OMM3 # 16

Sidebending Rotation
Not yet reviewed Chad McCormick for Jerry Ignatius
Thomas J. Fortopoulos, D.O.
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General Information: Dr. Fotopoulus followed his ppts., and stressed on certain points
that we should know for the exam and for future practicals. I have bolded everything
that he stressed on and that he alluded to following class. I have also added a pic that
Dr. Fotopoulus created and presented at the beginning of the 3rd hour lecture.

I. Case Presentation (Remember this Case!!!)

• A 26 y/o male presents to your clinic with severe headache not relieved by over
the counter medication for past 1-2 weeks. His family doctor referred him to a
neurologist, who found no neurological deficits. Both CT and MRI are negative for
fracture, mass lesion, AVM, or hemorrhage. Exhausting all consideration, the
neurologist refers the patient to your specialty OMM clinic. During your history,
the patient remembers a baseball game he recently played at, during which time he
suffered a blow to the left inferolateral aspect of the cranium, just behind the
mandible. You palpate the cranium and soon begin to distinguish the following
motion preference:
→ Right sphenoid greater wing moves inferior and anterior
→ Right occipital squama moves inferior and posterior
→ Left sphenoid greater wing moves superior and posterior
→ Left occipital squama moves superior and anterior
• Differential Diagnosis
→ Right sidebending rotation (correct diagnosis)
→ Tension headache
→ Cluster headache
→ Vascular headache
II. Sidebending Rotation
• Physiological Cranial Dysfunction (Remember that sidebending
rotation is a Physiological dysfunction)
• Deviation from normal SBS Flexion and Extension
• Diagnosed and described by cranial bone motion
• Results from tension or trauma which restricts or diverts the arc of
SBS
• A physiological adaptation to a lateral trauma exactly at the level of
the SBS inducing sidebending at the SBS with convexity to the opposite
side (eg. Force from right, convexity on left)
• Can occur from birthing process
• Sphenoid and occiput sidebend and rotate
• For sidebending= there are TWO vertical axes
– one through the foramen magnum of occiput
– one through the body of the sphenoid
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Sidebending Rotation
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• For rotation= there is ONE anteroposterior axis from opisthion to
nasion
• For sidebending= the sphenoid and occiput rotate in opposite
directions about the vertical axes
– creates convex and concave sides
• For rotation= the sphenoid and occiput rotate in same direction
• The rotation drops inferiorly on the side of the convexity of sidebending
• The temporals follow the occiput.
• Side of low occiput= temporal relatively externally rotated
• Left Sidebending Rotation= left externally rotated temporal bone (relative)
• Right Sidebending Rotation= right externally rotated temporal bone
(relative)
• Named for the direction of rotation (the side of the
convexity). That is, for the side that drops
• may be from trauma to the head or just other pulls on the body
• motion of the head may alternate between neutral and the strain pattern, or
the strain pattern may be present through inhalation and exhalation phases of
primary respiration

III. Sidebending Rotation Palpatory Findings

• Vault Hold
• Sidebending experienced by approximating or narrowing the index and
little fingers of hand on side of concavity
• Simultaneously, the other hand experiences a spreading or widening on the
side of convexity
• Rotation is represented by an inferior (caudad) movement of the whole
spread hand and superior (cephalad) movement of the whole
approximated hand
• In left sidebending rotation the left hand is spread wider, moves
inferior, and has an externally rotated temporal bone. The left head feels
fuller in the left hand
• In right sidebending rotation the right hand is spread wider, moves
inferior, and has an externally rotated temporal bone. The right head feels
fuller in the right hand

IV. Gross Anatomical Features

• All positions are relative
• Anterior quadrant with superior (cephalad) greater wing of sphenoid=
external rotation
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Sidebending Rotation
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• Anterior quadrant with inferior (caudad) greater wing of sphenoid=
internal rotation
• Posterior quadrant with superior (cephalad) occiput= internal rotation
• Posterior quadrant with inferior (caudad) occiput= external rotation
V. Specific Findings
• Right Sidebending/Rotation
– Right orbit narrow
– Right globe retracted
– Right frontal bone is flat, less full due to relative internal rotation
– Right ear away from head
– Right mastoid tip posteriomedial, due to right temporal bone in relative
external rotation
→ What your fingers will feel is:
1. Right hand will dip away and widen
2. Left hand will narrow and come up
• Left Sidebending/Rotation
– Left orbit narrow
– Left globe retracted
– Left frontal bone is flat, less full due to relative internal rotation
– Left ear away from head
– Left mastoid tip posteriomedial, due to left temporal bone in relative
external rotation
→ What your fingers will feel is:
1. Left hand will dip away and widen
2. Right hand will narrow and come up

At the beginning of the 3:00 hour Dr. Fotopoulos presented this drawing to explain the
ideas of Sidebending rotation.

Normal Right Side-bending

Left Right Left Right

concave convex
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Sidebending Rotation
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