Cervica

al Diagno
osis Occip
pitoatlan
ntal (OA) jjoint

Possiblediagnoses
Diagnosis

Sulcifin
ndings

Translaationfindinggs

OAFSLRR

Leftsulccusisshallow
w
andrigh
htsulcusis
deep
Rightsu
ulcusisshallo
ow
andleftsulcusisde
eep

Easiertotranslateto
theright

OAFSRRL

OAESLRR

OAESRRL

Leftsulccusisshallow
w
andrigh
htsulcusis
deep
Rightsu
ulcusisshallo
ow
andleftsulcusisde
eep

Easiertotranslateto
theleftt
Easiertotranslateto
theright
Easiertotranslateto
theleftt

Findin
ngswithflexxion
andeextension
Transslationandsulci
findin
ngsaremoree
equallwithflexion
n
Transslationandsulci
findin
ngsaremoree
equallwithflexion
n
Transslationandsulci
findin
ngsaremoree
equallwithextenssion
Transslationandsulci
findin
ngsaremoree
equallwithextenssion

Briefdesscription:TodiagnosistheeOAyouwillneedtopalppatethruthesuboccipitalm
musclesofth
he
posteriorneck.Feelforwhichsideiisshallowtodeterminethhedirectiono
ofsidebendinggandthench
heck
nandextension.Tocompletethediagn
nosis,rotationnwillbeinth
heoppositedirectionof
forflexion
sidebendiingduetothe
emechanicso
oftheOAjoin
nt.

Copyrightt2013NewYorkInstitute
eofTechnolo
ogyCollegeoffOsteopathiccMedicine
Departme
entofOsteop
pathicMedicin
ne

Look(observation):Observetheareaforanyabnormalitiesinposture,trauma,redness,orswelling.
Feel(palpation):
Physicianposition:Standingattheheadofthetable
Patientposition:Supine
Handpositioning:Placeyourfingersontheocciputandslideyourfingersdownuntiltheysinkintothe
suboccipitalmuscles.

Technique:
1. Sinkyourfingersintothesuboccipitalmusclesanddeterminewhichsidefeelsshallow
versusdeepbytryingtotranslateintheanterior/posteriordirection(pushyourfingers
towardtheceiling).Theshallowsideisthedirectionofsidebendingwhilethedeepside
isthedirectionofrotation.
2. TestingmayalsobedonebytranslatingtheOAtotherightandleft.Whentranslatingto
therighttheOAwillsidebendtotheleftandviceversa.
3. Tocheckflexionandextension,keepyourfingersinthesuboccipitalsulcusandplace
theheadinaneutralposition.
4. Nowgentlyflextheheadandextendtheheadwhiletryingtofeelforwhichmotion
makestheareaunderyourfingersmoreevenorequal(youshouldnotfeellikeoneside
isshallowordeep;iftranslatingtotherightandleft,itshouldfeellikenoonedirection
iseasier).
5. Thedirectionthatfeelsmostequalisfreedomofmotion.
6. Tonamethedysfunctionyouwillusefreedomsofmotion.(Ex.Ifyoufeelthattheleft
sideisshallow,therightsideisdeepanditfeelsmoreequalinflexion,thediagnosiswill
beOAFSLRR.)

Move(motiontesting)
Activemotiontesting:
1. Askthepatienttotouchtheirchintothechestandtotiptheirheadasfarbackas
possible.Thiswilltestflexionandextension,respectively.
2. Askthepatienttoturntheirheadasfartotherightandleftaspossibletotestfor
rotation.
3. Askthepatienttotryandtouchtheireartotheirshoulderwithoutliftingtheirshoulder.
Dothisbilaterallytocheckforsidebending.

Copyright2013NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine
DepartmentofOsteopathicMedicine

Passivem
motiontestiing:
1. Placeyourhaandontheto
opofthepatientsheaddforcontrolandplaceth
heheadinto
oits
anatomicalbarriersforflexion,exten
nsion,rotatioontotherigghtandleft,andsideben
nding
to
otherightandleft.

