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During side-bending, the upper thoracic vertebrae usually rotate i n the direction o f side-bending, whereas t h e lower thoracic vertebrae move in the opposite direction . Pathologic Findings • • • • Absence of coupled rotation: may be due to segmental dysfunction (somatic dysfunction, degenerative changes). Pain at the motion barrier: may be due to a segmental dysfunction. Soft endfeel: due to shortening of the strong, deep rotator muscles (rotatores muscles, multifidus muscle, semispinalis muscle) .

44, 45) . Fig. 44 Fig. 45 Note • It is important to properly fixate the patient's shoulder (for evalu­ ation of soft endfeel) . Pathologic Findings • • • • Overall side-bending motion restriction . Asymmetry of motion when comparing one side to the other side. Hard endfeel with degenerative changes. Soft endfeel: probably due to shortening of the postural neck mus­ cles (trapezius muscle , descending portion; levator scapulae mus­ cle). 37 examination Technique. Cervical Spine-Cervicothoracic Junction CO -T3 Examination Axial rotation , passive motion testing.

Once localized, the painful area should be described well, that is, in anatomic terms relating to certain landmarks. Zone of Irritation • • • • 28 The afferent source of the spondylogenic pain syndrome is primari­ ly the intervertebral joint. Mediated through the central nervous system, changes in related soft tissue structures can develop reflexly as a result of permanently suprathreshold stimulations of the nu­ merous mechanoreceptive and nociceptive receptors in the joint capsules and ligamentous structures.

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