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Musculoskeletal Pathology



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Surface Landmarks for Palpation
Vertebra Landmark

1 finger-width below mastoid process

2 finger-widths below occipital protuberance


Angle of the mandible

3 finger-widths below occipital protuberance

C3–4 Posterior to hyoid bone
C6 Posterior neck @ level of the cricoid cartilage
C7 Most prominent cervical spinous process
T2 Superior aspect of the scapula
T4 Spine of the scapula
T7 Inferior angle of the scapula
T10 Xiphoid process
T12 Lowest (12th) floating rib
L3 Posterior to umbilicus
L4 Iliac crest
L5 Lumbar dimples
Tip of coccyx Ischial tuberosities

Source: Anderson MK, Hall SJ & Martin M (2000).

Temporomandibular Joint (TMJ) Tests

TMJ AUSCULTATION: Used to identify poor joint kinematics or joint/disk damage; place stethoscope over TMJ, just anterior to tragus of ear, clinician listens for presence of joint sounds; very sensitive to finding a problem but not specific in the identification of the structure


  • Opening click = click as condyle moves over posterior aspect of disk in an effort to restore normal relationship; disk is anterior to condyle; the later the click, the more anterior the disk

  • Reciprocal click = in opening, the disk reduces as the condyle moves under the disk & in closing, a second click is heard as the condyle slips posteriorly & the disk becomes displaced anteriorly


Purpose: Assess soft tissues of TMJ

Position: Face client with clinician's index fingers palpating lateral pole of TMJ

Technique: Open & close mouth several times

Interpretation: + test = ↑ or reproduction of symptoms incriminating LCL or TMJ ligament


Purpose: Assess posterior disk

Position: Face client, clinician inserts little fingers into client's ears

Technique: While applying forward pressure with fingers, client opens & closes mouth repeatedly

Interpretation: + test = ↑ or reproduction of symptoms


Purpose: To mimic TMJ loading to differentiate between TMJ & muscle pain

Position: Sitting with roll of gauze between molars on 1 side

Technique: Client bites down on gauze roll

Interpretation: Compression occurs on contralateral side & distraction on ipsilateral side of gauze; + test = ↑ or reproduction of symptoms @ TMJ

Upper Limb Neurodynamic Tests


Position: Supine or sitting with contralateral cervical SB & ipsilateral shoulder depressed

Technique: Extend UE in plane of scapula with elbow extended, forearm supinated, & wrist/fingers extended

Interpretation: + test = pain or paresthesia into median ...

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