Spinal injuries Flashcards
What are the functions of the spine?
- Vertebrae protect spinal cord
- maintain posture
- allow mvmt
- shock absorption
- attachment for muscles and ligaments
At which vertebra would you have a problem breathing?
C3 (C4)
At which vertebra would you have a problem talking?
C5
Where does the phrenic n. originate from and what is it’s role?
Spinal roots C3, C4, C5
- breathing and respiration (contracts and expands diaphragm)
What happens when the phrenic n. is damaged?
Paralyzed diaphragm: unable to breathe on your own
What are the types of spinal injuries?
- compression fx (wedge compression or total flattening of body)
- Fractures (small fragments of bone)
- Subluxation (partial dislocation)
- overstretching/tearing or ligaments and muscles
MOI for spinal trauma
- axial loading
- excessive flexion (hyperflexion)
- excessive extension (hyperextension)
- excessive rotation (hyperrotation)
- sudden or excessive lateral bending
- distraction (overelongation of the spine)
Describe flexion with axial compression
- most common spinal
- vertebral body fractures, and fragments burst posteriorly into spinal cord
How does flexion with axial loading often occur (football)? How fast?
30degrees of flexion in the neck: spine is straightened and cannot distribute the force
- fracture, subluxation, dislocation
- time: 8.4ms
Describe extension w/ compression
- compression fx to neural arch and spinous process
- rupture of ant. longitudinal lig.
Descrie rotation and hyperextension
“facemask” injury
- fx
- dislocation
What is a burner or stinger
Stretch of compression injury to brachial plexus (sudden excessive lateral bending)
Where is the brachial plexus and what is it responsible for?
Above C5 to underneath T1
- cutaneous and muscular innervation of upper limb
What are S/S of cervical burners?
Subside within mins:
- immediate severe burning pain
- prickly paresthesia
- radiates neck, extending to arm or fingers
Hours-days:
- shoulder weakness + muscle tenderness of neck
What are the 2 mechanisms for cervical burners?
stretch: lateral flexion + depression
compression
What is plexus posture?
holding arm close to side w/ depressed shoulder
What are the 3 classifications of burners?
1st degree: neurapraxia
2nd degree: axonotmesis
3rd degree: neurotmesis
Describe neuropraxia
- cervical pinch/stretch syndrome
- most common brachial plexus injury
- shock to n.
- disruption in fcn of n. that produces neurotransmitters
What does praxia mean?
absence of action
Neuropraxia S/S
- burning/tingling/numbness in upper limb
- loss of funciton/sensation
- transient (temporary)
How long do the S/S of neuropraxia last?
Mild: seconds/mins
Moderate: mins/hours
Severe: unresolved at 12hrs
What is axonotmesis?
- damage of axon: axons cut apart from stretch
- regeneration: 1mm/day
- nerve sheath intact
-recovery possible
What does tmeisis mean?
cutting apart
S/S of axonotmesis
- numbness, tingling, affected fcn (may last days)
- long n. have greater healing time
- rare w/ athletics
- full strength/sensation 6wks to 6months
What is neurotmesis?
- complete cut of nerve fibers & sheath (pemanent n. damage)
- immediate loss of sensation
- very rare in athletics
Tx: ice, neurosurgery
What is the primary injury in spinal cord injuries?
At the time of impact:
- cord compression
- direct cord injury
- interruption of cord’s blood supply
What is the secondary injury in spinal cord injuries?
After initial insult:
- swelling
- ischemia
- mvmt of bony fragments
What are 4 specific conditions of the C-spine?
- fx
- dislocations
- sprains
- spinal stenosis
Describe cervial fx
- most common at C4,5,6
- axial loading
- fx of vertebral body
Describe cervical dislocations
- occur more in sports than fx
- violent flexion + rotation
- facts move beyond normal ROM
S/S of cervical fx and dislocation
- Pain
- Numbness
- Weakness
- Paralysis
- Tilted neck (dislocation)
- muscles on short side (spasm)
Describe cervical sprains
- sudden extension/flexion “whiplash”
- can have guarding
What is transient quadriplegia caused by?
cervical stenosis
Describe transient quadriplegia caused by cervical stenosis
- repeated hyperflexion or hyperextension w/ axial compression
- shock to spinal cord
- painless
- complete loss of sensation & motor fcn in all 4 extremities
What could be a non-traumatic cause of cervical stenosis:
- pre-existing narrowing of spinal canal (congenital)
S/S of transient quadriplegia caused by cervical stenosis?
- N/T/B
- full neck ROM
- full recovery after 10-15mins
(may not have S/S)
What are dermatomes for?
Sensation exam
What is myotome?
motor evaluation
What do you do in a myotome?
- evaluate motor signal to muscles
- does not require mvmt in acute injury
How to check integrity of NS with reflexes:
C5: biceps brachii
C6: brachioradialis
C7: Triceps brachii
L4: quadriceps femoris (knee jerk)
L5: extensor digitorum brevis
S1: achilles (tricpes surae)
