Diagnosing cranial somatic dysfunction
Osteopathic Cranial Manipulative Medicine
Diagnosing cranial somatic dysfunction
Diagnosis of cranial somatic dysfunction begins with the vault hold
- First fingers meet in the center of the frontal bone
- Second fingers over the greater wing of the sphenoid bone
- Third fingers over the zygomatic process
- Fourth fingers on the mastoid process
- Fifth fingers along the squamous portion of the occiput
Figure 1. A depiction of the vault hold with landmarks highlighted in red.
Types of cranial somatic dysfunction
DYSFUNCTION: FLEXION | ||
| SPHENOID & OCCIPUT | Rotate in opposite directions around two transverse axes | |
| DIAGNOSIS | Body spends more time in flexion phase of motion | |
| EXAMPLE IN VAULT HOLD | Fingers spread apart and move inferiorly | |
| CAUSES | N/A | |
Figure 2. Flexion: the sphenoid and occiput rotate in opposite directions around two transverse axes.
DYSFUNCTION: EXTENSION | ||
| SPHENOID & OCCIPUT | Rotate in opposite directions around two transverse axes | |
| DIAGNOSIS | Body spends more time in extension phase of motion | |
| EXAMPLE IN VAULT HOLD | Fingers shift closer together and move superiorly | |
| CAUSES | N/A | |
Figure 3. Extension: the sphenoid and occiput rotate in opposite directions around two transverse axes.
DYSFUNCTION: TORSION | ||
| SPHENOID & OCCIPUT | Rotate in opposite directions around one anterior-posterior (AP) axis | |
| DIAGNOSIS | Named according to side with more superior greater wing of sphenoid (left or right) | |
| EXAMPLE IN VAULT HOLD | Left 2nd finger moves cephalad and left 5th finger moves caudad (left torsion) | |
| CAUSES |
| |
Figure 4. Torsion: the sphenoid and occiput rotate in opposite directions around one anterior-posterior (AP) axis.
DYSFUNCTION: VERTICAL STRAIN | ||
| SPHENOID & OCCIPUT | Rotate in sam direction around two transverse axes | |
| DIAGNOSIS | Named according to direction in which sphenoid base moves (superior or inferior) | |
| EXAMPLE IN VAULT HOLD | Bilateral 2nd fingers move caudad and bilateral 5th fingers move cephalad (superior strain) | |
| CAUSES |
| |
Figure 5. Vertical strain: the sphenoid and occiput rotate in the same direction around two transverse axes.
DYSFUNCTION: LATERAL STRAIN | ||
| SPHENOID & OCCIPUT | Rotate in same direction around two vertical axes | |
| DIAGNOSIS | Named according to direction in which sphenoid base moves (left or right) | |
| EXAMPLE IN VAULT HOLD | Bilateral 2nd fingers move to right and bilateral 5th fingers move to left (left lateral strain) | |
| CAUSES |
| |
Figure 6. Lateral strain: the sphenoid and occiput rotate in the same direction around two vertical axes.
DYSFUNCTION: SIDE BENDING-ROTATION | ||
| SPHENOID & OCCIPUT | Rotate in opposite directions around two vertical axes (side bending) and same direction around one AP axis (rotation) | |
| DIAGNOSIS | Named according to side of convexity (side that moves inferiorly) | |
| EXAMPLE IN VAULT HOLD | Right hand feels more full (fingers spread apart) and moves inferiorly (right side bending-rotation) | |
| CAUSES |
| |
Figure 7. Side bending-rotation: the sphenoid and occiput rotate in opposite directions around two vertical axes (side bending) and the same direction around one AP axis (rotation).
DYSFUNCTION: COMPRESSION | ||
| SPHENOID & OCCIPUT | Compressed through one AP axis | |
| DIAGNOSIS | Lack of movement and cranium feels heavy | |
| EXAMPLE IN VAULT HOLD | No movement is palpated | |
| CAUSES |
| |