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Lower Extremity Injury Assessment > Cervical and Thoracic In juries > Flashcards

Cervical and Thoracic In juries Flashcards

1
Q

What artery supplies 20% of the blood supply to the brain?

A

Vertebral artery

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2
Q

What vertebrae articulates with the occipital condyles?

A

Atlas (C1)

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3
Q

What vertebrae has a dens that allows for cervical rotation?

A

Axis (C2)

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4
Q

At what vertebral level does flexion/extension occur at?

A

C1

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5
Q

At what vertebral level does rotation occur at?

A

C2

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6
Q

True or false:

T1 is slightly more prominent than C7.

A

True

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7
Q

True or false:

The large knob at the back of your neck is really a combo of both C7 and T1.

A

True

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8
Q

What ligaments are found laterally to control rotation?

A

Ondontoid

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9
Q

What ligament helps to hold the dens to the atlas?

A

Transverse ligament

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10
Q

What does the nuchal ligament do?

A

Checks flexion of the neck

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11
Q

What ligaments help to limit flexion? Extension?

A

Limit flexion= nuchal ligament & PLL

Limit extension= ALL

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12
Q

What do the interspinous ligaments do?

A

Limit rotation and flexion

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13
Q

Where do we normally herniate a disc? Why?

A

Posterolaterally because the ALL is broader and the PLL will be stretched (because we’re typically in a flexed position more than an extended)

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14
Q

Which portion of a IVD is along the outer portion of the disc? The innner?

A

Annulus fibrosis; nucleus pulposis

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15
Q

What is the IVD made of?

A

Hyaline cartilage

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16
Q

How are the IVDs named?

A

For the vertebrae above them (ex= C2 IVD is below the axis)

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17
Q

How much does IVDs contribute to the height of the C-spine?

A

25%

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18
Q

Why do we shrink as we get older?

A

The IVDs begin to degenerate

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19
Q

How are the nerve roots numbered?

A

For the vertebrae below (so the C3 nerve root comes out above the C3 vertebrae)

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20
Q

What type of joints are facet joints?

A

Synovial

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21
Q

Which nerve roots have reflexes?

A 
C5= biceps
C6= brachioradialis
C7= triceps
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22
Q

What is corticodiscrimination?

A

Distinguishing between sensations such as sharp/dull, hot/cold, firm/light, etc

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23
Q

What fibers of a nerve are more peripherial and which are more central?

A

Peripherial= sensory

Central=motor

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24
Q

What is the goal of the on-field exam?

A

Establish life or limb threatening injuries and decide if they need to be boarded.

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25
Q

What is the most severe type of MOI for a neck injury?

A

Axial loading

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26
Q

What does an axial load of the neck typically result in?

A

Fractures and dislocations

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27
Q

What type of loading does a cervical dislocation occur from?

A

Rotation and flexion

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28
Q

What are the 6 types of MOIs for acute neck injuries?

A 
Axial load
Flexion
Hyperextension
Rotation and flexion
Rotation and hyperextension
Lateral flexion
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29
Q

Why are axial loads dangerous?

A

There is no place for the force to dissipate due to the c-spine being in alignment–therefore it can lead to fractures, dislocations, and subluxations

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30
Q

What is spear tackler’s spine?

A

An increased kyphosis of the cervical spine that compresses the spinal cord through stenosis

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31
Q

What causes spear tackler’s spine?

A

Repeated axial loading (spear tackling)

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32
Q

What is spinal stenosis?

A

A narrowing of the spinal canal that puts pressure on the spinal cord

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33
Q

How much space should be around the spinal cord?

A

4mm

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34
Q

What could spear tackler’s spine also lead to (besides kyphosis of the c-spine) that could also contribute to stenosis of the spinal canal?

A

Increased osteophyte (bone growth) formation (bone spurs)

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35
Q

What are the 4 types of fractures to the c-spine?

A

Burst, wedge, hangman’s, and spinous process

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36
Q

What is a burst fracture?

A

The segments of the vertebrae go outward and away from the spinal cord

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37
Q

What is a hangman’s fracture?

