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LeFebvre > B8-9. Cervical Trauma > Flashcards

B8-9. Cervical Trauma Flashcards

1
Q

What are the most frequent cervical injuries in athletes?

A
  • acute sprains and strains

- contusions

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2
Q

Pain (sometimes burning and stiffness are often the main complaints with what cervical injury?

A

Acute cervical strain

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3
Q

A jammed-neck sensation and localized (sometimes sharp) pain are often the pain complaints with what cervical injury?

A

Acute cervical sprain

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4
Q

What is the symptom progression of a cervical sprain/strain?

A
  • Immediate pain at the time of injury that subsides after a few minutes
  • pain, swelling and tenderness with restricted motion that peaks several hours later or following day
  • referred pain into occipital area
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5
Q

What finding is more common with traumatic sprains/strains, Torticollis or decreased ROM?

A

Decreased ROM

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6
Q

What should be done is there is evidence of ligamentous instability in the cervical spine following injury?

A

Rigid collar

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7
Q

When should flexion-extension x-rays be taken of the spine following a cervical sprain/strain injury if ligamentous injuries are suspected?

A

May need to wait up to 2-3 weeks for muscle spams and splinting to resolve. During the acute phase, the splinting and spasms can cause a temporary loss of cervical lordosis

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8
Q

What are the three common mechanisms of macro trauma to the cervical spine?

A
  • flexion/extension injury
  • compressive injury to top of head
  • lateral flexion injury
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9
Q

What are the exam findings for a cervical sprain?

A
  • observation is unremarkable with some swelling and bruising
  • AROM is painful
  • neck muscle test are painless (except in set phase)
  • PROM is painful before end range
  • tender palpation over supraspinous ligament
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10
Q

Horizontal movement of one vertebral body on the next should not exceed ____.

A

3.5 mm

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11
Q

What is the upper limit of normal C1-C2 translation in an adult?

A

2.5 mm

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12
Q

What is the upper limit of normal C1-C2 translation in a child?

A

4.5 mm

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13
Q

What are the exam findings for a cervical strain?

A
  • observation is unremarkable with some swelling and bruising
  • AROM is painful in motions that require muscle to contract
  • neck muscle tests are painful and weak
  • PROM painful only at end range when muscle is stretched
  • tender palpation over muscle
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14
Q

What are the treatment goals for sprain/strain injuries to the cervical spine?

A
  • control pain and inflammation in acute phase (cryogenic or electrotherapy, hot/cold)
  • support and prevent further injury (activity restriction, k-tape, etc.)
  • prevent adhesions and atrophy and erosion of motor control pathway (CMT, isometrics, home ROM)
  • restore proper muscle balance (PIR, CRAC)
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15
Q

What are the late effects of sprain?

A

Periarticular fibrosis

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16
Q

What are the late effects of strain?

A

Myofibrosis, possibly trigger point

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17
Q

What is the most common cause of serious spinal injury?

A

Cervical acceleration-deceleration syndrome

Over 10% of population has residuals from CAD

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18
Q

Approximately 80% of MVAs occur at less than what speed?

A

25 mph

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19
Q

IN a rear end collision, at 60 msec, what happens to the cervical spine?

A

The S curve, where there is a bending moment in extension of the lower cervicals and bending moment in flexion of the upper cervicals

C0-C2 often develop restrictions
C4-C6 often become hypermobile

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20
Q

Why do head rests not prevent the S-curve?

A

Head contact with the head piece occurs at 70-100 msec while the S curve occurs at 60 msec

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21
Q

Following the S-curve, what happens to the cervical spine?

A

Hyperextension

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22
Q

How can a head rest help decrease injury?

A

If properly aligned with the EOP, it can decreased the amount of hyper extension

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23
Q

What anterior neck structure are at risk in cervical extension injuries?

A
  • strains SCM
  • strains anterior and middle scalenes
  • strains longus colli and capitus
  • sprains ALL
  • tear anterior disc fibers
  • traction injuries to vertebral artery and sympathetic plexus
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24
Q

What posterior neck structure are at risk in cervical extension injuries?

A
  • fascia

- alar ligaments

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25
Q

Upper cervical injury can result in injured nociceptors and mechanoreceptors which can cause:

A
  • balance disorders
  • dizziness
  • cognitive disorders (mild TBI)
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26
Q

How can whiplash cause TMJ?

A

Dropping of mandible during hyperextension can strain the anterior capsule of the TMJ

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27
Q

How can a whiplash injury cause injury dysphagia?

A

The tensile load with hyperextension may tear smooth muscle of the esophagus causing dysphagia although this is not the main cause of dysphagia in whiplash cases. Most are psychological

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28
Q

If the sympathetic chain is injured through traction in a whiplash injury, what can result?

