Palpation Assessment: Gross Musculature Protocol

DIGITAL MANIPULATION OF LARINX (Dr. David Parra)

- Muscles Assessed: deltoids, trapezius, stylohyoid, omohyoid,

sternocleidomastoid.
- Clinician Posture: stand behind seated patient with both hands on
shoulders/posterior neck regin
- Protocol:
Place hands firmly on shoulders and observe resting tonicity.
Begin conversation. Assess tonicity as they speak.
Begin massage. Observe tenderness and pain.

Palpation Assessment: Base of Tongue

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Muscles Assessed: Stylohyoid, hyoglossus, geniohyoid, genioglossus,

mylohyoid, digastric (anterior/posterior belly)
Clinician Posture: Stand behind seated patient. Use non-dominant to
support head cupping the angle of the skulls occipital bone. Use dominant
hands middle finger and apply upward pressure to underside of chin.
Protocol:
Observe resting tonicity.
Begin conversation. Assess tonicity as they speak.
Palpate with various pressures.
Apply moderate pressure (2.5 on a scale of 1-5).
Ask patient to identify, on a scale of 1 to 5 of increasing pressure, how
much pressure they feel you apply.

Palpation Assessment: Suprahyoid Musculature

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Muscles Assessed: Stylohyoid, hyoglossus, geniohyoid, mylohyoid,

digastric (anterior/posterior belly)
Clinician Posture: Stand behind seated patient. Use non-dominant to
support head cupping the angle of the skulls occipital bone. Use dominant
hands thumb and index or middle finger and apply medial pressure (as if
pinching) to suprahyoid muscles.
Tip: To locate hyoid bone, feel for tonsils then move inferior and anterior
OR feel for Adams Apple and move superior and posterior
Protocol:
Apply pressure during resting tonicity.
Begin conversation. Assess tonicity as they speak.
Palpate with various pressures rocking your fingers anterior and
posterior.
Apply moderate pressure (2.5 on a scale of 1-5).
Ask patient to identify, on a scale of 1 to 5 of increasing pressure, how
much pressure they feel you apply.

Palpation Assessment: Hyoid Bone Structures Assessed: Thyrohyoid Muscle

- Muscles Assessed: Suprahyoid: stylohyoid, hyoglossus, geniohyoid, mylohyoid
Infrahyoid: omohyoid, thyrohyoid, sternohyoid
- Clinician Posture: Stand behind seated patient. Use non-dominant to support
head cupping the angle of the skulls occipital bone. Use dominant hands
thumb and index or middle finger and apply medial pressure (as if pinching) to
lateral sides of the hyoid bone.
- Tip: To locate hyoid bone, feel for tonsils then move inferior and anterior OR
feel for Adams Apple and move superior and posterior
- Protocol:
Assess range of motion for the muscles surrounding the hyoid bone by
lateralizing the hyoid bone, stretching it to the right and then to the left.
Consider ease of the stretch. Is there much resistance?
Apply moderate pressure (2.5 on a scale of 1-5).Aplicar una presin moderada (2,5
en una escala de 1-5).
Ask patient to identify, on a scale of 1 to 5 of increasing tenderness
/sensitivity, how much pressure they feel you apply.

Palpation Assessment: Thyrohyoid Space

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Muscles Assessed: thyrohyoid Muscle

Clinician Posture: Stand behind seated patient. Use non-dominant to
support head cupping the angle of the skulls occipital bone. Use
dominant hands thumb and index or middle finger and apply medial
pressure (as if pinching) to thyrohyoid muscles.

- Protocol:
Apply pressure during resting tonicity and assess size of gap between
hyoid bone and thyroid cartilage.
Apply moderate pressure. Caution! This may be uncomfortable for
them!
Ask patient to identify, on a scale of 1 to 5 of increasing pressure,
how much pressure they feel you apply.
Move fingers onto the lateral portion of the hyoid bone, and assess
lateral ROM.

Palpation Assessment: Cricothyroid Muscle Assessed

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Muscles Assessed: Cricothyroid Muscle

Clinician Posture: Stand behind seated patient. Use non-dominant to
support head cupping the angle of the skulls occipital bone. Use
dominant hands middle finger to cricothyroid muscles.
Tip: This is felt as the gap inferior to the Adams Apple and superior
to the Cricoid Cartilage
Protocol:
Apply pressure during resting tonicity and assess size of gap between
thyroid and cricoid cartilage.
Ask patient to say ah and glide up and down in pitch. Notice if the
gap changes in size.
Ref.: Curtis J. (2015) Digital Manipulation