spinal column injuries Flashcards
what are 4 prevention methods used to reduce the risk of obtaining a spinal injury
1) proper lifting techniques
2) safe posture
3) protective equipment
4) rules and regulations
list 5 different types of posture
1) sway back
2) lumbar lordosis
3) thoracic kyphosis
4) forward head
5) good posture
dermatomes
sensation areas (where different spinal nerve roots go)
what are two assessment methods used to diagnose a possible spinal
1) dermatomes
2) reflexes
- biceps - between C5/6
- brachioradialis - C6
- triceps - C7
- patellar tendon - L4
- achilles tendon - S1
C-spine fracture and dislocation
- relatively uncommon
- but can cause catastrophic impairment to the spinal cord - damage to cone isn’t the main concern
in which cervical vertebrae do most fractures occur?
C4, C5, and C6
which sports have the highest incidence of C-spine fractures
gymnastics, ice hockey, diving, football, and rugby
-pool diving accidents as well
C-spine fracture - MOI
- axial load
- flexion
- hyperextension
- rotation and flexion
- rotation and hyperextension
- lateral flexion
fracture: axial loading with neck flexion; sudden forced hyperextension
dislocation: violent flexion and rotation of head
S&S of C-spine fracture
- point tenderness over spinous process (with or without deformity)
- restricted ROM
- muscle spasm
- pain in neck and or chest
- numbness in trunk and or extremities
- weakness or paralysis in trunk and or extremities
- loss of bladder or bowel control
management of C-spine fracture
- stabilize (collar and spinal board)
- activate EMS
there were approximately ______ spinal cord injuries in Canada in 2010
4300
___% of spinal cord injuries in Canada in 2010 were considered traumatic, ___% of all permanent injuries were sport related, and ___% of spinals in sports are related to inappropriate handling after the injury
42, 15, 25
lifelong care following a spinal cord injury is over ___$
one million
spinal cord injury: complete lesion
- spinal cord totally severed
- complete loss of all motor and sensory function below the level of injury - recovery below the level of injury is unlikely
- the higher up it is, the more severe it is considered
- some nerve root function may return 1-2 levels above the injury
at or above a C3 spinal cord lesion, what is impaired?
impaired respiration and death
a spinal cord lesion to C4-5 impairs which functions?
deltoid function
a spinal cord lesion at C5-6 impairs what?
elbow flexion and wrist extension
a spinal cord lesion at C6-7 impairs what?
elbow and finger extension and wrist flexion
a spinal cord lesion at C7-T1 impairs what?
grip function
what are the five basic mechanisms of a complete C-spinal lesion?
1) laceration by bone fragment
2) hemorrhage
3) contusion
4) cervical cord neuropraxia
5) shock
mechanism of complete C-spinal cord lesion - laceration by bone fragment
-jagged edges of bone from combined dislocation or fracture cut and tear spinal cord
mechanism of complete C-spinal cord lesion - hemorrhage
- hemorrhage from injury to surrounding tissues (fractures, dislocations, sprains, and strains) seldom causes harmful effects
- hemorrhage from the cord itself causes irreparable damage
mechanism of complete C-spinal cord lesion - contusion
- any violent force to the neck
- sudden displacement of vertebrae compresses the cord, then returns to its normal placement
- various degrees of temporary and or permanent damage
mechanism of complete C-spinal cord lesion - cervical cord neuropraxia
- temporary S&S (paralysis and numbness) following severe twist of neck
- S&S resolve leaving only a sore neck
- often associated with stenosis (narrowing of spinal canal)
mechanism of complete C-spinal cord lesion - shock
- most often with a cord transection
- immediate loss of function below the level of the lesion
- initially limbs are flaccid, later become spastic
- total loss of reflexes, which later become hyperreflexia
brown séquard syndrome
spinal cord injury
- below injury level, motor weakness or paralysis on one side of the body (hemiparaplegia)
- loss of sensation on the opposite side (hemianesthesia)
C-spine injury: whiplash MOI
sudden acceleration - deceleration
results in:
- sprain of ligaments
- anterior/posterior longitudinal ligaments
- interspinous ligs
- supraspinous ligs
- strain of neck musculature
S&S of whiplash
- localized pain
- pont tenderness (spinous process and transverse process)
- restricted ROM
- muscle guarding
- appears the day after trauma due to inflammation or injured tissue and protective muscle spasm
- ACUTE: last up to 2-3 months
- CHRONIC: over 3 months
management of whiplash
- evaluated by physician to rule out fracture, dislocation, disc injury, concussion
- cervical soft collar to reduce muscle spasm
- POLICE: 48-72 hours
- severe injury: bed rest and medication
- therapy: cryotherapy, heat, massage, and manual treatments (traction)
L-spine fracture/dislocation S&S
- recognize injury potential from MOI
- point tenderness of TP or SP
- localized swelling
- muscle guarding
- tingling, numbness in lower extremity
management of L spine fracture/dislocation
- immobilize and transport via spinal board
- minimize movement of fractured segment
- xray required for diagnosis
what are common L-spine fracture sites?
1) compression of vertebral body
- MOI: hyperflexion or fall from height landing on feet or buttock
2) fracture of TP or SP
- MOI: kick or direct impact to back
- erector spinae protect TP
dislocations to L-spine vertebrae are common
true or false?
false, they are rare due to facet orientation
spondylosis -def
fracture in the pars interarticularis (region between superior and inferior articular facets)
-L-spine
spondylolithesis - def
- anterior dislocation of the pars interarticularis fracture (step deformity)
- often L5 on S1
- biggest change in angle here
- shifting is more common
between spondylosis and spondylolithesis, which is more common in boys and girls?
spondylosis is more common in boys and sponsylolithesis is more common in girls
what is the cause of spondylosis/spondylolithesis?
- congenital
- acquired - repetitive hyperextension movements
- back bends in gymnastics, lifting weights, football block, tennis serve, volleyball spike, butterfly stroke
S&S of spondylosis/spondylolithesis
- no symptoms (spondylosis)
- persisten mild to moderate back ache or stiddness
- increase pain after, but not during activity
- low back tired or weak
- need to change positions frequently
management of spondylosis/spondylolithesis
- bracing and bed rest (1-3 days)
- core and trunk strengthening to stabilize hypermobile segment
- brace for high level activity
herniated disc
- nucleus pulposus protrudes through the annulus fibrosis
- compresses nerve root
what is the most common site of a herniated disc?
L4-L5
-L5-S1 is second most common
MOI of herniated disc
forward bending and twisting
S&S of herniated disc
- sharp, central pain
- radiates unilaterally in a dermatomal pattern to the buttock and down the back of the leg
- pain that spreads across back
- weakness in lower limb
- worse in the morning
posture: forward bend with side bending away from side of pain
what position worsens the pain of a herniated disc? what makes it better?
pain is worse in forward bending and sitting positions
pain is better in backward bending (extension) position
how do we assess a herniated disc?
- straight leg raise (SLR): pain at 30 deg is a positive test
- use this to see hamstring length/tension as well
- diminished tendon reflexes
- bilateral muscle weakness
- valsalva maneuver increases pain - deep breath or movement that increases thoracic pressure
management of a herniated disk
- pain reduction (ice or modalities)
- manual traction
- back extension progression exercises - helps push everything anteriorly
- core strengthening