Othernottes:Whendiaagnosing,noticethattherotationandssidebendingccomponentso
ofdiagnosisaare
alwaysop
ppositedueto
othephysiolo
ogicmotionaattheOAjoinntandtheanaatomy.Torem
memberthis,use
themnem
monicOAisO
OppositeAlwaays.Also,tore
ememberwhhichsideisthesideofsideebending,feelfor
thesidethatisshallow
wwhenyoupalpatethruth
hesuboccipittalmuscles.TTorememberthis,usethe
mnemonicShallowisSSidebent.

Cervica
al Diagno
osis Atlan
ntoaxial ((AA) jointt

Possiblediagnoses:A
AARR,AAR
RL

Briefdesscription:TheemotionattheAAjointissrotation.WhhentestingthheAAjointitisimportantto
lockoutth
hevertebraebelowtheAA
Ajointinorde
ertotestthe rotationpureelyattheAAjoint.To
accomplisshthis,youw
willneedtofle
extheheadandneckupb eforetestinggrotationofthehead.

Look(ob
bservation):O
Observetheaareaforanyaabnormalitiessinposture,ttrauma,redness,orswelling.
Feel(palpation):
Physician
nposition:SStandingatthheheadoftheetable
Patientp
position:Suppine
Handpositioning:Plaaceyourhanddssothatyouucanproperllysupporttheeheadasyouulifttheheaddand
rotateit.
Copyrightt2013NewYorkInstitute
eofTechnolo
ogyCollegeoffOsteopathiccMedicine
Departme
entofOsteop
pathicMedicin
ne

Technique:
1. Placeyourhandsunderthepatientsheadssothatyourfingersareontheposterior
aspectoftheheadandyourthumbsareinfrontoftheears.
2. Liftthepatientsheadoffthetableuntilyoucannotflextheheadanymore,inorderto
lockoutthelowercervicalspine.
3. Testforrotationbymovingtheheadtotheleftandright.Usethenosetohelpgauge
howfartheheadturnsineachdirection.
4. Tonamethedysfunction,youwillusethefreedomofrotation.(Ex.Iftheheadisableto
rotatemoretotheright,thediagnosiswouldbeAARR.)

Move(motiontesting)
Activemotiontesting:
1. Askthepatienttoturntheirheadasfartotherightandleftaspossibletotestfor
rotation.(Note:ThiswillnottestpureAAjointmotionbecausethelowercervicalspine
isnotlockedout.)

Passivemotiontesting:
1. Placeyourhandsunderthepatientsheadssothatyourfingersareontheposterior
aspectoftheheadandyourthumbsareinfrontoftheears.
2. Liftthepatientsheadoffthetableuntilyoucannotflextheheadanymore,inorderto
lockoutthelowercervicalspine.
3. Testforrotationbymovingtheheadtotheleftandright.Usethenosetohelpgauge
howfartheheadturnsineachdirection.

Othernotes:Theheadshouldbeflexeduptoatleast45degrees,butyoumaytoneedflexmoreto
lockoutthelowercervicalvertebraesothattheydonotcontributetotherotation.

Copyright2013NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine
DepartmentofOsteopathicMedicine

Cervical Diagnosis C2 C7 vertebrae

Possiblediagnoses
Diagnosis
FRSR

FRSL

ERSR

ERSL

AnteriorPosterior(A
P)findings
Pushinguptowards
theceiling,theright
sidefeelsmore
shallowand
resistanceisfelton
therightsidesooner
thanleft
Pushinguptowards
theceiling,theleft
sidefeelsmore
shallowand
resistanceisfelton
theleftsidesooner
thanright
Pushinguptowards
theceiling,theright
sidefeelsmore
shallowand
resistanceisfelton
therightsidesooner
thanleft
Pushinguptowards
theceiling,theleft
sidefeelsmore
shallowand
resistanceisfelton
theleftsidesooner
thanright

Translationfindings

Findingswithflexion
andextension
Pushingthearticular TranslationandAP
pillarfromrighttoleft findingsaremore
iseasier
equalwithflexion

