Upper Extremity Cervical and Thoracic Spine Injuries

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Upper Extremity Cervical and Thoracic Spine Injuries
2014-11-18 13:00:44
upper extremity cervical thoracic spine injuries

Injuries of the upper spine
Show Answers:

  1. Cervical Fx's-Etiology
    • relatively uncommon
    • potential to cause paralysis
    • MOI:
    •    axial load to top of head
    •    flexion force
    •    hyperextension force
    •    rotation and flexion force
    •    rotation and hyperextension force
    •    lateral flexion force
    • More likely in: gymnastics, football, rugby, ice hockey, and diving
    • most common in 4th, 5th, and 6th cervical vertebrae
  2. Cervical Fx's-S&S
    • point tenderness and restrictive movements
    • cervical muscle spasm
    • possible paralysis and loss of control of body
  3. Cervical Fx's-Mgmt
    • 911
    • stabilize, collar, spine board
    • unconscious athlete should be treated as if they have a neck injury
  4. Cervical Dislocation-Etiology
    • not common, but more common than cervical fx's
    • usual MOI- violent flexion and rotation of neck
    • 2 types:
    •   *if the superior facet moves completely past the inferior facet=luxation
    •   *if the facet catches the edge of the other and it stays=subluxation (more common)
    • complete luxations are more likely to affect 4th, 5th, and 6th
  5. Cervical Dislocation-S&S
    • pain, numbness, muscle weakness or paralysis
    • positioning
    •   *unilateral dislocation: neck will be tilted to the dislocated side, extreme muscle tightness on the elongated side with relaxed muscle on the tilted side
  6. Cervical Dislocation-Mgmt
    • 911
    • immobilize, spine board
    • greater chance of a spinal cord injury
  7. Cervical Whiplash-Etiology
    • MOI: violent forced flexion, extension or rotation
    • produces tears of supporting tissue
    •    *anterior and posterior longitudinal ligaments
    •    *interspinous ligaments
    •    *supraspinous ligaments
  8. Cervical Whiplash-S&S
    • localized pain, point tenderness, restricted motion
    • muscle guarding from pain
    • tender over the spinous and transverse processes
    • may not have pain right after but always the next day
  9. Cervical Whiplash-Mgmt
    • 911
    • immobilize, spine board
    • greater chance of spinal cord injury
  10. Cervical Cord and Nerve Root Injuries-Etiology
    • 5 basic MOI's:
    •   1. laceration: caused by a dislocation or fx. Bony fragments may cut and tear nerve roots or the spinal cord causing varying degrees of paralysis
    •   2. cervical cord and nerve root injuries: caused from dislocations and fx's. Seldom causing problems but could if the hemorrhage is within the spinal cord itself
    •   3. Contusion: may result from a sudden displacement of a vertebrae that compresses the cord or nerve root then returns to normal position. May cause temporary or permanent damage
    •   4. Cervical cord neuropraxia: a severe twise or snap of the neck may cause temporary numbness, tingling and paralysis. After a short while normal function will return. Usually caused by cervical spine stenosis.
    •   5. Spinal cord shock: seen with severe trauma to the spinal cord, usually a cord transaction. Immediate loss of function below injured site.
  11. Cervical Cord and Nerve Root Injuries-S&S
    • complete lesions: total loss of function and sensation below level of injury
    • incomplete lesions: 
    •   *central cord syndrome: caused by hemorrhage or ischemia in the central portion of the cord an dresults in complete quadripeligia with non specific sensory loss and in sexual as well as bowel-bladder dysfunction
    •    *brown-sequard syndrome: injury to one side of the spinal cord that results in loss of motor function, vibration and position sense on the one side of the body, loss of touch, pain and temperature sensation
    •    *Anterior cord syndrome: injury to the anterior 2/3rds of the cord that results in loss of motor function and pain and temperature sensation. However, sexual and bowel-bladder function are present
    •    *Posterior cord syndrome (rare): injury to the posterior cord. May leave the person with good muscle power and pain and temperature sensation. May experience difficulty in coordinating movement of the limbs
  12. Cervical Cord and Nerve Root Injuries-Mgmt
    • suspected injuries to the spinal cord must be handled with extreme caution
    • in cases where there is evidence of a cord injury, efforts must be made to minimize additional trauma to the cord
  13. Brachial Plexus Neuropraxia-Etiology
    • AKA: stinger, burner, pinched nerve
    • stretching or compression or brachial plexus
    •   *stretch MOI-neck is forced laterally while the shoulder is depressed
    •   *compression MOI-neck is extended, compressed and rotated toward the affected side
    • can result in the partial rupture of the nerve without complete rupture (axonotmesis)
  14. Brachial Plexus Neuropraxia-S&S
    • burning sensation, numbness, tingling and pain extending from the shoulder to the hand with loss of function for several minutes
    • rarely will it last for several days
    • repeated trauma: neuritis, muscular atrophy and permanent damage
  15. Brachial Plexus Neuropraxia-Mgmt
    • athlete may return to play once symptoms have completely resolved
    • begin strengthening and stretching of neck musculature
  16. Cervical Disk Injuries-Etiology
    • herniated disk is relatively uncommon
    • develops from an extruded posterolateral disk fragment or from degeneration of the disk
    • MOI-repetitive cervical loading during contact sports
  17. Cervical Disk Injuries-S&S
    • neck pain with some restriction in neck motion
    • radicular pain (nerve root) in upper extremity
    •    *motor weakness or sensory
  18. Cervical Disk Injuries-Mgmt
    • rest and immobilization
    • neck mobilization to increase ROM
    • cervical traction
    • surgery may be necessary
  19. Scheuermann's Disease-Etiology
    • kyphosis that results from wedge fx's of 5 degrees or greater in 3 or more consecutive verebral bodies, with associated disk space abnormalities and irregularity of the epiphyseal endplates
    • accentuation of the kyphotic curve, back ache in young patients
    • adolescents-gymnastics and swimming (butterfly)
    • cause is unknown
    •   *multiple minor injuries seems to be the factor may cause avascular necrosis
  20. Scheuermann's Disease-S&S
    • may have kyphosis and lordosis without back pain
    • later stages:
    •    *point tenderness over spinous processes
    •    *complain of back pain at the end of a physical day
    •    *hamstrings are very tight
  21. Scheuermann's Disease-Mgmt
    • prevent kyphosis
    • early stage: extension exercises and postural education
    • bracing, rest, NSAIDs, and avoid painful movement