By Alan Stoddard
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More occurs in the atlanto-axial joint. The mobility X-rays shown here are normal (Fig. 5) and restricted movements at the occipito-allantal joint are shown in Fig. 6. Forward bending may be tested with a similar grip, the vertex of Ihe patient's head resting on the operator's abdomen. A firm downward pressure with Ihe hands will throw Ihe occipul into nexion, when Ihe mastoid processes will become more separaled from Ihe atlantal transverse processes. DI A G N O S I S O F S P I N A L L [S I O N 48 a b FIG.
Or extend the neck while palpating each cervical joint. Occipito-A t/allta/ Joillts Radiographic studies of the occipito-atlantal articulation indicate that these joints possess only a small range of movement which takes place at or near the extreme excursion of the head and neck in any direction. The characteristic movement which occurs there is a shift of the occipital condyles on the superior atlantal articular facets. As the head and neck approach the point of full rotation a slight rotary movement of the occiput on the atlasoccurs.
The operator stands facing the patient's back and slightly to the right, supporting her torso against his own, to give her an added sense of security. This affords the patient the maximum opportunity for relaxation which is so essential for testing mobility and passive movements. The operator then places the flat of his right hand on the top of the patient's head. The left thumb then palpates between the spinous processes. The patient's head is flexed almost to the limil and then, with a slight increase of flexion and release, the movement causes separation of the spinous processes which is detected by the thumb.