Layout of survey #1, this includes items that were edited out.

We took a survey of UC doctors to see how many of you feel that you can palpate the transverse process of the atlas on an average adult male patient.   If you think you can palpate it, please respond  yes.  If not, vote no. We will be collecting data from you, the anonymous voter, until October 31st.  After which we will post the results. 
 
We had 29 votes registered on our survey.
YES votes 18
NO votes 11
 
Annonymous comments submitted with some votes:
Of course you can. BJ said you can. Grostic said you can. Sweat says you can. Gregory said you can. Why are you having this meaningless debate on a topic that is accepted?

Your survey made me think. I did some experimenting on palpation and on my x-ray work. My vote is no, but some times you can feel it. I can feel it on my daughter she is 8 years old with a scrawny little pencil neck. I could not feel it on my fat Uncle Freddie, who tops the scale at over 350 lbs. I could barley palpate his mastoids. So, I think it is dependent upon the patient.

My vote on the transverse process question is "No...but with an explanation."  I know, from anatomy labs, that the atlas transverse process is separated from the surface of the skin by an inch to an inch and a half
of muscle, fat, fascia and dermis.  Thus it would be impossible for one to actually palpate the tp in an adult male, especially enough to even have a hint of how to adjust the atlas.  However, I also know that I have trained my fingertips to be extremely sensitive to differences in texture, density and temperature.  I CAN feel where the density of the skin changes and I assume that the tp is the cause for that change.  I also know that the location of the difference in density changes after an adjustment.  I DO NOT, however, rely solely upon scanning palpation for my pre and post adjustment analysis.  I always check for body balance (leg check), thermographic imbalance (Titron 3000) and for muscular imbalance/facet joint inflammation (scanning palpation).  If and ONLY IF all three of these agree, will I make the decision of whether to adjust or not. Sorry to get long, but the only thing I hate more than incompetence is to be misunderstood and I felt the explanation is necessary to fully understand my answer.

Yes, usually, unless the atlas is malformed with a bent transverse process. I have found that the T.P. is occasionally malformed. Thus I must ask how does this affect the vector when your contact is not where it is supposed to be?

We do agree on this one!  Most chiropractors couldn't find the C1 TP accurately with palpation on a lucky day!  If anyone has done specific, post x-rayed upper cervical work, they know how hard it is to find the contact.    Your post films will show when you missed the contact because they look exactly like the pre!  It is very difficult to do even using a BB on the earlobe, etc., with a great amount of accuracy and consistency.  Add this to the fact that the C1 transverse is at least 1/2 in. under the skin's surface and an angle vectored adjustment requiring a "lead"  that gets larger for higher lines of drive and you have a situation that requires great thought and skill to master!  My vote is absolutely No.  One cannot find the C1 TP with any degree of accuracy using only palpation.

I tried to find it on a couple of my old and funky patients that are kind of out of it and I vote yes. I tried on these patients because I really spent a lot of time probing in their neck and they would not wonder what was going on. In fact I must embarrassedly admit that one of them developed torticollis after all of my digging.
I vote NO. Look at Netter. Look at a spine. It is tucked up there so high, that you would have to remove the mastoids and the SCM to find it.

Yes,it can in average adult male but, not all the way around.

I am in my 9th quarter, so I went back to the anatomy lab, after hours, and did some probing. After checking it out, I have to vote no. I really wished I could say yes, because you have messed me up. I have to go back and rethink a lot of things that were told to me.

I found it on my dog, does that count?

This is stupid. What is even more stupid is that I occasionally read your stupid web site and I am stupidly responding to a question that was debated 90 years ago. If you cannot feel it why have we been adjusting it for the last 100+ years. If we cannot feel it, what do upper cervical doctors adjust? The lower cervicals?
I vote yes. I heard Al Gore say that the atlas can be palpated, so I believe him.

I vote yes, it's in the fossa.

Sometimes yes, sometimes no. When a patient has a lot of cervical spasms their transverse process cannot be palpated, because the SCM is in the way. When a patient can lie on their side and relax you can feel it. It jumps out at you.

I did my own little study, using ten patients. I x-rayed them after palpating them. I compared what I thought was their atlas to what I saw on the films. Frequently the mastoids were too long. Also I think that the mastoids are longer then they appear on x-ray. As they descend they get thinner and more cartilaginous; this will not show up on films. You can feel it though. I think DC’s frequently mistake the mastoids for the TP of the atlas. I vote no.
 
Comments by oncause:
To state it simply and unequivocally, the atlas T.P. cannot be palpated with any reasonable degree of accuracy.

Regardless of which technique you use, contact location is fundamental and of extreme importance.
Does it really make sense to go through various and sundry line drawings and angle calculations, and then miss your contact point by an inch?

Contact error is one of the major factors, which can blunt the amount of correction, and thus, the level of results -- especially in the chronic and severely ill patient.

Here is a very simple method of determining the accuracy of your palpation:
1.      Prior to taking your lateral film, palpate to locate what you estimate to be your contact point.
2.      Mark that point with a washable pen.
3.      Tape a lead shot, BB or split shot (any small piece of dense metal will work) on the mark you have made.
4.      Shoot the film.
5.      Check contact location with marker location.
If you miss contact, you miss a certain level of results and a certain level of referrals.