A

Horner’s syndrome

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29
Q

What kind of instability results from weak, injured or inhibited deep neck flexors?

A

Functional instability

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30
Q

Sprains of the ALL can lead to what kind of instability in the cervical spine?

A

Structural instability

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31
Q

Tearing of what structures were the most common hyperextension injuries in cadavers?

A

Disc

ALL

32
Q

What are the two typical lesions that occur to the disc in a hyperextension injury?

A

Avulsion
Anterior annular fiber tears

NOTE: posterior disc herniations are rare in the cervical spine

33
Q

Where in the cervical spine are disc injuries most common?

A

Middle and lower cervicals

34
Q

What kind of injury can happen to the facets during a hyperextension injury?

A
  • shear forces can put tensile load on facet capsule which is rich in nociceptors
  • middle and lower cervical facets can compress posteriorly causing meniscus to become impinged
35
Q

What percentage of chronic pain in late whiplash comes from the facet joints?

A

60%

36
Q

How can nerve root trauma happen with a hyperextension injury?

A

The NR can be traumatized in the IVF during hyperextension

37
Q

Following the S curve and hyperextension phase of a cervical whiplash injury, what is the next phase?

A

Cervical flexion

38
Q

During a front end collision, the head is forcibly flexed forward, followed by a degree of recall resulting in hyperextension. This is called a deceleration injury. What part of the cervical spine undergoes deceleration first?

A

C0-C1, then C6

39
Q

What ligamentous structures can be sprained during a deceleration injury?

A
  • alar ligament
  • PLL
  • nuchal
  • supraspinous ligament
  • interspinous ligament
  • facet capsule
40
Q

What muscles can be sprained during a deceleration injury?

A

posterior thoraco-cervical muscles

  • semispinalis
  • splenius capitis
  • rectus capitis
  • suboccipitals
  • trapezius
  • levator scapula
41
Q

Other than sprains and strains, what other injuries can happen to the cervical spin in a deceleration injury from a head on collision?

A
  • chip fractures to anterior vertebral bodies
  • orthopedic subluxations and dislocations
  • traction injuries to NR or cord
  • traction injury to greater occipital nerve
42
Q

A broad side collision/lateral flexion injury will cause ______ stress on the concave side and _____ stress on the convex side

A

Compressive

Tensile

43
Q

What are the long term effects of whiplash that can become chronic whiplash?

A
  • facet syndrome (40-68% of cases)
  • joint dysfunction
  • instability
  • myofascial pain syndrome
  • post traumatic HAs
  • CNS and PNS dysfunction
  • altered cervical biomechanics
44
Q

What are the two most common facets that result in persistent facet syndrome in chronic whiplash?

A

C5-6

C2-3

45
Q

What position can be assumed to help minimize injury from a collision?

A
  • head and back against the seat
  • straight arm the steering wheel
  • put foot on brake
  • look straight ahead and slightly up
  • scrunch your shoulders up to brace
46
Q

What absorbs damage better, muscle or ligaments?

A

Muscles are more injury resistant and heal with high resiliency

47
Q

What 4 parts of a history are needed to determine the mechanism of injury following an MVA?

A
  • magnitude and direction of forces
  • position and attitude of the body
  • force dampeners and augmenters
  • detailed list of symptoms and when they occurred including LOC
48
Q

How does head position affect prognosis in a MVA?

A

Rotated or laterally flexed head at time of impact is a primary feature related to symptom persistence

49
Q

If the head is rotated to the right during impact of an MVA, what facets will experience more load?

A

Right

50
Q

If the head is rotated to the right during impact of an MVA, what SCM will more likely tear?

A

Left

51
Q

Is a seat belt a dampener or augmenter?

A

Both.

Dampener for body and augmenter for head and neck

52
Q

What are examples of force dampeners in an MVA?

A
  • airbag
  • damage to seat
  • state of preparedness
53
Q

What is an example of an augmenter in an MVA?

A

Brakes applied

Augmenter but prevents double impact

54
Q

What are some possible head and neck symptoms that may be present follow an MVA?

A
  • dizziness
  • headache
  • vision changes
  • TMJ
  • dysphagia
  • neck pain
55
Q

What are some possible higher brain center symptoms that may be present after a MVA?

A
  • cognitive: trouble processing, concentrating, remembering
  • affective: irritability, fatigue, sadness, anxiety
  • sleep: trouble sleeping or too much
56
Q

What three conditions Of the cervical spine can present with Horner’s syndrome?

