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Diagnosing cranial somatic dysfunction

Notes

Notes

Osteopathic Cranial Manipulative Medicine

Diagnosing cranial somatic dysfunction

Diagnosis of cranial somatic dysfunction begins with the vault hold

With the patient supine, you place your hands on the lateral aspects of the cranium, using the following landmarks:
  1. First fingers meet in the center of the frontal bone
  2. Second fingers over the greater wing of the sphenoid bone
  3. Third fingers over the zygomatic process
  4. Fourth fingers on the mastoid process
  5. 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 & OCCIPUTRotate in opposite directions around two transverse axes
DIAGNOSISBody spends more time in flexion phase of motion
EXAMPLE IN VAULT HOLDFingers spread apart and move inferiorly
CAUSESN/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
  • Traumatic force to head (superior or inferior)
  • Dental pathologies or procedures
  • Head / neck surgery
  • Improper sleeping positions

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
  • Traumatic force to vertex of head or below mouth
  • Dental pathologies or procedures
  • Head / neck surgery
  • Improper sleeping positions

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
  • Traumatic force to side of head
  • Dental pathologies or procedures
  • Head / neck surgery
  • Improper sleeping positions

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
  • Traumatic force to side of head (causing convexity to occur on opposite side of head)
  • Dental pathologies or procedures
  • Head / neck surgery
  • Improper sleeping positions

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
  • Traumatic force to head
  • Circumferential compression (e.g. childbirth)
  • Severe depression