A

A displaced fracture in which the vertebrae comes forward and lacerates the spinal cord

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38
Q

Is a spinous process fracture stable or unstable? Why?

A

Stable because of all the soft tissue that is there to hold it in place

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39
Q

Where do wedge fractures occur?

A

Vertebral bodies

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40
Q

Above what vertebral level will a laceration of the spinal cord result in death? Why?

A

Above C4–the vagus nerve will be severed (it controls your heart and lungs)

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41
Q

What is a spinal cord neuropraxia?

A

The spinal cord “shuts down” for a short amount of time because the spinal cord bumped into the vertebral column.

42
Q

How long does a spinal cord neuropraxia typically last?

A

15 minutes

43
Q

What condition could possible increase the risk for an athlete having spinal cord neuropraxia episodes?

A

Stenosis of the spinal canal

44
Q

What are some major signs and symptoms of a serious C-spine injury? (x 11)

A

Unremitting neck pain, severe neck spasms, paraesthesia/numbness/tingling/burning (especially in multiple extremities), paralysis, neuropraxia/weakness/loss of movement, loss of sensation, reluctance to move, heard a “pop” and has symptoms, deformity, crepitis, or unconscious/LOC/severe head injury

45
Q

When do you test for ROM and use special tests?

A

After ruling out a serious injury

46
Q

When do you do a neurological exam?

A

When the pt is having neurological problems (i.e. tingling, burning, stinging, numbness, etc.)

47
Q

What are the 3 stipulations for RTP?

A

Full ROM
Full strength
Full functioning

48
Q

What tests should you use if you suspect a stinger/burner?

A

Shoulder abduction and depression

49
Q

What should you utilize if you suspect a muscle spasm?

A

MMT and ROM

50
Q

What is a brachial plexus neuropraxia?

A

A stretching or compression of the brachial plexus that disrupts peripherial nerve function without degenerative changes

51
Q

How long does a brachial plexus neuropraxia usually last?

A

A few minutes (anything longer than 10 you should explore other possibilities

52
Q

What is a burner or stinger?

A

A brachial plexus neuropraxia

53
Q

What are the signs and symptoms of a brachial plexus neuropraxia?

A

Burning sensation/numbness and tingling
Pain extending into the hand
Some loss of function of the arm/hand for several minutes

54
Q

What can repeated brachial plexus neuropraxia episodes lead to?

A

Neuritis, muscular atrophy, and permanent damage

55
Q

What is the management of a brachial plexus neuropraxia?

A

Monitor neurological symptoms and after signs and symptoms subside, then the athlete can RTP

56
Q

What are the 3 types of nerve injury? Which ones are significant injuries?

A

Neuropraxia
Axonotmesis (significant)
Neurotmesis (significant)

57
Q

What is neuropraxia?

A

Intact nerve fibers that recover spontaneously over a few hours to a few months

58
Q

What is axonotmesis?

A

The nerve sheath may remain intact but the axons may be divided–it can result in complete loss of muscle (motor) function, sensation, and autonomic functions

59
Q

What is the normal movement for neck flexion?

A

Touching chin to chest

60
Q

What is the normal movement for neck extension?

A

Look straight up with eyes in neutral

61
Q

What is the normal movement for neck lateral flexion?

A

Around 45 degrees

62
Q

What is the normal movement for neck rotation?

A

(90 degrees) Being able to turn the chin to be inline with the shoulder

63
Q

How can you differeniate between a disc or peripherial nerve issue?

A

Disc= pain in the neck (only affect 1 spinal cord level), pain with coughing, laughing, pooping, sneezing, etc.

Peripherial= peripherial symptoms (may affect multiple spinal cord levels)
**Think about MOI

64
Q

What is true whiplash?

A

Injury to both the anterior and posterior cervical spine structures

65
Q

What are thee differentials for a stiff neck?

A

Facet impingement
SCM spasm
Trapezius spasm

66
Q

What is the MOI for a muscle strain in the neck?

A

Sudden turn of the head, forced flexion, extension or rotation, or chronic stress

67
Q

What are the signs and symptoms for a neck muscle strain?

