KenasarePhysio

CERVICAL MYOTOME TESTING
PURPOSE To assess the integrity of the cervical spine nerve roots supplying the muscles of the
upper limb.
SUSPECTED INJURY Pathological condition of the spinal nerve root.
PATIENT POSITION The patient is sitting.
EXAMINER POSITION The examiner is positioned directly in front of or to the side of the patient’s upper
extremity.
TEST PROCEDURE Myotomes are tested by resisted isometric contractions with the joint at or near the
resting position. As with the resisted isometric movements previously mentioned, the
examiner should position the joint being tested and instruct the patient, “Don’t let me
move you,” so that an isometric contraction is obtained. The contraction should be
held at least 5 seconds, because myotome weakness commonly takes time to develop.
C1-C2 myotome (neck flexion). The patient’s head should be slightly flexed (a
nod). The examiner applies pressure to the patient’s forehead while stabilizing the
patient’s trunk with a hand between the scapulae (A). The examiner should make
sure the patient’s neck does not extend when pressure is applied to the forehead.
C3 myotome and cranial nerve XI (neck side flexion). The examiner places one
hand above the patient’s ear and applies a sideflexion force to the head while stabi
lizing the patient’s trunk with the other hand on the opposite shoulder (B). Both
right and left side flexion must be tested.
C4 myotome and cranial nerve XI (shoulder elevation). The examiner asks the
patient to elevate the shoulders to about half of full elevation. The examiner applies
a downward force on both of the patient’s shoulders while the patient attempts to
hold them in position (C). The examiner should make sure the patient is not
“bracing” the arms against the thighs if testing is done with the patient sitting.
C5 myotome (shoulder abduction). The examiner asks the patient to elevate the
arms to about 75° to 80° in the scapular plane with the elbows flexed to 90° and the
forearms pronated or in neutral. The examiner applies a downward force on the
humeral shaft while the patient attempts to hold the arms in position (D). To prevent
rotation, the examiner places his or her forearms over the patient’s forearms while
applying pressure to the humerus.
C6 and C7 (elbow flexion and extension). The examiner asks the patient to put the
arms by the sides with the elbows flexed to 90° and the forearms in neutral. The
examiner applies a downward isometric force to the forearms to test the elbow
flexors (C6 myotome) (E) and an upward isometric force to test the elbow extensors
(C7 myotome) (F). For testing of wrist movements (extension, flexion, and ulnar
deviation), the patient has the arms by the side, the elbows at 90°, the forearms
pronated, and the wrists, hands, and fingers in neutral. The examiner applies a
downward force to the hands to test wrist extension (C6 myotome) (G) and an
upward force to test wrist fl exion (C7 myotome) (H).
C8 myotome (thumb extension). The patient extends the thumb just short of full
ROM. The examiner applies an isometric force to bring the thumb into flexion (I).
A lateral force (radial deviation) to test ulnar deviation may also be performed to
test the C8 myotome. The clinician stabilizes the patient’s forearm with one hand
and applies a radial deviation force to the side of the hand.
T1 myotome (finger abduction/adduction). To test hand intrinsics (T1 myotome),
the examiner may have the patient squeeze a piece of paper between the
fingers (usually the fourth and fifth fingers) while the examiner tries to pull it away.
Alternatively, the patient may squeeze the examiner’s fingers, or the patient may
abduct the fingers slightly with the examiner isometrically adducting the fingers (J).