A
  • Pancoast tumor
  • internal carotid artery dissection
  • CAD/WAD
57
Q

What percentage of patients with concussions lose consciousness?

A

10%

58
Q

What are the indications from the history that a patient should have radiographs after an MVA?

A
  • 65 +
  • dangerous mechanism of injury
  • presence of paresthesia in extremities
  • painful, distracting injury elsewhere in the body
  • altered level of alertness
  • evidence of intoxication
  • patients with known vertebral disease
59
Q

What is Rust’s sign?

A

Patient holds head up in distraction and this suggests fracture or structural instability

60
Q

Patients > 65 years, dangerous mechanism of injury, or paresthesia must undergo cervical spine radiography PRIOR to undergoing what other physical exam?

A

active range of motion testing

61
Q

What are the indications from the physical exam that a patient should have radiographs after an MVA?

A
  • unable to actively rotate neck 45 degree to left and right
  • midline cervical spine tenderness
  • focal neurologic deficit
62
Q

Post-traumatic headache can occur in up to ____% of patients in the first
three months post head trauma.

A

80

63
Q

The symptoms of post traumatic headache fall into three groups:

A
  • physical (headache, dizziness, double/blurred vision, nausea, light and sound sensitivity)
  • emotional (irritable, frustrated, depressed or restless)
  • cognitive (forgetful, poor concentration, taking longer to think)
64
Q

What radiographic studies are included in the Davis series?

A

AP, APOM, lateral, 2 obliques, flexion/extension

65
Q

What are the 4 possible fractures and dislocations that can occur to C1-C2 from CAD?

A
  • anterior displacement associated with cruciate and capsular tearing, rupture or fracture of the dens
  • posterior displacement associated with C1 anterior arch or odontoid fracture
  • Jefferson fracture from axial compression of C1
  • Hangman’s fracture of posterior elements such as pedicles associated with disruption of ALL and anterior annulus
66
Q

What are the possible fractures and dislocations that can occur in C2-C7 following a CAD?

A
  • unilateral dislocation from throng rotational/lateral flexion injury
  • bilateral dislocation from hyperflexion injury
  • compression fractures of vertebral body or articular pillars
  • chip fracture in the anterior superior vertebral body from compression in hyperflexion
  • avulsion fracture in the anterior inferior vertebral body from hyperextension
  • clay shoveler’s fracture of the SPs
67
Q

Instability leading to joint laxity and excessive motion is what kind of instability?

A

Structural

68
Q

Instability from damaged mechanoreceptors leading to altered motor control is what kind of instability?

A

Functional instability

69
Q

What is the tetrad of clinical instability from CAD based on AP and lateral radiographs?

A
  • widening of the interspinous space
  • subluxation of facet joints
  • compression fractures of subjacent vertebrae
  • loss of cervical lordosis
70
Q

What are the signs of instability from CAD based on flexion and extension views?`

A
  • listhesis >3.5mm
  • forward displacement >11 degrees
  • C1-C2 translation >2.5mm
71
Q

What is the management for structural instability?

A

Stabilize with rigid collar and possibly surgery

72
Q

During the acute phase of a CAD injury, what are the treatment goals? What is the operation end point for the acute phase?`

A
  • reduce pain, inflammation and spasm
  • decrease anxiety

This phase ends when there is no pain at rest

73
Q

What specific treatments can be given for CAD patients during the acute phase?

A
  • CMT
  • light massage or PIR
  • cryotherapy
  • NSAIDs
  • orthoses such as a soft collar
  • home ROM and isometric exercises
74
Q

During the sub acute repair phase of a CAD injury, what are the treatment goals? What is the operation end point for the acute phase?`

A
  • control pain
  • promote flexible healing
  • improve circulation
  • restore function
  • minimize effects of fibrosis
  • minimize atrophy

This phase ends when patient can perform unstressed ADLs

75
Q

During the repair rehab phase of a CAD injury, what are the treatment goals? What is the operation end point for the acute phase?`

A
  • decrease adhesions
  • restore normal movement patterns
  • restore strength, endurance and motor control
  • increase physical work capacity

this phase ends when patient can perform normal activities under some constraints

76
Q

During the remodeling rehab phase of a CAD injury, what are the treatment goals? What is the operation end point for the acute phase?`

A
  • return to full lifestyle
  • prevent future injury
  • change psychosocial factors affecting or altered by injury

This phase ends when full recover to pre injury status has been achieved

77
Q

What were the finding of the Britain orthopedic surgeon study of patients who received cervical spine soft tissue injuries in MVAs?

A

70% of patient still had symptoms 15 years after injury indicating that soft tissue injuries are more often than not permanent

LeFebvre (29 decks)

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