By placing the middle finger of either hand on the transverse processes
of the atlas when the patient is in the sitting posture, or the thumbs
on the transverse processes when the patient is in the dorsal posture
and comparing the two sides, undue prominence of one side or the
other can easily be noted. Remember the transverse processes of the
atlas are slightly above and posterior to the angle of the inferior
maxilla. Always, in examining one side of the patient, compare it
with the other; it may save considerable embarrassment. One side may
seem abnormal when by comparing it with the other side, both sides
may be found the same and still be normal. With the fingers still
on the transverse processes note the distance between the process
and angle of the jaw, besides take into consideration the tenderness
of the locality, and, also, what is of essential importance in all
interosseous lesions, its articular range of movements. There should
be room enough (approximately) to just comfortably wedge the end of
a medium sized middle finger between the transverse process of the
atlas and the angle of the inferior maxilla when both are normal. Thus
with the fingers on the transverse processes an expert will be able to
readily determine whether or not an atlas is lateral or anterior. If
an atlas is posterior the distance between the angles of the jaw and
the transverse process will be increased, besides the atlas will be
quite prominent posteriorly. In conjunction with the abnormality of the
tissues (prominence or depression of the bone and state of the muscles)
the sensitiveness of the locality is extremely significant.
Outside of displacements of the atlas, a lesion between the =axis=
and =third cervical= is most common; following next in frequency are
lesions of the =skull= and =atlas=. By that is meant where all the
cervical vertebræ are intact as far as their individual relation is
concerned, but the skull is forward, backward or lateral upon the
spinal column. This condition occurs quite frequently. To determine
its condition the same methods are employed as in diagnosing a
deranged atlas; for if the dislocations exist between the atlas and
skull the same diagnostic points are presented as far as the skull is
concerned as when the atlas, or atlas and axis, are dislocated from
the occipital bone or from the axis or third cervical. Following the
preceding examinations, additional examination will have to be made to
see whether or not the atlas is intact with the vertebræ below. If the
atlas is found to be intact with the vertebræ below and lesions are
presented between the atlas and the skull, then the disorder must be
between the atlas and the skull and nowhere else. Occasionally there
are cases where the skull is so far posterior upon the spinal column
that the angles of the jaw strike against the transverse processes of
the atlas when the jaw is opened widely.
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