Spinal injuries

Question 1

What are the functions of the spine?

Answer 1

• Vertebrae protect spinal cord
• maintain posture
• allow mvmt
• shock absorption
• attachment for muscles and ligaments

Question 2

At which vertebra would you have a problem breathing?

Answer 2

C3 (C4)

Question 3

At which vertebra would you have a problem talking?

Answer 3

C5

Question 4

Where does the phrenic n. originate from and what is it’s role?

Answer 4

Spinal roots C3, C4, C5
- breathing and respiration (contracts and expands diaphragm)

Question 5

What happens when the phrenic n. is damaged?

Answer 5

Paralyzed diaphragm: unable to breathe on your own

Question 6

What are the types of spinal injuries?

Answer 6

• compression fx (wedge compression or total flattening of body)
• Fractures (small fragments of bone)
• Subluxation (partial dislocation)
• overstretching/tearing or ligaments and muscles

Question 7

MOI for spinal trauma

Answer 7

• axial loading
• excessive flexion (hyperflexion)
• excessive extension (hyperextension)
• excessive rotation (hyperrotation)
• sudden or excessive lateral bending
• distraction (overelongation of the spine)

Question 8

Describe flexion with axial compression

Answer 8

• most common spinal
• vertebral body fractures, and fragments burst posteriorly into spinal cord

Question 9

How does flexion with axial loading often occur (football)? How fast?

Answer 9

30degrees of flexion in the neck: spine is straightened and cannot distribute the force
- fracture, subluxation, dislocation
- time: 8.4ms

Question 10

Describe extension w/ compression

Answer 10

• compression fx to neural arch and spinous process
• rupture of ant. longitudinal lig.

Question 11

Descrie rotation and hyperextension

Answer 11

“facemask” injury
- fx
- dislocation

Question 12

What is a burner or stinger

Answer 12

Stretch of compression injury to brachial plexus (sudden excessive lateral bending)

Question 13

Where is the brachial plexus and what is it responsible for?

Answer 13

Above C5 to underneath T1
- cutaneous and muscular innervation of upper limb

Question 14

What are S/S of cervical burners?

Answer 14

Subside within mins:
- immediate severe burning pain
- prickly paresthesia
- radiates neck, extending to arm or fingers
Hours-days:
- shoulder weakness + muscle tenderness of neck

Question 15

What are the 2 mechanisms for cervical burners?

Answer 15

stretch: lateral flexion + depression
compression

Question 16

What is plexus posture?

Answer 16

holding arm close to side w/ depressed shoulder

Question 17

What are the 3 classifications of burners?

Answer 17

1st degree: neurapraxia
2nd degree: axonotmesis
3rd degree: neurotmesis

Question 18

Describe neuropraxia

Answer 18

• cervical pinch/stretch syndrome
• most common brachial plexus injury
• shock to n.
• disruption in fcn of n. that produces neurotransmitters

Question 19

What does praxia mean?

Answer 19

absence of action

Question 20

Neuropraxia S/S

Answer 20

• burning/tingling/numbness in upper limb
• loss of funciton/sensation
• transient (temporary)

Question 21

How long do the S/S of neuropraxia last?

Answer 21

Mild: seconds/mins
Moderate: mins/hours
Severe: unresolved at 12hrs

Question 22

What is axonotmesis?

Answer 22

• damage of axon: axons cut apart from stretch
• regeneration: 1mm/day
• nerve sheath intact
  -recovery possible

Question 23

What does tmeisis mean?

Answer 23

cutting apart

Question 24

S/S of axonotmesis

Answer 24

• numbness, tingling, affected fcn (may last days)
• long n. have greater healing time
• rare w/ athletics
• full strength/sensation 6wks to 6months

Question 25

What is neurotmesis?

Answer 25

• complete cut of nerve fibers & sheath (pemanent n. damage)
• immediate loss of sensation
• very rare in athletics
  Tx: ice, neurosurgery

Question 26

What is the primary injury in spinal cord injuries?

Answer 26

At the time of impact:
- cord compression
- direct cord injury
- interruption of cord’s blood supply

Question 27

What is the secondary injury in spinal cord injuries?

Answer 27

After initial insult:
- swelling
- ischemia
- mvmt of bony fragments

Question 28

What are 4 specific conditions of the C-spine?

Answer 28

• fx
• dislocations
• sprains
• spinal stenosis

Question 29

Describe cervial fx

Answer 29

• most common at C4,5,6
• axial loading
• fx of vertebral body

Question 30

Describe cervical dislocations

Answer 30

• occur more in sports than fx
• violent flexion + rotation
• facts move beyond normal ROM

Question 31

S/S of cervical fx and dislocation

Answer 31

• Pain
• Numbness
• Weakness
• Paralysis
• Tilted neck (dislocation)
• muscles on short side (spasm)

Question 32

Describe cervical sprains

Answer 32

• sudden extension/flexion “whiplash”
• can have guarding

Question 33

What is transient quadriplegia caused by?

Answer 33

cervical stenosis

Question 34

Describe transient quadriplegia caused by cervical stenosis

Answer 34

• repeated hyperflexion or hyperextension w/ axial compression
• shock to spinal cord
• painless
• complete loss of sensation & motor fcn in all 4 extremities

Question 35

What could be a non-traumatic cause of cervical stenosis:

Answer 35

• pre-existing narrowing of spinal canal (congenital)

Question 36

S/S of transient quadriplegia caused by cervical stenosis?

Answer 36

• N/T/B
• full neck ROM
• full recovery after 10-15mins
  (may not have S/S)

Question 37

What are dermatomes for?

Answer 37

Sensation exam

Question 38

What is myotome?

Answer 38

motor evaluation

Question 39

What do you do in a myotome?

Answer 39

• evaluate motor signal to muscles
• does not require mvmt in acute injury

Question 40

How to check integrity of NS with reflexes:

Answer 40

C5: biceps brachii
C6: brachioradialis
C7: Triceps brachii
L4: quadriceps femoris (knee jerk)
L5: extensor digitorum brevis
S1: achilles (tricpes surae)