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Extra resources for Checklist: Manual Medicine
Tension and stretching of the joint capsule is monjtored through the mechanoreceptors. Changes in tension and pressure will reflexly alter not only the paravertebral muscular tone, but also muscles in the extremities. The free, very small, myelinated plexiform nerve endings (nocicep tors) may become depolarized as a result of constant pressure upon the joint capsule (nonphysiologic position, abnormally quick move ment), as well as a result of a decrease in the intervertebral disk height and dislocated of the facet joints.
Suboccipital pain: indicates a segmental dysfunction. Vertigo at the extreme of the movement may occur, requiring fur ther neurologic investigation (vertebral artery). Zones of irritation. In the presence of enhanced rotation: technically incorrect perfor mance of this examination , or the patient may be recruiting addi tional movement. However, one should always consider the possi bility of rotation instability in the upper cervical spine . 31 Examination Techniques Cervical Spine C 1 -C 2 Examination Axial rotation at C l-C2 Goint play), passive motion testing.
Suboccipital pain during this movement may be due to segmental dysfunction (differential diagnostic considerations include instabil ity at CO-C3, i nflammatory changes ) . If autonomic symptoms or dizziness occur, a further neurologic work-up becomes necessary. Zones of irritation . Examination Techniques Cervical Spine CO-C3 Examination Axial rotation, passive motion testing. Examination Procedure • • • Patient sitting. The examiner introduces maximal flexion to the cervical spine. With the other hand placed broadly over the patient's mandible , the examiner introduces rotation t o the upper cervical spine, alter nating to either side (Figs.