Spine

Question 1

Reason to stabilize, spine board, and initiate EMS

Answer 1

Altered LOC
Neck pain 
TTP in C-spine
Peripheral paresthesia 
Numbness
Weakness 
Radicular pain

Question 2

Canadian C-spine rules

Answer 2

> 65, MOI, N/T in extremities
Active rotation <45 deg
Inability to maintain seated position
C-spine tenderness

Question 3

Clay shoveler’s fx

Answer 3

Avulsion of spinous process (C7)

Forceful FLEXION of c spine

Question 4

RTP following cervical fx

Answer 4

May RTP if healed, full pain-free cervical ROM, Full muscle strength, no neurological deficits

Question 5

Contraindication for RTS following C-spine injury

Answer 5

Multilevel fusions
Fusion of C1/2 or C2-3
(Low contact sports may be allowed)

Question 6

Absolute contraindications for RTS

Answer 6

OA fusion
AA rotary fixation or instability 
Spear tackler’s spine 
Subaxial instability on radiograph 
Residual canal compromise 
Persistent neurological findings 
3+ level ant or post fusion

Question 7

Stinger/burner

Answer 7

Unilateral
Temporary
Symptoms not in dermatomal pattern
Secondary to traction or compression of brachial plexus

Question 8

RTP burner/stinger

Answer 8

1st or 2nd episode: no RTP unless symptoms fully resolved and individual has full pain-free ROM, full UE strength, and normal neurological exam
2nd stinger in same season: can RTP next game I’d complete resolution (same as above)
3 stingers in same season: discontinue play for rest of game and advanced imaging to assess stenosis, foraminal disorder, disc pathology

Question 9

Cervical ligamentous laxity

Answer 9

A-P displacement on flexion-extension radiograph > 3.5 mm or 11 deg rotation may indicate laxity
Contraindication to contact or collision sport

Question 10

Cervical cord neuropraxia

Answer 10

Temporary neurological injury resulting in symptoms in both arms, both legs, or ipsilateral arm and leg

Question 11

Transient quadriparesis

Answer 11

Temporary symptoms in both arms and both legs
Any athlete with this and rapid/full resolution of symptoms should receive radiographs and/or MRI to screen for injury and assess spinal cord

Question 12

Cervical stenosis

Answer 12

Sagittal diameter of canal norm 15 mm, <13mm=stenosis

Torg-Pavlov ratio (canal-to-body ratio) normal 1.0,

Question 13

Cervical disc herniation

Answer 13

Symptomatic disc herniation is absolute contraindication to RTP due to increased risk of SCI

Question 14

Most common site for lumbar and thoracic fractures

Answer 14

T11-L1
Transition from thoracic spine by fixed thoracic ribs to less stable lumbar spine creates increased risk of injury to lower aspect of thoracolumbar spine

Question 15

Rib fracture acute management

Answer 15

Remove from competition if suspected.

Red flags: sharp pain, palpable crepitus/clicking, pain with coughing and deep inspiration

Question 16

Rib fracture exam findings

Answer 16

TTP at site of injury
Decreased thoracic ROM
Localized pain
Difficulty breathing 
SOB
Pain with coughing 
Clicking with twisting and/or valsalva maneuver

Question 17

Disc protrusion

Answer 17

Focal

Disc material protrudes beyond margins of adjacent vertebral body but outer annular fibers are intact

Question 18

Disc extrusion

Answer 18

Focal herniation of disc through annular defect remaining in continuity of disc
Base is narrower than dome of extrusion

Question 19

Disc sequestration

Answer 19

Distal migration of extruded disc material away from disc with no direct continuation with adjacent disc

Question 20

Spondylolisis defect

Answer 20

Pars interarticularis

Question 21

Risk factors for spondy

Answer 21

Bony ossification of pars 
Spina bifida occulta 
Scoliosis 
Scheuermann’s disease 
Excessive lordosis 
CP

Question 22

Spondy imaging

Answer 22

Radiographs
Bone scan
SPECT scan

Question 23

Spondylolisthesis grades

Answer 23

I: <25% slippage
II: 26-50% slippage
III: 51-75% slippage
IV: 75-99% slippage