Fig. 5. Technic of nerve tracing, showing position of fingers and marking of tender points.
Palpation as Guide
When palpation has been made, remember that the impinged nerve is usually found on the side opposite to the direction of the spinous process in its departure from the median line. With a left subluxation the tenderness is usually, though not always, on the right side. If in the Lumbar, and the subluxation a rotation, the impinged nerve will be found below the transverse process of the subluxated vertebra. In the Cervical and Dorsal regions the tender nerve is usually below, but may be either above or below, the transverse of the subluxated one.
Examine the nerves having exit from the foramina of each subluxated vertebra in turn from above downward. When a tender point is found about an inch from the mid-spinal line, attempt to follow the nerve and palpate until it has been traced as completely as possible.
Where to Expect Tenderness
The region immediately surrounding the spinous process of the subluxated vertebra may be tender because of impingement of the axons of the posterior primary division of that spinal nerve which emerges below the vertebra. Such tenderness is more common with anterior subluxations than with others. It is not to be confused with the soreness which often appears after adjustment and is due to bruising or straining of the tissues.
Nerve tenderness may be discovered at a little distance from the mid-spinal line and at a level slightly lower than the emergence of the nerve. If a nerve is irritated, the finger inserted between the ribs near their articulation with the transverse processes will elicit tenderness. The discovery of tender points along the spine is the most important part of nerve-tracing.
Nerve-Paths
Detailed description of the paths of all the spinal nerves may be studied from any standard work on anatomy and will not be included here, but it may be well to remind the reader of certain general tendencies.