Volume 92, Issue 9

It is assumed that the atlas (Cl) glides superiorly and laterally along the occipital (CO) condyle during translatory motion of the head in the opposite direction. To provide roentgenographic documentation, a translatory test of atlantooccipital (CO-Cl) motion was performed to the left and to the right on a healthy, asymptomatic volunteer subject. Roentgenographic examination was made at the extreme in each direction. The films indicate the change in atlantal position relative to the occiput and support the assumption. A translation of the head in the coronal plane to test for atlanto-occipital joint mobility is described.

The Spencer technique is a standardized series of shoulder treatments with broad application in diagnosis, treatment, and prognosis. The evolution of this technique is traced from 1916 to date to try to identify factors in the development of manipulative methods. Few suggestions about the basic steps to be followed in developing any new manipulative technique were seen. Of chief importance were changes in sequence, the addition of steps, and the combination of one technique with another, as in the addition of muscle-energy methods to each step. One change, accidentally introduced in the 1970s, displaced a critical step in the procedure. The principal element guiding the development of the Spencer technique appears to be clinical necessity interpreted in terms of anatomy and pathology.

This monthly series was developed from the AOA Task Force on AIDS Writers' Workshop, held August 16 to 18, 1991, in New York. The workshop was sponsored by an education grant from Burroughs Wellcome. It will provide brief clinical updates and perspectives on the human immunodeficiency virus (HIV). Readers may request tear sheets from the AOA editorial offices.

Stress is an inherent component of residency training and its effect on healthcare provided is well documented. Although stress-related signs and symptoms are easily recognized, residents and trainers are likely to ignore them-until a crisis occurs. Based on the theory that good communication alleviates stress, the "I" Language Model, discussed in this article, is designed to enhance communication between residents and their superiors, colleagues, and families. As such, it is meant to provide one means of intervention before stress affects the resident's on-the-job performance.

Manipulation while the patient is under anesthesia is an old, widely recognized procedure in musculoskeletal medicine. It is used for treating acute and chronic musculoskeletal conditions with significant biomechanical dysfunction unresponsive to conservative therapy. The procedure is helpful when muscle spasm and irritability preclude success without anesthetization of the patient. Safety and effectiveness are favored by appropriate selection of patients, knowledge of indications and contraindications, suitable anesthetic, and services of a qualified physician trained in structural diagnosis and manipulative technique. A team approach is recommended. To illustrate effective use of the procedure, a classic case is described.

The empty sella syndrome has become a rather frequent finding in magnetic resonance imaging (MRI) scanning. The usual presentation of empty sella syndrome involves an incidental finding on a computed tomography scan or an MRI scan. It is unusual to find empty sella syndrome associated with hypopituitarism. The authors describe such an unusual finding in a 54-year-old nulliparous woman.