A

Localized pain/point tenderness
Restricted motion
reluctance to move neck

68
Q

What is the MOI for a cervical sprain (“whiplash”)

A

Move violent but same as muscle strain

69
Q

What are the signs and symptoms of a cervical sprain (“whiplash”) (x2)

A

Tenderness over the transverse processes (or spinous)

Pain the day after the trauma

70
Q

What does whiplash involve?

A

A snapping of the head and neck (ALL, PLL, interspinous ligament, or supraspinous ligament)

71
Q

What is torticollis?

A

They’re stuck in the position

72
Q

What is the MOI for torticollis?

A

Pain on one side of the neck (usually upon wakening)

73
Q

What is typically the cause of torticollis?

A

Synovial capsule impingement within a facet

74
Q

What are the signs and symptoms of torticollis? (x3)

A

Palpable point tenderness or muscle spasm
Restriced ROM
Muscle guarding

75
Q

True or false

Cervical disc injuries may be acute or chronic in nature

A

True

76
Q

What may the patient experience with a cervical herniated disc?

A

Neck pain
Painful/restricted ROM
Radicular pain
Symptoms may be present in the distal dermatome

77
Q

What maneuver may increase the symptoms from a herniated disc? Why?

A

Valsalva–the increase in intrathecal pressure

78
Q

What can cause a nerve root injury?

A

A compression or stretch of a nerve root as it exits the spinal column

79
Q

What is a repetitive stress injury to the c-spine?

A

Spinal stenosis

80
Q

What is spinal stenosis?

A

A narrowing of the spinal canal in the cervical region as a result of a congenital condition or changes in the vertebrae

81
Q

What changes in the vertebrae could lead to spinal stenosis?

A

Bone spurs, osteophytes, or disc bulges

82
Q

What are the signs and symptoms of spinal stenosis?

A

Transient quadriplegia from axial loading or hyperflexion or extension that recovers slowing within 10-15 minutes

83
Q

True or false:

Athletes with spinal stenosis could be one hit away from complete paralysis

A

True

84
Q

What is a sign from an athlete that they could possible have spinal stenosis?

A

If they have multiple stingers or burners

85
Q

How is spinal stenosis typically diagnosed?

A

Testing, x-ray or MRI can be used to determine extent of problem

86
Q

What is thoracic outlet symdrome?

A

An occulusion of the nerves and vessels from the C-spine area between the clavicle, subclavius muscle, and the first rib

87
Q

What happens in TOS?

A

The NAV is compressed by wither an extra rib or the scalene muscles

88
Q

In what sport is it common to have TOS?

A

Swimmers (or people with bad posture)

89
Q

What are the signs and symptoms of TOS?

A

Tingling, numbness, cold, blanching of hand, decreased circulation

90
Q

Which ribs attach to the sternum via costochondral cartilage?

A

1-10

91
Q

Which ribs are floating?

A

11 & 12

92
Q

Of the rib compression tests, which one typically affects the joints (sternocostal and costochrondral) and which one typically affects the ribs?

A

A/P compression- ribs (fracture)

Lateral compression- joints (seperation)

93
Q

What are the most common ribs to break?

A

5-9

94
Q

What potentially serious conditions do you need to be worried about with a rib fracture(s)?

A

Pneumothorax or hemothroax

95
Q

True or false:

Rib fractures can occur both acutely or from repetitive stress.

A

True

96
Q

What causes a costochondral seperation?

A

Blow to the anteriolateral aspect of the thorax

97
Q

What activity (common to athletes) could possible cause a costochondral seperation?

A

Intensive weight lifting (especially bench press)

98
Q

Chronic throacic back pain is often due to what?

A

Poor posture

99
Q

What bony abnormality is found in younger patients. What is it characterized by?

A

Schuermann’s

Increased kyphosis and wedging of the vertebral bodies

100
Q

What is acute thoracic back pain usually caused by?

A

Muscular issue (middle/lower trap, rhomboids, erector spinae strains)

101
Q

True or fale:

Thoracic fracture are common

A

False

102
Q

True of false:

Landing hard on the tailbone can cause a compression fracture in the lower thoracic area

A

Tre

Lower Extremity Injury Assessment (3 decks)

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