Having completed the scanning examination of the peripheral joints, the examiner should then determine muscle power and possible neurological weakness origatating from the nerve roots in the cervical spine by me ting the myotomes .myotomes are tested by resisted isometric contractions with the joint at or near the resting position. As with the resisted isometric movements previously menoned, the examiner should position the seated patient and say, "Don't let me move you," so that an isometric contraction is obtained.
Cervical Myotomes:-
• Neck flexion: C1-C2
• Neck side flexion: C3 and CN XI
• Shoulder elevation: C4 and CN XI
• Shoulder abduction: C5
• Elbow flexion and/or wrist extension: C6
• Elbow extension and/or wrist flexion: C7
• Thumb extension and/or ulnar deviation: C8
• Abduction and/or adduction of hand intrinsics: T1
The contraction should be held for at least 5 seconds so that weakness, if any, can be noted. Where applicable, both sides are tested at the same time to provide a comparison. If possible, the examiner must not apply pressure over the joints, because this action may mask symptoms if the joints are tender. To test neck flexion (CI-C2 myotome), the patient's head should be slightly flexed. The examiner applies pressure to the forehead while stabilizing the trunk with a hand between the scapulae .The examiner should ensure the neck does not extend when applying pressure to the forehead. To test neck side flexion (C3 myotome and cranial nerve XI), the examiner places one hand above the patient's ear and applies a side flexion force while stabilizing the trunk with the other hand on the opposite shoulder . Both right and left side flexion must be tested.The examiner then asks the patient to elevate the shoulders (C4 myotome and CN XI) to about one 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 . The examiner should ensure that the patient is not "bracing" the arms against the thighs if in sitting. To test shoulder abduction (C5 myotome), the examiner asks the patient to elevate the arms 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 humerus while the patient attempts to hold the arms in position. To prevent rotation, the examiner places his or her forearms over the patient's forearms while applying pressure to the humerus. To test elbow flexion and extension, the examiner asks the patient to put the arms by the sides, with the elbows flexed to 90° and forearms in neutral. The examiner applies a downward isometric force force (radially deviation) to test ulnar deviation (C8 myotome), the clinician stabilizes the patient's forearm with one hand and applies a radial deviation force to the side of the hand. In the test for thumb extension (C8 myotome), the patient extends the thumb just short of full range of motion. The examiner applies an isometric force to bring the thumbs into flexion. To test hand intrinsics (Tl myotome), the patient squeezes a piece of paper between the fingers while the examiner tries to pull it away; the patient may squeeze the examiner's fingers, or the patient may abduct the fingers slightly with the examiner isometrically adducting them


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