Spine Injuries Flashcards
What are the 2 best lifts (for spine boarding) for reducing cervical spinal motion post suspected cervical trauma, SCI?
- eight person lift technique
- lift and slide technique
Which parts of the athletes equipment should be removed with ACUTE management of cervical trauma?
- LEAVE EQUIPMENT IN PLACE
- can remove FACEMASK for airway access
Why use the Canadian C-spine rules?
- to reduce unnecessary imaging
- identify those with increased likelihood of c-spine injury
What HIGH risk factors would warrant radiographs per Canadian C-Spine rules?
- dangerous MOI
- > 65 years old
- numbness and tingling into extremities
*radiographs if YES to any
What LOW risk factors would rule out need for radiographs per Canadian C-spine rules?
- NO cervical midline tenderness
- delayed onset cervical pain
- ambulatory
- sits up in ER
- simple rear end MVA
*if NONE present = perform radiographs
What is the 3rd step for determining need for cervical x-rays after HIGH and LOW risk factors have been ruled out per Canadian C-spine Rules?
- if unable to achieve Cervical rotation ~45 degrees L and R = X-RAY
What is the CLAY SHOVELERS FRACTURE? What is the MOI?
- Spinous Process Avulsion Fracture
- forceful contraction of upper traps, rhomboids
- forceful flexion of cervical spine
*C7, T1 most common
What is the MOI for a vertebral compression fracture?
Hyperflexion
What is one CONCOMITANT injury that you must be concerned of with VERTEBRAL COMPRESSION FRACTURE?
- Posterior aspect of vertebrae and posterior ligaments
- may require SURGICAL STABILIZATION with >50% anterior body fx and posterior disruption and instability
*<25% = conservative
What are the RTP requirements post VERTEBRAL COMPRESSION AND AVULSION fractures?
- stable
- no neuro symptoms
- full and pain-free cervical ROM and strength
*increased risk of injury if deficits in ROM, biomechanics
What types of spinal fractures may require surgery and why?
- Unstable fractures or dislocations (severe comminuted vertebral body, type 2 odontoid, unstable posterior elements - pedicle, lamina, facet, transverse process)
- need to prevent development or progression of neurological deficit (Canal or SC compromise)
What is the most common type of THORACIC fracture? What is the MOI?
- Compression fracture (wedge)
- MOI = axial load or axial load with flexion or traumatic sidebend forces
What is the difference between a WEDGE and BURST fracture?
- both are types of COMPRESSION fracture
- similar MOI but higher forces with burst (eg MVA)
- more structures affected with BURST (anterior and posterior columns)
- Burst = may not be unstable
- severe Burst = bone may be retropulsed into spinal canal = neuro injury
What is a SEATBELT fracture? What is the MOI? What structures can be affected?
- FLEXION-DISTRACTION fracture
- MOI= hyperflexion
- posterior ligaments can be disrupted and facet joints can be injured
What diagnostics should be utilized to achieve maximum accuracy for bone injuries?
CT and radiographs = 99% accuracy
With THORACIC FRACTURE conservative treatment, how should these athletes be braced? For how long?
- TLSO, or clamshell brace
- 8-12 weeks
- wean from brace - depends on severity
When should SURGICAL STABILIZATION be considered with THORACIC fracture?
- UNSTABLE fractures
- kyphotic deformities > 30 deg
- ligamentous injuries
*injuries at TL junction increase risk of neuro injury = fusion may be beneficial
With an athlete who has permanent neurological injury post cervical injury/fracture - what are the RTP recommendations?
- Avoid competition or activity that may increase risk for further injury
What are the RTP recommendations for multi-level cervical fusions, C1-C2, or C2-C3 fusions?
- contact sports are CONTRAINDICATED
- may allow non-contact, low injury risk sports
What are the SYMPTOMS of a BURNER/STINGER?
- unilateral arm - transient loss of sensation or motor function (seconds to minutes)
- non-dermatomal pattern
- favoring of UE (e.g. hanging by side)
What are the RTP guidelines post STNIGER?
- RTP if symptoms resolved, full ROM and strength
- if unresolved symptoms = refer for imaging
- if >3 stingers or symptoms >24 hours = refer for radiographs
What is a common MOI for CERVICAL SPRAINS?
- rapid acceleration-deceleration force causing sudden flex-ext neck movement
- may result in INSTABILITY - if suspected = IMMOBILIZE