Upper neck movement

Placing a pencil on the vertex or forehead allows measurement. Full extension to full flexion should be approximately 90-110 degrees. A marked reduction may lead to difficulty.

Alternatively, in the neutral position, place one finger on the patient’s chin and one finger on the occipital bone. There are three classes:

Class 1	Normal cervical mobility - finger on the chin is higher than the one on the occiput
Class 2	Moderate limitation - fingers are at same level
Class 3	Severe limitation - finger on the chin is lower than the finger on the occiput

Table 1 Classes of upper neck movement