OA, AA, + Cx Assessment

• spinal nucleus of the trigeminal nerve consists of 3 parts:

  • pars oralis
  • pars interpolaris
  • pars caudalis

  
• the pars caudalis is the most caudal of the 3 trigeminal nuclei + merges with the dorsal horns of the upper 3 cervical spinal cord segments
• the spinal tract of the trigeminal nerve descends caudally through the medulla oblongata as far as C4 level
• the trigeminocervical nucleus can be seen as the nociceptive nucleus for the entire head + upper neck
• C2 + C3 facet joints are thought to play the most significant role in cervicogenic headaches
• OA biomechanics:

  • cv flexion: occiput glides posteriorly
  • cv extension: occiput glides anteriorly
  • cv side-bending: rotation towards the opposite side
• when the atlas rotates, the articular facet of the side of rotation glides caudally over the posterior slope of the posterior facet of the axis
• input from OA, AA, + C2/3 to the trigeminocervical nucleus can cause dizziness
• C2/ + cx spine combine movements of side-bending + rotation ipsilaterally
• translation of the cervical spine is side bending at the segmental level
• PIVM + joint mobilization of OA joint:

  • anterior glide:
  • move to barrier + pull occiput anterior
  • posterior glide:
  • move to barrier + push TVP of C1 anterior which is relative posterior glide
• PIVM + joint mobilization of AA joint:

  • anterior glide:
  • move to barrier + glide TVP of C1 anterior/inferior
  • posterior glide:
  • move to barrier + glide TVP of C2 anterior/superior which is relative posterior/inferior glide of ipsilateral TVP on C1