Cervical Spine Somatic Dysfunction Lecture

Question 1

Bone Anatomy

Answer 1

Cervical Spine has 7 vertebral segments:

1) C1 and C2 at ATYPICAL
- Atlas has no VERTEBRAL BODY

• Vertebral body of C2 extends SUPERIORLY to FORM DENS (ODONTOID PROCESS)

2) Articulation between C2 and C3 and rest of Cervical joints is considered TYPICAL
- Facets are in plain that points towards the eye in the Uppers, and opposite shoulder for the Lower Segments

• This is important for Manipulative Force Vectors

Question 2

Cervical Spine Passive and Active ROM

Answer 2

• Start in a Neutral position
• Palpate at C7 T1 Junction
• Have patient perform ACTIVE MOTION firs until motion palpated at your monitoring finger
• Repeat for PASSIVE MOTION
• Assess degrees of Motion

**Flexion 45-90 Degrees!!!!!!!!

**Extension 45-90 Degrees!!!!!!

**Side Bend Left 45 Degrees!!!!

**Side Bend Right 45 Degrees!!!

**Rotation Right 70 - 90 Degrees!!!!

**Rotation Left 70 - 90 Degrees!!!!

Question 3

Biomechanics

Occipital Atlantal (OA) Joint:

Answer 3

• Major motions are FLEXION and EXTENSION
• Shape of the joint allows for more SAGITTAL PLANE motion
• Minot motions are SB and Rotation
• The OCCIPUT FLEX/ EXT + Rotates and SB to Opposite Sides

**MODIFIED TYPE I MECHANICS!!!!!!!!!!!!!!!!

Question 4

Cervical Spine OA Segmental Diagnosis

Answer 4

• Contact the Posterior aspect of the Occiput with middle finger and the Lateral aspect with the Index Finger
• Assess ROTATION RIGHT by LIFTING Anterior on the LEFT SIDE
• Asses ROTATION LEFT by LIFTING Anterior on the RIGHT Side
• TRANSLATE to the LEFT for RIGHT Side Bending
• TRANSLATE to the RIGHT for LEFT Side Bending
• Reassess each of these in FLEXION and EXTENSION to determine the SAGITTAL PLANE Component

*****MODIFIED TYPE I SPINAL MECHANICS!!!!!!!

**OA F RR SL**

Question 5

Biomechanics

Atlantoaxial (AA or C1-2) Joint

Answer 5

• Primary motion is ROTATION
• ATLAS rotates about the DENS
• Almost no SB or Flexion/ Extension

Question 6

Cervical Spine AA Segmental Diagnosis

Answer 6

• Cup the Occiput and place fingers on the AA joint
• FULLY FLEX HEAD and NECK to take out ROTATION of Vertebra below AA
• Rotate Right
• Rotate Left

**Note ease of Motion and Restriction of Motion!!!

AA RR

Question 7

Biomechanics

Typical Cervical Segments (C2 through 7)

Answer 7

• Rotation and SB to SAME SIDE!!!!!
• Studies have noted Clinically, SB and Rotation to Opposite sides
• Currently thought to be due to Compensatory patterns for Dysfunction from Lower parts of Spine

**TYPE II SPINAL MECHANICS!!!!!!!!

Question 8

Diagnostic Maneuvers

Answer 8

1) Rotational (ROTOSCOLIOSIS TESTING)
- Transverse Plane

• Induce Force VENTRALLY on RIGHT LATERAL MASS = Rotate L
• Induce Force VENTRALLY on LEFT LATERAL MASS = Rotate R

2) TRANSLATION (Moving Segment Laterally)
- CORONAL PLANE

• Translation from Left to Right = SB L
• Translation form Right to Left = SB R

3) Recheck motions in Flexion and Extension
- More restricted in Flexion = EXTENSION Dysfunction

• When Segment is Flexed the Rotation or the Translation motions have a Harfer End feel at END RANGE
• More restricted in Extension = FLEXION Dysfunction
• When segment is Extended the Rotation or the Translation motions ahem a harder end feel at end Range
• The change in the Sagittal plane component will allow you to determine the Segment is TYPE 2!!!!!!!!!!!!!
• You can infer the Side Bending with ROTATIONAL TESTING or Rotation with Side Bending Testing
• DOCUMENT THE DYSFUNCTION FOUND IN THE OBJECTIVE PORTION OF THE CHART!!!!!!

Question 9

Cervical Spine Typical Vertebra Segmental Diagnosis- Rotational

Answer 9

• Contact the Vertebral Segment POSTERIORLY on the ARTICULAR PILLAR
• Asses Tissue Texture Changes
• Rotate Right
• Rotate Left
• Assess ease of Motion and Restriction of Motion
• Reassess in FLEXION and EXTENSION
• Determine Sagittal plane motion component
• TYPE 2 SPINAL MECHANICS!!!!!!!!!!!!!!

**C4 E RL SL*****

Question 10

Cervical Spine Typical Vertebra Segmental Diagnosis- Translation

Answer 10

• Contact the Vertebral Segment on the TIP of the TRANSVERSE PROCESS (MIDCORONAL LINE)
• Assess Tissue texture changes
• Translate Right
• Translate Left
• Asses EASE of MOTION and RESTRICTION of Motion
• Reassess in FLEXION and EXTENSION
• Determine Sagittal Plane Motion Component

**TYPE 2 SPINAL MECHANICS*****

C4 E RL SL*