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Pathologic Findings • • • • 36 Overall flexion restriction : indicates degenerative changes. Pain at the extreme (barrier) of movement . Soft endfeel: indicates shortening of the postural neck muscles. Localized, stabbing pain : may be due to segmental instability, espe­ cially with extension . Exemlnation Techniques Cervical Spine-Cervicothoracic J u n ction CO-T3 Examination • Side-bending, passive motion testing. Examination Procedure • • • • • Patient sitting. The examiner stands behind the patient and fixates the patient's trunk against his or her thighs.

41 34 Fig. 40 Examination Techniques Cervical Spine-Cervicothoracic J u n ction C3-T3 Note • • • • During maximal cervical spine extension, the upper cervical spinal joints become fixated (stabilized) due to increased tension in the alar ligaments. This allows selective rotation movement of the lower cervical spine . The symmetry of range of motion to either side is determined . Empirical measurements have been determined to be 60° of rota­ tion . Pathologic Findings • • • • • • Overall rotation restriction .

The articular surfaces are covered by cartilage, the joint capsules contain synovia and, depending on the vertebral region, they have very strong collagenous fibers. The meniscoids or invaginations of the synovial fold smoothen ir­ regularities of the joint surfaces, in particular at the cervical spine. These are vascularized and innervated (Fig. 26). The fibrous joint capsules reveal mechanoreceptors as well as noci­ ceptive free nerve endings (nociceptors). Tension and stretching of the joint capsule is monjtored through the mechanoreceptors.

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