Praxis of the Cervical Diagnosis

00:01 Cervical somatic dysfunction diagnosis.

00:04 When we're diagnosing the cervical spine, first we always wanna follow our rule of look-feel-move, so we're gonna look for any sort of assymetries, we're going to feel for any tenderness, landmarks, any muscle hypertonicities and then we're going to move by doing range of motion testing on the coronal planes To diagnose specific somatic dysfunctions, we're gonna look at each of these cervical joints.

00:26 The first join is the OA joint - the occcipitoantlantal joint.

00:30 At the OA joint, what we wanna do is we wanna get our fingertips into that sulcus right underneath the occiput so we're gonna start a little bit higher by the occiput in the nuchal line and let our fingers kinda slide and curl so it goes right to where the occiput drops off.

00:47 So those are the soft tissue suboccipital space, we're gonna see where does our figers sink in a little bit more? on the side where my fingers do not sink in or the shallow side is gonna be your sidebent side because if you imagine your head your head or your skull being like a helment, if your head is sidebent to one side, your fingers then can't go into that sulcus as well so here I feel a shallow sulcus a little bit more on the right side, so that tells me the OA is sidebent right remember the OA is "opposite always" so rotation is gonna be to the left.

01:26 So I figured out that the OA junction here, I have a sidebent right, rotate left dysfunction, I just need to figure out now if it's flexed or extended.

01:35 so I'm gonna gently extend the head and bring chin up to the ceiling, Im not extending the entire neck, so it's just the slight extension almost like a nodding motion to get my fingers and I'm assessing if that sulcus changes and then I'm going to bring the OA into flexion so again, just bringing the chin down gently and I'm getting a sense of my fingers of whether or not they're sinking a little bit more It felt like they start to sink in a little bit more with extension as opposed to flexion, so we want to name it for the freedom where things became more symmetrical so this is gonna be the freedom of motion, it's extension.

02:11 so my OA diagnosis is gonna be "OA extended, sidebent right and rotated left" For the AA junction, remember that AA is a pure rotation joint so what we're going to do is we're going to lock out the rest of the cervical spine by flexing the head up a little bit here and we're just gonna to rotate the head slowly to the left until I feel an end barrier and note how far my patient was able to rotate and then slowly rotate to the right and nutate how far he was able to rotate to the right So comparing left to right, I noticed that there's increased rotation to the right so here the freedom of motion is rotation to the right so this is "AA rotated right" For C2-C7 there's two ways to assess for sidebending or rotational freedom.

03:09 So remember from C2-C7 we're gonna feel the articular pillars so we're gonna find these processes come about an inch out lateral, feel your posterior process those are your articular pillars.

03:21 You're not feeling these transverse processes because transverse processes are a little bit more anterior so we're gonna come from the spinous process and come out a little bit lateral and if I come off the occiput and I feel those articular pillars, the first one I'm gonna feel is C2 because C1 is hidden by the occiput.

03:39 So I'm gonna get my fingers on the articular pillars of C2 and I could do one of two things - I could either check rotation by gently springing up towards the ceiling because when I spring up towards the ceiling, that is causing a rotation at that segment or I could bring the segment laterally and translate it so I could try to push the segment from right to left and from left to right so I am motion testing at the segment and I feel that C2 does not like to push up on the right side.

04:10 Since it doesn't like to push up towards the celing on the right side, I know that it's rotated right cause it's more posterior on the right I could also confirm it by checking translation.

04:21 So as I translate, I could feel a little bit more freedom of motion as I try to push the segment from right to left.

04:31 So if I know that the freedom of rotation is rotation right, from C2-C7, sidebending will always be in the same direction.

04:41 So here I have C2 rotated right, and sidebent right.

04:44 Now I have to check for the flexion or extension component so I'm going to gently flex down to C2 and see if that restriction is still there and extend up to C2 and see if it is still there and I felt that feel like it became more symmetric when I flexed so this is "C2 flexion dysfunction, sidebent and rotated right" You could do the same thing as you go down the neck assessing for any sort of assymetries, any TART changes, remember tenderness, assymetry, restriction of motion, tissue texture changes are the signs of somatic dysfunctions so I just screen, you could come down and see if anything's tender or if there's decreased range of motion by just springing on those segments.

05:28 So that's how we screen for somatic dysfunctions on the cervical spine.