REIDER PART 2
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310 Chapter 8 Cervical and Thoracic Spine

spine and, thus, are less common. However, palpation of the thoracic spine may be used to detect localized tender-ness or discontinuity just as in the cervical spine.

Anterior Aspect

The principal landmarks of the anterior neck have already been described. Whcn not readily visible, the hyoid bonę, the thyroid cartilage, and the cricoid cartilage can be gently palpated. The primary purpose of identify-ing these structurcs is to orient the examiner to the cor-responding vertebral level of spinał pathology.

The hyoid is a horseshoe-shaped bonę that lies just caudal to the angle of the mandible at about the level of the C3 vertebral body (see Fig. 8-9). The hyoid is rarely visible but usually easily palpable. The examiner may gently grasp this firm curved structure between the thumb and the index frnger (Fig. 8-21).

Just inferior to the hyoid bonę is the thyroid cartilage. The thyroid cartilage forms the Adams apple, which is prominently visible in many men. This large superficial wing-like structure is freely mobile (Fig. 8-22). The thyroid cartilage is located at the level of the C4 and C5 ver-tebral bodies.

Inferior to the thyroid cartilage is a narrow groove fol-lowed by the prominent curved band that is the anterior

Figurę 8-21. Palpation of the hyoid.

Figurę 8-22. Palpation of the thyroid cartilage.

portion of the cricoid cartilage ring (Fig. 8-23). This mobile ring is located approximately at the level of the C6 vertebral body. The cxaminer s fingers may then be slid laterally to the right or the left of the cricoid in the smali depression formed by the anterior strap muscles and the anterior borders of the sternocleidomastoid. Direct gentle posterior pressure should result in the detection of the tubercles of Chassaignac, or carotid tubercles, located on C6. Typically, pulsations of the carotid artery are felt just medial to Chassaignac^ tubercles. The examiner should takc care not to compress both carotid arteries simultancously.

■ MANIPULATION Muscle Testing

Strength testing of the muscles that move the cervical spine is not usually emphasized as much as the cvaluation of the muscles that are innervated by the various cervical nerve roots. Nevertheless, it is important to establish that the protective function of the intrinsic cervical muscula-ture is present. In addition, the identification of specific weak muscle groups, although not as significant as the identification of a specific central or peripheral neurologie dcficit, may allow the clinician to formulate a treat-ment plan to restore normal function.