The occiput-atlas articulation and joint-play will be examined, taking into account the above mention osseous variations that impact on the function of the occiput. C0-C1 flexion occurs only in the first eight degrees of head flexion. After this point, there is a backward rotation (extension) of the occiput relative to the tilting atlas. It is vital to your patients' well-being that you are knowledgeable about the normal function anatomy and biomechanics of the area in question.
The cervical and thoracic spine motion palpation will include some coupled motions, once again to prepare for the introduction of Coupled Motion Joint-Play Analysis in 1995, with the major emphasis being placed on the ability of the doctor to find the primary fixation in the region being examined.
The thoracic spine and associated ribs will be examined and palpated, keeping in mind the thoracic cage subserves body statics, respiration and, to some extent, organ function; that dysfunction affects primarily key regions of the thoracic cage and those muscle pairs essential to the maintenance of equilibrium; that joint dysfunction resulting in a disturbance of respiration (difficult inspiration or postural changes as in an attempt to hold the chest up so that breathing is easier) causes overstrain of the cervical musculature and postural change associated with an anterior head carriage, and eventual perpetuation of the subluxation complex.
The A-C and S-C joints will be dealt with only briefly as they are covered in detail in the E2 Seminar. The costochondral, costosternal and costotransverse articulations will be palpated and the appropriate adjustments taught. The real significance of these joints is their impact on the function of other structures. If the dysfunction involves the costochrondral junction of the ribs 3-5, then the pectoralis minor could be involved as well, with resultant shoulder joint dysfunction and pain secondary to scapulothoracic rhythm abnormalities. The other joints also have significant impact on the neuromusculoskeletal system and will be discussed in some detail as they relate to the chiropractic profession.
The concepts of "crush," single, multiple, reverse and tennis elbow will be mentioned, however they will be dealt with in exquisite detail in the E2 seminar.
The Upper Extremities -- The E-2 Seminar
The E-2 Upper Extremity Seminar focuses on specific joint-play examination techniques that allow the doctor to locate and adjust the various articulations of the hand, wrist, elbow and shoulder. The actions of supination and pronation do not occur only at the wrist, but include the elbow as well, in fact there are five joints working in harmony to perform this seemingly simple action. The direction of slide and therefore the direction of joint-play of the trapezoid and trapezium during wrist flexion are opposite to the direction of slide and subsequent joint-play of the capitate and hamate. The ulna does not articulate with the triquetrum, but has a major roll to play in other actions. Where is the middle radio-ulnar joint and what is its function with respect to, for example, tennis elbow? How does the common flexor tendon group being dominant actually become a major contributor or cause of lateral epincondylitis? How is it to be treated? These are great questions with clinically significant answers that will impact on your practice the very next day.
The remainder of the hand and carpal bones will be included in the palpation and differential diagnostic procedures. Specific adjustive procedures will also be demonstrated. Nerves from their origin in the spinal cord to their effector organ risk compression, damage, and impairment of their end function. Careful linking of these signs and symptoms can indicate a specific compressive or painful pathology commonly known as a "tunnel syndrome." A number of the more common tunnel syndromes will be presented with respect to the spinal related component.
Elbow joint dysfunction has profound effects both at the elbow and at the wrist. A detailed joint play examination will be a major component of every patient presenting with wrist, elbow or shoulder pain. The elbow is made up of the radiohumeral, radioulnar and trochlear joints but how many joint capsules are there? A picky point? No, not at all. For this reason alone numerous patients are misdiagnosed by inadequately trained doctors. The joint will be joint-played through many planes and axes simultaneously and adjusted accordingly utilizing the latest in biomechanical rationales.
The shoulder joint, being a true ball and socket and mechanically simple by definition, has three axes which dictate the planes as well as the axes being palpated and joint played at the same time. The shoulder joints is ideally suited for the concave-convex rule concept of adjustment so that if the IAR is in the convex partner, the direction of slide of the concave partner is in the same direction as the movement restriction. And it follows that the direction of slide of the convex partner is in the direction opposite to the direction of movement restriction. The acromioclavicular joint must be included in all shoulder joint examinations, but at what point during shoulder function does the A-C joint actually move? This is absolutely critical to the proper examination and treatment of the patient. The same scenario applies to the S-C joint except that the S-C joint is an anatomically compound joint and has implications to cervical spine dysfunction.
All of the upper limb articulations will be adjusted and some time will be spent on the use of various modalities to aid in the reduction of treatment time.