Investigation of the head joints before, during and after an anesthesia with complete neuromuscular blockade

Abstract

To determine wether a somatic dysfunction of head joints depends from segmental muscle strain, we investigated 89 patients before, during and after general anesthesia. We examined the disturbed joint motion as exclusive criterion for a somatic dysfunction, because through an anesthesia with endotracheal intubation including complete neuromuscular blockade segmental influences on the inspected joint were eleminated. For complete muscle relaxation as required for orotracheal intubation a non depolarizising muscle relaxant was used. Somatic dysfunctions were found most frequent for side-inclination and retroflexion in segment O/C1. Both before as well as during complete neuromuscular blockade could be found in the majority of examinations (89,1 %) similar restraints of joint motions. To 10,9 % were found, that somatic dysfunctions established before the muscle relaxant was applicated, were no more demonstrable under complete blockade of neuromuscular transmission. Different theoretical models are presented for the interpretation of our results. We assume, that the disturbance of one component of the metamer organized segment is the basic phanomenon of somatic dysfunction. This disturbance break through the spinal segmental inhibition and expand into the segment. Subsequently we discuss to replace the term "somatic dysfunction" through "segmental dysfunction" and to define it as increasing of nozizeptive afference in the segment over a determined period of time with breakthrough of the spinal segmental inhibition threshold. Based on the model of disturbed nerval – reflex functional circle we recommend for treatment at first chiropractic muscle relaxing techniques. The indication for manipulation is to be judged in case of rezidivation. The primary employment of manipulation appears promising, includes however in the area of head joints at faulty technology the danger of serious neurological complications.