Cervical Spine injuries

In cervical stenosis, the canal should not be less than ___mm at ___ through ___.

14.5; C-3 through C-6

What causes long thoracic nerve injury?

Acute: brachial plexus injury or paralysis of the nerve from blunt trauma; patient may not know they have it, but scapular winging would be present

What causes nerve root compression?

Acute: forced lateral flexion, cervical disc injury Chronic: overuse of neck and C-spine

Describe disc sequestrion

Anulus ruptures and nucleu is mobilized (touches spinal cord or nerve roots); leads to LOF, numbness, and tingling

Is acute or chronic nerve root compression more common?

Chronic

What are the three spinal cord injuries from least to most severe? What is their common MOI?

Concussion, contusion, transection; MOI axial load or compression

What is cervical stenoisis? What causes it?

Congenital narrowing or spinal canal; MOI born with it but symptoms will start to appear over time (asymptomatic at birth)

Describe disc extrusion

Discal matter (nucleus) may come out a little but is still intact, has not ruptured

Describe spinal cord compression

Due to disc or vertebral injury but will resolve once the pressure is taken off the cord; traction may help; pressure may need to be surgically removed

When doing Tinel's sign on someone with a potential brachial plexus stretch, what portion of the shoulder do you test over?

Erb's point

What happens in a rotation injury?

Facet joint injury; cord rotation

Describe a spinal cord transection

Fx will always be present; cord is severed by vertebral body shards; no way to fix it; prognosis is dependent on the level of transection

How does compression occur?

Head driven into something fixed and spine accordion folds; blowout fx, disc compression; bone fragment can cut cord

How does hyperflexion occur?

Head forced downward which exposes C-spine; we see fx and dislocation

How does hyperextension occur?

Head is forced posteriorly; not typically a cause of significant C-spine injuries; mostly ligament and muscle injury

What causes axillary nerve damage?

Hit to armpit (especially anterior portion) or anterior shoulder dislocation

What are the 4 main mechanisms of cervical spine injuries, in order of severity from least to most severe?

Hyperextension, rotation, hyperflexion, compression

How can you treat a C-spine strain?

Ice, e-stim, ultrasound, NSAIDS, increase ROM, increase strength, increase function

How can you manage a brachial plexus stretch?

Ice, work on neck strengthening to prevent further injury, check strength (especially hand squeezing)

How do you manage a C-spine fx?

If they walk off, spine board them immediately and send them; if it is on field, send them

How do you mange nerve root compression?

Improve C-spine and Trapezius strength, traction, surgery (disc removal/fusion is more common than disc repair), injection to reduce swelling of internal disc

If you have Methylprednisolone on the sideline, where should it be kept and what should you have with it?

In its own separate bag or container; keep gloves, the syringes, a tourniquet, and alcohol wipes with it

What is a major rehab technique in C-spine injury?

Isometrically strengthening the neck

What is a halo brace used for?

It keeps the spine from moving when recovering from spinal cord injury

What medication can be used in spinal cord injury?

Methylprednisolone/Solu medrol ; reduces swelling in spinal cord in minutes; keep this with you if physician wants you to (must ask them if they want you to keep it or not)

What is the common management for spinal cord concussion, contusion, and transection?

Monitor their vitals (expect decreased BP and breathing rate); spine board and transport

Describe a spinal cord contusion

No reflexes; could be unilateral or bilateral; blood (bruising) will be on cord; the cord may reabsorb the blood on it's own (good outcome) but if not, it must be removed surgically

Can an athlete with a C-spine sprain participate in activity?

No, they cannot protect themselves

Can an athlete with a C-spine strain participate in activity?

No, they cannot protect themselves

Describe disc prolapse

Nucleus pushes toward edge but is still contained; disc is drying out

What are the four possible intervertebral disc injuries? Which two are considered to be herniated discs?

