Checklist: Manual Medicine by Dvorak

By Dvorak

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52) . Mobility and rotation of the vertebrae are evaluated. Fig. 52 Note • • The vertebrae rotate in the same direction as the side-bending. The spinous processes, however, move i n the opposite direction . Pathologic Findings • • • • • Asymmetric range of motion during side-bending movement when comparing one side to the other. Hard endfeel : indicates articular degenerative changes. Soft endfeel: may be due to shortening of the postural neck and shoulder muscles (descending portion of the trapezius muscle, leva­ tor scapulae muscle) .

Soft endfeel : indicates shortening of the postural lumbar muscles (longissimus dorsi , quadratus lumborum muscles) . Examination Techniques Lumbar Spine L1- L5 Examination Axial rotation, passive motion testing. side-lying position, close to the table's edge . Both legs are flexed to 90° at the hip and knee joint. The examiner takes hold of the patient's leg just above the ankles (Fig. 66) . Both legs are lifted as far as possible. The palpating fingers are placed over the spinous processes of the vertebrae to be examined .

The joint capsules are innervated by the dorsal rami of the spinal nerves. However, one particular ramus is not responsible for only one segmentally related joint capsule but sends out lateral branches connecting to the neighboring proximal and distal apophyseal (fa­ cet) joints as well. This plurisegmental innervation of the facet joints is of significant importance for the coordination of complex regional movement patterns. This may also explain the fact that the pain described by the patient often cannot be localized to one segment as it is per­ ceived over an area covering several segments (overlap of the der­ matomas).

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