Cervical and Thoracic In juries Flashcards
What artery supplies 20% of the blood supply to the brain?
Vertebral artery
What vertebrae articulates with the occipital condyles?
Atlas (C1)
What vertebrae has a dens that allows for cervical rotation?
Axis (C2)
At what vertebral level does flexion/extension occur at?
C1
At what vertebral level does rotation occur at?
C2
True or false:
T1 is slightly more prominent than C7.
True
True or false:
The large knob at the back of your neck is really a combo of both C7 and T1.
True
What ligaments are found laterally to control rotation?
Ondontoid
What ligament helps to hold the dens to the atlas?
Transverse ligament
What does the nuchal ligament do?
Checks flexion of the neck
What ligaments help to limit flexion? Extension?
Limit flexion= nuchal ligament & PLL
Limit extension= ALL
What do the interspinous ligaments do?
Limit rotation and flexion
Where do we normally herniate a disc? Why?
Posterolaterally because the ALL is broader and the PLL will be stretched (because we’re typically in a flexed position more than an extended)
Which portion of a IVD is along the outer portion of the disc? The innner?
Annulus fibrosis; nucleus pulposis
What is the IVD made of?
Hyaline cartilage
How are the IVDs named?
For the vertebrae above them (ex= C2 IVD is below the axis)
How much does IVDs contribute to the height of the C-spine?
25%
Why do we shrink as we get older?
The IVDs begin to degenerate
How are the nerve roots numbered?
For the vertebrae below (so the C3 nerve root comes out above the C3 vertebrae)
What type of joints are facet joints?
Synovial
Which nerve roots have reflexes?
C5= biceps C6= brachioradialis C7= triceps
What is corticodiscrimination?
Distinguishing between sensations such as sharp/dull, hot/cold, firm/light, etc
What fibers of a nerve are more peripherial and which are more central?
Peripherial= sensory
Central=motor
What is the goal of the on-field exam?
Establish life or limb threatening injuries and decide if they need to be boarded.
What is the most severe type of MOI for a neck injury?
Axial loading
What does an axial load of the neck typically result in?
Fractures and dislocations
What type of loading does a cervical dislocation occur from?
Rotation and flexion
What are the 6 types of MOIs for acute neck injuries?
Axial load Flexion Hyperextension Rotation and flexion Rotation and hyperextension Lateral flexion
Why are axial loads dangerous?
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
What is spear tackler’s spine?
An increased kyphosis of the cervical spine that compresses the spinal cord through stenosis
What causes spear tackler’s spine?
Repeated axial loading (spear tackling)
What is spinal stenosis?
A narrowing of the spinal canal that puts pressure on the spinal cord
How much space should be around the spinal cord?
4mm
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?
Increased osteophyte (bone growth) formation (bone spurs)
What are the 4 types of fractures to the c-spine?
Burst, wedge, hangman’s, and spinous process
What is a burst fracture?
The segments of the vertebrae go outward and away from the spinal cord
What is a hangman’s fracture?
A displaced fracture in which the vertebrae comes forward and lacerates the spinal cord
Is a spinous process fracture stable or unstable? Why?
Stable because of all the soft tissue that is there to hold it in place
Where do wedge fractures occur?
Vertebral bodies
Above what vertebral level will a laceration of the spinal cord result in death? Why?
Above C4–the vagus nerve will be severed (it controls your heart and lungs)
What is a spinal cord neuropraxia?
The spinal cord “shuts down” for a short amount of time because the spinal cord bumped into the vertebral column.
How long does a spinal cord neuropraxia typically last?
15 minutes
What condition could possible increase the risk for an athlete having spinal cord neuropraxia episodes?
Stenosis of the spinal canal
What are some major signs and symptoms of a serious C-spine injury? (x 11)
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
When do you test for ROM and use special tests?
After ruling out a serious injury
When do you do a neurological exam?
When the pt is having neurological problems (i.e. tingling, burning, stinging, numbness, etc.)
What are the 3 stipulations for RTP?
Full ROM
Full strength
Full functioning
What tests should you use if you suspect a stinger/burner?
Shoulder abduction and depression
What should you utilize if you suspect a muscle spasm?
MMT and ROM
What is a brachial plexus neuropraxia?
A stretching or compression of the brachial plexus that disrupts peripherial nerve function without degenerative changes
How long does a brachial plexus neuropraxia usually last?
A few minutes (anything longer than 10 you should explore other possibilities
What is a burner or stinger?
A brachial plexus neuropraxia
What are the signs and symptoms of a brachial plexus neuropraxia?
Burning sensation/numbness and tingling
Pain extending into the hand
Some loss of function of the arm/hand for several minutes
What can repeated brachial plexus neuropraxia episodes lead to?
