=Cervical Nerves.=—The =great occipital= nerve may be controlled at a
point on the occiput between the mastoid process and the first cervical
vertebra. The =small occipital= and the =great auricular= nerves may
be controlled at a point just behind the mastoid process. The great
auricular nerve and the frontal branch of the trigeminus nerve meet
over the parietal protuberance. The preceding points are the places
where one may inhibit the nerves and control certain headaches or
neuralgic attacks, although subdislocations of the upper cervical
vertebræ, or contracted muscles between the atlas and occiput are
usually the cause of such disturbances. Adjustment of the lesion will
usually correct the disturbance. Carefully exclude possible caries or
tumors.
=Treatment= of the upper cervical region, by relaxing muscles and
correcting deranged vertebræ, constitutes the principal treatment of
an ordinary =headache=. It is best to have the patient flat upon his
back and the osteopath stand at the head of the patient, and, first,
thoroughly relax these contracted muscles or correct the derangement of
the vertebræ; then after the foregoing has been accomplished, give an
inhibitory treatment of the suboccipital region. In inhibiting, place
the fingers over the contracted and tender tissue; hold tightly for
several minutes, or at least until the tissues have thoroughly relaxed.
Many times one will be able to detect a slight twitching underneath
the fingers, and when such is felt, he knows at once that the headache
is relieved. In inhibiting at any point along the spine, seek the
contracted fibers and tender points and inhibit exactly over the area.
Headaches that are due to a disturbed circulation of the brain, may
be relieved by this inhibitory treatment in the suboccipital region.
The treatment tends to reestablish a normal circulation to the brain.
Although the large vascular areas such as the splanchnic, should,
if possible, be normalized. Headaches may also be due to lesions at
various points along the spine and ribs, and a correction of such
points is necessary in order to cure the affection. A place often found
involved is the upper dorsal region. =Reflex headaches= can be cured
only by relieving the irritation. The treatment to the head would only
be temporary. In headaches of the chronic type it is well to examine
the scalp and if not freely movable over occipital region it may be
adherent to the skull and cause pressure on the occipital nerves.
Lesions to the =phrenic nerve= usually occur in the region of the
third, fourth and fifth cervical vertebræ. The lesion may be due to a
deranged vertebra, or to disease of the membrane of the cord, or of the
anterior horn of the gray matter (See Hiccoughs).
Paralysis of diaphragm from the phrenic may be single or double. When
single it is not very noticeable. When double, respiration must be
carried on by the intercostals and accessory muscles. When quiet,
the patient may not notice it but on exertion there may be temporary
dyspnea. Bronchitis with its constant coughing is a bad complication.
Various disorders of the phrenic nerve are principally treated in the
area of the origin of the phrenic nerve. Tumors, aneurism, caries, and
neuritis are possible complications.
Lesions to the =brachial plexus= are usually derangements of the
cervical or upper dorsal vertebræ. Focal infections should not be
overlooked. Direct injuries, contraction of muscles, a deranged
clavicle, a cervical rib, or a dislocated shoulder are to be thought
of. (See, also, Painful Shoulders, Part I) The X-ray as a diagnostic
aid may be invaluable.
In obstructions to the =musculo-cutaneous= nerve, the power to flex the
forearm upon the arm is greatly impaired. The lesion is most likely to
be found between the fifth and sixth cervical vertebræ.
Clinically, the =median nerve= is of special interest from the fact
that atrophy of the muscles of the ball of the thumb, which is
pathognomonic of progressive muscular atrophy, may be caused by an
affection of this nerve. The lesion is usually from the third to the
seventh cervical vertebræ.
Lesions of the =ulnar nerve= may arise between the sixth and seventh
cervical vertebræ, but are oftentimes found as low as the fifth dorsal,
especially at the fifth rib on the side affected.
Lesions of the =circumflex nerve= may be found in the lower cervical
vertebræ, but are commonly caused by dislocations of the humerus and
clavicle.
Lesions of the =suprarscapular nerve= occur most frequently from the
fifth to sixth cervical vertebræ.
The =posterior thoracic= may be lesioned at the fifth or sixth
segments, or by pressure injuries to the serratus magnus.
=Dorsal Nerves.=—The essential osteopathic points of the dorsal nerves
have been considered under intercostal neuralgia. It might be stated
that the posterior fibers of the sixth and seventh dorsal nerves supply
the skin of the pit of the stomach. This is of value, clinically, as
severe pains in the epigastric region which may result from impingement
of these nerves, are supposed by the patient to be due to stomach
disorder.
Diseases of the =liver= may be manifested by =pains= in the region of
the right scapula. It has been suggested that the stimulus passes from
the liver up the pneumogastric to the spinal accessory and down the
spinal accessory to the trapezius muscle and thus causes the “liver
pain.”
=Intercostal neuralgia= is more common on the left side of the body.
The intercostal veins of the left side empty into the left superior
intercostal vein or the left azygos. Thus the blood, to reach the vena
cava, is obliged to take a circuitous route and stagnation is more
likely to occur than on the other side.
The glandular structure of the =mammary glands= is supplied by
intercostal nerves from the third to the sixth interspace. Lesions here
will cause various diseases of the breasts and adjustment will cure
many of them.
=Lumbar Nerves.=—The lumbar nerves may not only be deranged by various
growths, inflammatory processes and abscesses in the abdomen, but by
lesions, infections, parturition, and developmental defects of the
lumbar vertebræ. Tuberculosis of spine, sacro-iliac and hip joints, is
not rare. In doubtful cases utilize the X-ray plate.
Lesions in the region of the =first lumbar= may affect the
=iliohypogastric= and =ilio-inguinal= nerves and causes various
irritations of the penis, scrotum, labium and thigh. Also, the perineal
region may be involved, as well as connecting branches of these nerves
to various visceral nerves underneath.
The =genital organs= may be affected by lesions to the =genitocrural=
and =external cutaneous= nerves, caused by vertebral lesions of the
second and third lumbar vertebræ. The latter nerve may be irritated by
pressure underneath Poupart’s ligament.
Lesions at the third and fourth lumbar vertebræ and sacro-iliac
articulation may affect the =obturator nerve=.
=Sacral Nerves.=—Lesions to the sacral nerves are especially liable
to occur when an innominatum is subdislocated, as that changes the
relative position of the femur with the body and causes impingement to
the sacral nerves. Contraction of the pelvic and thigh muscles also
affect sacral nerves. Other lesions to the sacral nerves may be located
at the fifth lumbar and sacrum. It should be remembered that the
centers of the sacral nerves are in the lower dorsal and upper lumbar
region. Various lesions to the sacral nerves may be caused by pelvic
inflammation, compressions by growths, and injuries and contractions of
muscles within the pelvis. Sciatica has been described under neuritis.