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By Dos Winkel

Dutch and German Academy of Orthopaedic drugs. A reference for physicians and actual therapists emphasizing practical anatomy, scientific exam, pathology, and remedy of spinal issues. comprises dialogue on temporomandibular joint.

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Extra resources for Diagnosis and Treatment of the Spine: Nonoperative Orthopaedic Medicine and Manual Therapy

Sample text

Without an urgent indication to palpate more deeply, the palpation remains superficial in order not to injure the deeper-lying structures. Often the abdominal pulse is visible at the abdominal wall, making palpation unnecessary. Painful conditions of the stomach or other epigastric organs can make palpation in this region very painful, and it is performed only when necessary. 22 DIAGNOSIS AND TREATMENT OF THE SPINE palpable. Palpation of the kidneys is not within the scope of routine musculoskeletal examinations.

To the left of the ster­ num , at approximately the level of the second i ntercostal space, the aortic arch curves first d or sally and then caudally. The descending aorta begins d or sally in the thorax at the level of the f ourth thoracic vertebra and pierces through the diaphragm in its distal course. The brachi ocephalic trunk arises at t he right side of the aortic arch and bifurcates into the right subclavian and common carotid arteries . The left common carotid and subcla­ vian arteries spring from the aortic arch, just to the left of the brachiocephalic trunk.

Atlantal Transverse Process The transverse process of the atlas can be palpated in the tip of the carotid triangle , where it lies between the mandibular angle and the mastoid process, and is covered by the sternocleidomastoid muscle. The transverse process of the atlas is also indirectly palpable. It is felt as a hard struc­ ture through the overlying musculature. This palpation is seldom necessary, and because it can be painful and uncomfortable, it is per­ formed with great care and only when neces­ sary.

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