Pushingthearticular TranslationandAP
pillarfromlefttoright findingsaremore
iseasier
equalwithflexion

Pushingthearticular TranslationandAP
pillarfromrighttoleft findingsaremore
iseasier
equalwithextension

Pushingthearticular TranslationandAP
pillarfromlefttoright findingsaremore
iseasier
equalwithextension

Copyright2013NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine
DepartmentofOsteopathicMedicine

Pictureo
ofrelatedan
natomy
Briefdesscription:Inoordertodiagnosisthecervvicalvertebraa2thru7,youmustpalpatethearticullar
pillar.Byu
usingtranslattiontotherigghtandleft,aaswellasfeellingforwhich
hpillarispostterior,youcan
determine
ethesideben
ndingandrotaation,respectively,ofthe cervicalverteebrae.Inaddition,flexionand
extension
nisdetermine
edbywhichm
motionmakessthesideben dingandrotaationcompon
nentsofmotion
moresym
mmetrical.

Look(ob
bservation):Observetheareaforanyaabnormalitiessinposture,ttrauma,rednness,orswelliing.
Feel(palpation):
Physician
nposition:SStandingatthheheadoftheetable
Patientp
position:Suppine
Handpositioning:Plaaceyourfingeerpadsonthearticularpi llarsoftheceervicalvertebbrayouareteesting.
Techniqu
ue:
1. Palpatethearticularpillaarsbilaterallyyanddeterm
minewhichssideismoreeposteriorby
applyinganu
upwardforce
etowardsth
heceiling.Thhesidethatyyoufeelresiistanceon
ooneristhesidethatisposterioran
ndisthefreeedomofrotaation.
so
2. Anothermeth
A
hodthatmaaybeusedisstranslation..Again,findthearticulaarpillarsand
d
applyaforcefromrightttolefttoinducerightsiddebendingandlefttorigghttoinduceeleft
siidebending.Thedirectio
onthatiseassiertotranslatetowardsdetermineesthefreedo
omof
siidebending.
3. Usingeitherm
U
method(step1or2),testthesamemethodinfflexionandeextension.
4. Totestflexion,liftthehe
eadupandaassessforrottationandsidebending.Lookfora
fe
eelingofsym
mmetry.Ifro
otationandssidebendinggdonotfeelsymmetricaalinflexion,try
exxtendingthe
eheadandaagaintestro
otationandssidebendingwhilelookin
ngforsymm
metry.
5. Tonamethedysfunction,youwillusethefreedoomsofmotio
onandtheccervicallevelyou
areat.(Ex.Ifyouareatth
helevelofC
C4,felttheriightsideism
moreposteriiorwhile
trranslationw
waseasiergoingfromrighttoleftan dthemotionsfeltmoreesymmetricaalor
equalinflexio
on,thediagn
nosiswouldbeC4FRSR..)

Copyrightt2013NewYorkInstitute
eofTechnolo
ogyCollegeoffOsteopathiccMedicine
Departme
entofOsteop
pathicMedicin
ne

Move(motiontesting)
Activemotiontesting:
1. Askthepatienttotouchtheirchintothechestandtotiptheirheadasfarbackas
possible.Thiswilltestflexionandextension,respectively.
2. Askthepatienttoturntheirheadasfartotherightandleftaspossibletotestfor
rotation.
3. Askthepatienttotryandtouchtheireartotheirshoulderwithoutliftingtheirshoulder.
Dothisbilaterallytocheckforsidebending.

Passivemotiontesting:
2. Placeyourhandonthetopofthepatientsheadforcontrolandplacetheheadintoits
anatomicalbarriersforflexion,extension,rotationtotherightandleft,andsidebending
totherightandleft.

Othernotes:ItisimportanttorememberthatforC2C7themotionsofrotationandsidebendingare
coupledtothesameside.Thismeansthatifrotationistotheright,sidebendingwillalsobetotheright.
Also,whenflexingandextendingthespine,onlyflexandextendtothevertebrayouaretesting.

Copyright2013NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine
DepartmentofOsteopathicMedicine