Cervical Somatic Dysfunction: Etiology and Diagnosis

00:01 There are many potemtial causes for cervical somatic dysfunction One consideration is posture imbalance.

00:06 Sometimes when we have imbalance between the anterior, posterior, right and left neck muscles, that could potentially cause increased tightness and lead to an imbalance causing cervical somatic dysfunction of assymetry.

00:20 Traumatic cranial somatic dysfunctions could also lead to cervical somatic dysfunction, If we have a significant assymetry of the cranium leading to assymetry at the occiput, that could lead to somatic dysfunctions of the neck Some cervical traumas could cause cranial somatic dysfunctions Whiplash is example, if you have an impending accident and you're driving, you tighten up and so you take these muscles that are shortened already and then you suddenly stretch them And so this whiplash occurs and could cause imbalance of the neck muscles, could cause increased spasm and tightness leading to cervical somatic dysfunctions Certain chronic inflammatory conditions could lead to cervical somatic dysfunctions.

01:03 Repetitive injuries such as taking a phone and holding it against your shoulder, or doing something repetitively with your shoulders or your head and neck could lead to somatic dysfunctions of the neck.

01:13 Certain pathologies of your eyes, ears, nose and throat could potentially cause cervical somatic dysfunctions Your viscera, your vagus nerve or cranial nerve X can have visceral somatic reflexes up to the C2-C3 upper cervical region Your diaphragm C3-4 and 5 which is your phrenic nerve could potentially have also reflexes up to the mid cervical region so irritations of the diaphragm, whether of the pulmonary issue or direct issue with the diaphragm that could potentially cause problems with your mid-neck.

01:51 Your thoracic outlet at your C7-T1 junction in the first rib, if you have neck muscles there - if you have muscle imbalance here, if you have issues with your brachial plexus as it comes out through that thoracic outlet to your fingers could lead to cranial somatic dysfunctions; and then problems with your sacrum and pelvis could also contribute to cervical somatic dysfunctions because of the connection between the sacrum, the dura up all the way to C2 and 3 and then attaching to the foramen magnum of your occiput.

02:24 Making the somatic dysfunction diagnosis at the OA junction involves understanding how the anatomy, the condyle sitting on the atlas causes the OA junction and joint to move in this particular way.

02:39 So specifically, sidebending rotation at the OA joint will always occur in opposite direction A mnemonic you could remmeber, is OA stands for "opposite always" This occurs because of the position of the condyles and also because of the lateral atlantooccipital ligament so whenever you sidebend the joint, it also pulls it and rotates it in the opposite direction.

03:03 Here you have a patient and you find on palpation at the OA junction that your fingers on the right side does not advance as deep as your fingers on the left side, when you flex the neck , the sulci become more symmetric.

03:15 What is your somatic dysfunction diagnosis? So here, our patient has a shallow sulcus on the right, meaning when I was putting my fingers in that suboccipital space and pushing up, the right side does not advance as much.

03:32 So the shallow side is usually your sidebent side.

03:35 If you imagine your skull is like a helmet and I bend my helmet a little bit to the right and sidebend to the right, you can see how I wouldn't be able to get my fingers in that sulcus.

03:47 so you know that the sulcus is shallow on the right so they'll always sidebend right and since you know that the sidebending and rotation are opposite, rotation's gonna be to the left.

03:58 Since the dysfnction became more even with flexion, that is a freedom of motion, so we're gonna name it as the "OA is flexed, sidebent right and rotated left" At the AA articulation, diagnosis of this joint is purely rotation, so when we diagnose this segment, what we need to do is to really lock the segment out and then rotate the head to the right or to the left, and the freedom of motion is the side where the head rotates more towards so it's gonna be either AA rotated right, or AA rotated left.

04:32 So here's a practice question - in your patient you find on passive range of motion testing, that there's increased rotation to the right compared to the left, so what is your diagnosis? The AA is rotated right since there is freedom of motion rotating the head more to the right compared to the left.

04:53 Cc3-C7, diagnosing this region is similar to diagnosing for any of the type II somatic dysfunction of the thoracic and lumbar spine.

05:04 There's always gonna be a flexion-extension component and thus rotation and sidebending are gonna be in the same direction.

05:11 There is no type I or neutral somatic dysfunctions in the cervical spine.

05:16 So let's practice.

05:18 You find that at the level of C2 you cannot translate from right to left in a flexed position but in extension, it becomes easier to translate the segment, what is your diagnosis and what is you rotational barrier? So here we're utilizing translation to motion test.

05:38 Typically, you could use rotation when you're motion testing, or you could translation.

05:44 Translation occurs in the coronal plane and so when we translate from right to left, so if I'm pushing one segment from right to left, that's gonna cause sidebending to that side, so if I cannot translate from right to left, that means that the barrier is right sidebending, so that means the freedom is left sidebending and in this case, the segment became easier in extension.

06:12 So the diagnosis is "C2, extended, rotated sidebent at left" cause I know sidebending was left, I assumed that rotation is also left because of the rotation and sidebending is coupled to the same side.

06:30 So the rotational barrier is right rotation so we name it for a left rotation freedom