Neuritis, muscular atrophy, and permanent damage
What is the management of a brachial plexus neuropraxia?
Monitor neurological symptoms and after signs and symptoms subside, then the athlete can RTP
What are the 3 types of nerve injury? Which ones are significant injuries?
Neuropraxia
Axonotmesis (significant)
Neurotmesis (significant)
What is neuropraxia?
Intact nerve fibers that recover spontaneously over a few hours to a few months
What is axonotmesis?
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
What is the normal movement for neck flexion?
Touching chin to chest
What is the normal movement for neck extension?
Look straight up with eyes in neutral
What is the normal movement for neck lateral flexion?
Around 45 degrees
What is the normal movement for neck rotation?
(90 degrees) Being able to turn the chin to be inline with the shoulder
How can you differeniate between a disc or peripherial nerve issue?
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
What is true whiplash?
Injury to both the anterior and posterior cervical spine structures
What are thee differentials for a stiff neck?
Facet impingement
SCM spasm
Trapezius spasm
What is the MOI for a muscle strain in the neck?
Sudden turn of the head, forced flexion, extension or rotation, or chronic stress
What are the signs and symptoms for a neck muscle strain?
Localized pain/point tenderness
Restricted motion
reluctance to move neck
What is the MOI for a cervical sprain (“whiplash”)
Move violent but same as muscle strain
What are the signs and symptoms of a cervical sprain (“whiplash”) (x2)
Tenderness over the transverse processes (or spinous)
Pain the day after the trauma
What does whiplash involve?
A snapping of the head and neck (ALL, PLL, interspinous ligament, or supraspinous ligament)
What is torticollis?
They’re stuck in the position
What is the MOI for torticollis?
Pain on one side of the neck (usually upon wakening)
What is typically the cause of torticollis?
Synovial capsule impingement within a facet
What are the signs and symptoms of torticollis? (x3)
Palpable point tenderness or muscle spasm
Restriced ROM
Muscle guarding
True or false
Cervical disc injuries may be acute or chronic in nature
True
What may the patient experience with a cervical herniated disc?
Neck pain
Painful/restricted ROM
Radicular pain
Symptoms may be present in the distal dermatome
What maneuver may increase the symptoms from a herniated disc? Why?
Valsalva–the increase in intrathecal pressure
What can cause a nerve root injury?
A compression or stretch of a nerve root as it exits the spinal column
What is a repetitive stress injury to the c-spine?
Spinal stenosis
What is spinal stenosis?
A narrowing of the spinal canal in the cervical region as a result of a congenital condition or changes in the vertebrae
What changes in the vertebrae could lead to spinal stenosis?
Bone spurs, osteophytes, or disc bulges
What are the signs and symptoms of spinal stenosis?
Transient quadriplegia from axial loading or hyperflexion or extension that recovers slowing within 10-15 minutes
True or false:
Athletes with spinal stenosis could be one hit away from complete paralysis
True
What is a sign from an athlete that they could possible have spinal stenosis?
If they have multiple stingers or burners
How is spinal stenosis typically diagnosed?
Testing, x-ray or MRI can be used to determine extent of problem
What is thoracic outlet symdrome?
An occulusion of the nerves and vessels from the C-spine area between the clavicle, subclavius muscle, and the first rib
What happens in TOS?
The NAV is compressed by wither an extra rib or the scalene muscles
In what sport is it common to have TOS?
Swimmers (or people with bad posture)
What are the signs and symptoms of TOS?
Tingling, numbness, cold, blanching of hand, decreased circulation
Which ribs attach to the sternum via costochondral cartilage?
1-10
Which ribs are floating?
11 & 12
Of the rib compression tests, which one typically affects the joints (sternocostal and costochrondral) and which one typically affects the ribs?
A/P compression- ribs (fracture)
Lateral compression- joints (seperation)
What are the most common ribs to break?
5-9
What potentially serious conditions do you need to be worried about with a rib fracture(s)?
Pneumothorax or hemothroax
True or false:
Rib fractures can occur both acutely or from repetitive stress.
True
What causes a costochondral seperation?
Blow to the anteriolateral aspect of the thorax
What activity (common to athletes) could possible cause a costochondral seperation?
Intensive weight lifting (especially bench press)
Chronic throacic back pain is often due to what?
Poor posture
What bony abnormality is found in younger patients. What is it characterized by?
Schuermann’s
Increased kyphosis and wedging of the vertebral bodies
What is acute thoracic back pain usually caused by?
Muscular issue (middle/lower trap, rhomboids, erector spinae strains)
True or fale:
Thoracic fracture are common
False
True of false:
Landing hard on the tailbone can cause a compression fracture in the lower thoracic area
Tre
