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. Join Dr. Philip E. Greenman, D.O., F.A.A.O., 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.
illustrating the effects of flexion, extension, and rotation upon the vertebral artery.
Translatory movement will be used to introduce a sidebending component for the motion test. Rotation is not actively tested, but restriction of rotation is inferred when restriction of sidebending is detected. At the occipitoatlantal articulation, sidebending and rotation are always coupled to opposite sides. Join Dr. Philip E. Greenman, D.O., F.A.A.O., as he discusses the biomechanics of the occipitoatlantal junction.
The patient's head should be held and positioned as follows:
The patient should be positioned supine on the table with the operator sitting or standing at the head of the table.
The operator's grasps the patient's head in the two hands overlying the temporoparietal regions.
The operator introduces backward-bending by rotating the head around an approximate axis through the external auditory meatus.
Join Dr. Philip E. Greenman, D.O., F.A.A.O., as he Illustrates the correct way to hold and position the patient's head.
With the head backward-bent (but not off of the table), the operator introduces translatory movement from right to left, keeping the patients eyes in the horizontal plane. If resistance is encountered, a diagnosis is made of restriction of occipitoatlantal backward-bending, right sidebending, and left rotation. Positionally, the occiput is flexed, sidebent left, and rotated right (FSleftRright).
With the head remaining in a backward-bent position, the operator introduces translatory movement from left to right, keeping the patient's eyes in the horizontal plane. If resistance is encountered, a diagnosis is made of restriction of occipitoatlantal backward-bending, left sidebending, and right rotation. Positionally, the occiput is flexed, sidebent right, and rotated left (FSrightRleft).
Join Dr. Philip E. Greenman, D.O., F.A.A.O., as he positions and motions tests with the head in the backward-bent position.
The operator introduces forward-bending by rotating the head around an approximate axis through the external auditory meatus.
With the head forward-bent, the operator introduces translatory movement from right to left, keeping the patient's eyes in the horizontal plane. If resistance is encountered, a diagnosis is made of restriction of occipitoatlantal forward-bending, right sidebending, and left rotation. Positionally, the occiput is flexed, sidebent left, and rotated right (FSleftFSright).
With the head remaining in a forward-bent position, the operator introduces translatory movement from left to right, keeping the patients eyes in the horizontal plane. If resistance is encountered, a diagnosis is made of restriction of occipitoatlantal forward-bending, left sidebending, and right rotation. Positionally, the occiput is flexed, sidebent right, and rotated left (FSrightFSleft).
Join Dr. Philip E. Greenman, D.O., F.A.A.O., as he positions and motions tests with the head in the forward-bent position.
Join Dr. Philip E. Greenman, D.O., F.A.A.O., as he interprets the results of the motion test. A diagnosis is made of restriction of occipitoatlantal backward-bending, right sidebending, and left rotation. Positionally, the occiput is flexed, sidebent left, and rotated right (FSleftRright).
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