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.
The first join is the OA joint -
the occcipitoantlantal joint.
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.
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.
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.
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.
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.
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
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.
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.
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.
So as I translate, I could feel a
little bit more freedom of motion
as I try to push the segment from
left to right or right to left.
So if I know that the freedom
of rotation is rotation right,
from C2-C7, sidebending will
always be in the same direction.
So here I have C2 rotated
right, and sidebent right.
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.
So that's how we screen for somatic
dysfunctions on the cervical spine.