At the conclusion of this chapter, the reader will be able to:
Identify the key anatomical and biomechanical features of the cervical spine and temporomandibular joint (TMJ) and their impact on examination and intervention.
List and perform key procedures used in the orthopaedic manual physical therapy (OMPT) examination of the cervical spine and TMJ.
Demonstrate sound clinical decision-making in evaluating the results of the OMPT examination.
Use pertinent examination findings to reach a differential diagnosis and prognosis.
Discuss issues related to the safe performance of OMPT interventions for the cervical spine and TMJ.
Demonstrate basic competence in the performance of a skill set of joint mobilization techniques for the cervical spine and TMJ.
Neck-related disorders (NRD) impact an estimated 10% to 15% of the general population.1 Some estimate that 70% of individuals will experience mechanical neck pain at some point in their lives.2 Twenty-five percent of all individuals seeking outpatient physical therapy services present with primary complaint of neck pain.2 These conditions are more common in women, and their prevalence increases over the age of 50 years.1 In addition to personal hardship, neck pain places a substantial financial burden on society, with one-third of those reporting neck pain requiring long-term medical care.
FUNCTIONAL ANATOMY AND KINEMATICS
Cervical Spine Arthrology and Kinematics
Largely due to its anatomical complexity, differential diagnosis of neck-related disorders is challenging. The cervical spine is comprised of two distinct regions. The subcranial, or suboccipital, region consists of the occiput, the atlas (C1), and the axis (C2). The midcervical to lower cervical region is defined as the inferior aspect of C2 to C7. Due to its facet joint orientation and subsequent kinematics, which resembles that of the cervical spine, the first three or four thoracic vertebral segments (T1-T4) are often considered in the management of NRD.
The Subcranial Articulations
The cervical vertebra possessing the greatest breadth is the atlas (C1). Its prominently projecting lateral masses, which provide protection for the vertebral arteries, may be palpated between the angle of the mandible and the mastoid process bilaterally (Fig. 30–1). The anterior arch of C1 forms a bony buttress and an important articulation with the odontoid process, or dens, which projects superiorly and posteriorly from the body of C2. C1 is without a vertebral body, and its spinal canal is divided by the transverse ligament, which is the horizontal component of the cruciform ligament. The axis (C2) is located approximately three finger-widths inferior to the greater occipital protuberance (Fig. 30–2). C2 represents the first vertebra with a body and spinous process, the latter of which can be easily palpated upon cervical flexion.