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SCM related tests
Erratum to “Sternocleidomastoid muscle imbalance in a patient with recurrent headache”: [Manual Therapy 11(1), 78–82] Manual Therapy, Volume 11, Issue 4, November 2006, Page 352, Michael T. Cibulka Posture and alignment When standing in a comfortable upright stance with the feet placed shoulder's width apart no forward head posture or thoracic kyphosis was noted from a lateral view. From an anterior/posterior view the head was held in a position of 10° of left lateral flexion. However, no obvious torticollis was observed in the cervical spine. Examination in sitting showed that she did display some forward head posture. Examination of her jaw showed a normal angle class I occlusion with normal centric position of her teeth on full occlusion. She had no missing teeth except for her Wisdom teeth. 2.2.3. Palpation Palpation of the muscles of the cervical spine showed tenderness only in the right SCM muscle when compared to the left. Also, the right SCM muscle appeared to be smaller in circumference than the left SCM muscle when palpating with the thumb and index finger. 2.2.4. Range of motion Active cervical range of motion was measured with the cervical range of motion (CROM) goniometer. The reliability of the CROM has shown to be high (Youdas et al., 1992). Left and right active shoulder range of motion was full, with 175° of abduction and flexion, 90 of external rotation and 60° of left internal rotation and 55° of right internal rotation (Norkin and White, 1995). Muscle length tests of the pectoralis major and latissimus dorsi, as described by Kendall et al., were symmetrical and normal in length (Kendall et al., 1952). Testing the antero-lateral neck flexors (SCM and AS) by side-bending the head as far as possible and then rotating to the opposite side showed reduced length of the left when compared to the right side. This test showed the left SCM and AS were shorter in length than the right side. 2.2.5. Joint mobility Specific joint mobility of the cervical spine was tested, although the inter-tester reliability of testing specific joint mobility has been shown to be fair to moderate (Kappa coefficients 0.28–0.43) (Smedmark et al., 2000). In a study of patients with headache Jull et al. (1997) found high intra-tester reliability in finding cervical dysfunction. The atlanto-occipital joint was assessed using the method described by Bourdillon and Day (1987). On passive motion testing the author noticed that right side bending motion appeared less than left side bending at the atlanto-occipital joint. Assessment of the atlanto-axial joint was performed using a method described by Bourdillon and Day (1987). Assessment of the atlanto-axial joints showed less right rotation than left rotation observed visually by 20°. After the upper cervical joints were tested the lower cervical joints were testing using a side gliding technique. Movement of right side gliding was found diminished at C2/3 but not with left side gliding. Movement appeared symmetrical for segments from C3/4 to C6/7. Also, no pain was created nor did the “end feels” appear different from side to side. 2.2.6. Muscle performance Manual muscle testing was performed according to the method of Kendall et al. (1993). Testing the left and right shoulders of the right abductor, right shoulder flexor, and right external rotator muscles, all displayed Normal muscle grades. Manual muscle testing of the SCM and AS muscles showed weakness on the right, a Good Minus muscle grade (Kendall et al., 1993). Testing the anterior head and neck flexor muscles (longus capitus and colli and rectus capitus anterior aided by the SCM, AS, and hyoid muscles) was performed supine as described by Kendall et al. (1993). Resistance was applied to the chin and resistance was placed in the direction of head. Backward bending was attempted to test the ability of the anterior neck flexor muscles (longus capitus and colli and rectus capitus anterior) to maintain the head in chin tucked or flexed position. No weakness of the anterior neck flexors was noted suggesting a Normal muscle grade. Although some studies suggest that manual muscle testing scores have questionable reliability, (Frese et al., 1987; Wadsworth et al., 1987) others suggest that they can be used for detecting substantial weakness. Florence et al. found the manual muscle testing intrarater reliability for individual muscles range from kw=.80 to .99 (Cohen's weighted Kappa) in patients with neuromuscular impairments (Florence et al., 1992). Bohannon (1999) found that manual muscle tests grades correlated well with hand held dynamometry scores in 50 patients suggesting that they measure the same variable-strength. 2.2.7. Special tests A Sharp-Purser test was performed as well as the extension-rotation test to assess the possibility of atlanto-axial ligamentous laxity or vertebral artery occlusion. Uitvlugt and Gndenbaum (1988) showed that the Sharp-Purser test is a useful clinical examination to diagnose atlanto-axial instability (sensitivity 88%; specificity 96%). The extension-rotation test, like other vertebral artery tests, has been shown to have excellent specificity but poor sensitivity (Cote et al., 1996). Both tests were negative.
