Many osteopathic medical students and physicians are concerned about injuring patients when they perform cervical manipulation. While the risk of patient injury is very small, once an injury has occurred, permanent damage is the rule, and progression to death is not uncommon. as he discusses the unique morphology of the vertebral artery that makes it susceptible to kinking and/or stretching when the head is suddenly rotated, and precautions that should be taken when treating the upper cervical complex.
Rotation makes up approximately 90% of the mobility of the atlantoaxial articulation. Consequently, if there is restriction of rotation there will undoubtedly be restriction of minor movements as well. as he explains how and why we will just test the capacity of the joint to rotate.
as he as he reviews precautions that should be observed when testing and treating the upper cervical complex and then positions and motion tests the atlantoaxial junction.
The patient should be positioned supine on the table with the operator standing at the head of the table.
The operator's grasps the patient's head in the two hands and flexes the head on the neck to approximately 45 degrees.
While retaining the 45 degree forward-bending, the operator introduces rotation to the right and then to the left, testing for resistance to the rotational movement.
Resistance of head rotation to the left would result in a diagnosis of restriction of atlas rotation to the left. Positionally the atlas would be right-rotated on the axis. Resistance of head rotation to the right would result in a diagnosis of restriction of atlas rotation to the right. Positionally the atlas would be left-rotated on the axis.
as he interprets the results of the motion test (Atlas right-rotated on the axis).
Once the atlantoaxial component of the upper cervical complex has been diagnosed as dysfunctional, it should be appropriately treated before evaluation of the occipitoatlantal junction.
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