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302 Chapter 8_Ceryical and Thoracic Spine
Figurę 8-8. A, Flexion deformity of ankylosingspondylitis. B, Sniffingposition. C, Scheucrmanns kyphosis. D, Fiat back deformity. (A, From Polly HF, Hunder GG: Rheumatologic lnterviewing and Physical Examination of the Joints, ed 2. Philadclphia, WB Saunders, 1978, p 161. C, From Boachie-Adjei O, Lonncr B: Spinał deformity. Pediatr Cliii Norlh Am. 1996;43:890. D, From La Grone MO: Loss of lumbar lordosis: a complication of spinał fusion for scoliosis. Orthop Glin North Am. 1988;19:391.)
the shouldcrs and the chin positioncd dircctly above the stemal notch (Fig. 8-9). Pain or fixcd deformity may causc the head to hc held at an anglc. Prominent midlinc anterior landmarks include the hyoid bonę, the thyroid cartilage, and the cricoid cartilage. Although evaluation of thcsc structures does not fali within the domain of the orthopaedic physical examination, their Identification allows the examincr to localize an abnormality at the cor-responding lcvel of the cervical spine. For this purpose, the examiner should keep in mind that the hyoid lies approxi-mately at the level of C3, the thyroid cartilage at the level of CA and C5, and the cricoid cartilage at the level of C6.
Lateral to the midline, the two sternocleidomastoid muscles are prominent landmarks that are visible in most
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