Erratum to “Sternocleidomastoid muscle imbalance in a patient with recurrent headache”: [Manual Therapy 11(1), 78–82] Manual Therapy, Volume 11, Issue 4, November 2006, Page 352, Michael T. Cibulka Posture and alignment When standing in a comfortable upright stance with the feet placed shoulder's width apart no forward head posture or thoracic kyphosis was noted from a lateral view. From an anterior/posterior view the head was held in a position of 10° of left lateral flexion. However, no obvious torticollis was observed in the cervical spine. Examination in sitting showed that she did display some forward head posture. Examination of her jaw showed a normal angle class I occlusion with normal centric position of her teeth on full occlusion. She had no missing teeth except for her Wisdom teeth. 2.2.3. Palpation Palpation of the muscles of the cervical spine showed tenderness only in the right SCM muscle when compared to the left. Also, the right SCM muscle appeared to be smaller in circumference than the left SCM muscle when palpating with the thumb and index finger. 2.2.4. Range of motion Active cervical range of motion was measured with the cervical range of motion (CROM) goniometer. The reliability of the CROM has shown to be high (Youdas et al., 1992). Left and right active shoulder range of motion was full, with 175° of abduction and flexion, 90 of external rotation and 60° of left internal rotation and 55° of right internal rotation (Norkin and White, 1995). Muscle length tests of the pectoralis major and latissimus dorsi, as described by Kendall et al., were symmetrical and normal in length (Kendall et al., 1952). Testing the antero-lateral neck flexors (SCM and AS) by side-bending the head as far as possible and then rotating to the opposite side showed reduced length of the left when compared to the right side. This test showed the left SCM and AS were shorter in length than the right side. 2.2.5. Joint mobility Specific joint mobility of the cervical spine was tested, although the inter-tester reliability of testing specific joint mobility has been shown to be fair to moderate (Kappa coefficients 0.28–0.43) (Smedmark et al., 2000). In a study of patients with headache Jull et al. (1997) found high intra-tester reliability in finding cervical dysfunction. The atlanto-occipital joint was assessed using the method described by Bourdillon and Day (1987). On passive motion testing the author noticed that right side bending motion appeared less than left side bending at the atlanto-occipital joint. Assessment of the atlanto-axial joint was performed using a method described by Bourdillon and Day (1987). Assessment of the atlanto-axial joints showed less right rotation than left rotation observed visually by 20°. After the upper cervical joints were tested the lower cervical joints were testing using a side gliding technique. Movement of right side gliding was found diminished at C2/3 but not with left side gliding. Movement appeared symmetrical for segments from C3/4 to C6/7. Also, no pain was created nor did the “end feels” appear different from side to side. 2.2.6. Muscle performance Manual muscle testing was performed according to the method of Kendall et al. (1993). Testing the left and right shoulders of the right abductor, right shoulder flexor, and right external rotator muscles, all displayed Normal muscle grades. Manual muscle testing of the SCM and AS muscles showed weakness on the right, a Good Minus muscle grade (Kendall et al., 1993). Testing the anterior head and neck flexor muscles (longus capitus and colli and rectus capitus anterior aided by the SCM, AS, and hyoid muscles) was performed supine as described by Kendall et al. (1993). Resistance was applied to the chin and resistance was placed in the direction of head. Backward bending was attempted to test the ability of the anterior neck flexor muscles (longus capitus and colli and rectus capitus anterior) to maintain the head in chin tucked or flexed position. No weakness of the anterior neck flexors was noted suggesting a Normal muscle grade. Although some studies suggest that manual muscle testing scores have questionable reliability, (Frese et al., 1987; Wadsworth et al., 1987) others suggest that they can be used for detecting substantial weakness. Florence et al. found the manual muscle testing intrarater reliability for individual muscles range from kw=.80 to .99 (Cohen's weighted Kappa) in patients with neuromuscular impairments (Florence et al., 1992). Bohannon (1999) found that manual muscle tests grades correlated well with hand held dynamometry scores in 50 patients suggesting that they measure the same variable-strength. 2.2.7. Special tests A Sharp-Purser test was performed as well as the extension-rotation test to assess the possibility of atlanto-axial ligamentous laxity or vertebral artery occlusion. Uitvlugt and Gndenbaum (1988) showed that the Sharp-Purser test is a useful clinical examination to diagnose atlanto-axial instability (sensitivity 88%; specificity 96%). The extension-rotation test, like other vertebral artery tests, has been shown to have excellent specificity but poor sensitivity (Cote et al., 1996). Both tests were negative.
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