recoil

cartilage- a hard, but malleable feel. You are able to bend it in many places like the nose and ears.

b. Choose 2 structures we have already covered and compare and contrast them using descriptions of their "feel".

SCM – muscle- softer sinking feeling, with fibers running  diagonally, from  the  attachment at the mastoid process to the sternum and clavicle.

SCM’s tendonous attachments- can be felt distinctly at the sternum and clavicle as a more rounded, rubbery  feeling than the mscl.

c. What unique tissue qualities do these structures have? What strategies can you use to help differentiate them?

The SCM is an easy muscle to palpate and to see that you are on the right one. You can tell the patient to lie Supine (Face up) and then have them look to their right (cervically rotate to their right) and then lift their head up off the table. This makes the left SCM pop up and you can see it to grab onto it, and then tell them to relax it so you can hold on and palpate all along the belly of the SCM with a (compressor grip technique) down to the tendonous attachments at the sternum and the clavicle. You can feel the differentiation of the tendons from the muscle because the tendons have a more rounded, rubbery feeling than the muscle belly- what I referred to earlier as “ropey.”

d.  As an alternate you could compare/contrast the same structure on two different people and answer the question: How does your palpation technique differ and do you have to modify what you do to compensate for differences in patient body types?

With some people, especially thin people, you can see their SCM  when they are just lying on the table. F the client is heavy or just has a “thicker” superficial layer, the turning and lifting techniques will ensure that you can see where that muscle lies.