Protrusion, prolapse, extrusion, sequestrion (extrusion and sequestrion are the herniated discs)

How do you manage subscapular nerve injury?

Refer to neurologist

How do you manage cervical stenoisis?

Remove from contact sports; maintain cervical strength; no strenuous activities/heavy lifting; work on isotonic and isometric strengthening of neck; surgically go in and clean out vertebral body or (in extreme cases) spinal fusion

How do you manage long thoracic nerve injury?

Scapular retraction exercises to strengthen scapular muscles and Serratus anterior; they can still play with this unless they can no longer raise their arm

How are C-spine fxs surgically corrected? How long before this person can return to activity?

Spinal fusion or use hardware to make structure stable again; 8-12 weeks

How do you manage C-spine dislocation/subluxation?

Squad them because it must be surgically reduced

What are the S/S of a brachial plexus stretch?

Symptoms: burning/heat/pain radiating, dangling arm; Signs: strength deficit, limited function, + Tinel's sign

What are the S/S of C-spine strain?

Symptoms: decreased ROM, pain, spasm; Signs: spasms, pint tender, AROM is more painful compared to PROM

What are the S/S of axillary nerve damage?

Symptoms: loss of sensation to anterolateral aspect, numbness, Deltoid will eventually flatten; Signs: limited ROM (especially in lifting/abduction arm)

What are the S/S of nerve root compression?

Symptoms: pain over posterior spine, no swelling, decrease in sensation in one or more dermatomes, muscle weakness; Signs: + Spurling test

What are the S/S of a C-spine fx?

Symptoms: pain, LOF, numbness; Signs: significant spasm, motor weakness loss of strength, point tender

What common S/S do all spinal cord injuries (concussion, contusion, and transection) have?

Symptoms: pain, numbness, tingling; Signs: weakness

What are the S/S of C-spine sprain? What kind of ROM should cause pain if a sprain is present?

Symptoms: point tender, slight swelling, not much muscle spasm; Signs: LOF or ROM, point tender, pain with AROM and PROM (because it is ligamentous, ALL or PLL); PROM

What are the S/S of C-spine dislocation/subluxation?

Symptoms: sudden pain, numbness, point tenderness, loss of ROM (direction depends on the direction of injury); Signs: spasm, loss of sensation, weakness (grip strength, resisted wrist flexion), paraplegia in upper extremity (may be immediate), step-off deformity (gap in spine)

What are the S/S of subscapular nerve injury?

Symptoms: weakness in supraspinatus and infraspinatus, inability to utilize subscapularis, + Gerber lift off test (indicated by inability to raise arm from back), numbness, tingling, burining

What are the S/S of cervical stenosis?

Symptoms: weakness, numbness, tingling, painful extension of the neck that increases symptoms; Signs: + Spurling test, based on symptoms, diagnose via X-ray through top of skull

How do you manage axillary nerve injury?

Treat symptoms from hit-this is a secondary injury; put them in a sling but work elbow and hand; monitor how much sensory loss they have; conduct EMG/nerve conduction tests; will not RTP until they have regained full strength

Where do the subscapular nerves originate?

Upper roots of brachial plexus

What are the S/S of long thoracic nerve injury?

Winged scapula

What is a C-spine strain more commonly known as? What causes it?

Wry neck; Excessive forceful contraction, "slept wrong," fatigue

What causes a C-spine fx?

axial load, possibly forced flexion

What causes subscapular nerve injury?

brachial weakness

Describe disc protrusion

disc degeneration, typically found in older patients; disc is no longer perfectly round because it has a slight bulge

What causes C-spine dislocation/subluxation?

forced flexion or axial load

Does subscapular nerve injury show motor or sensory damage?

motor

What are the 3 main C-spine injury prevention methods?

proper techniques, neck strengthening, and equipment selection

How do you manage a C-spine sprain?

rest, immobilize, NSAIDS, injection (to quiet down symptoms), then work on strength and ROM

How do you treat a brachial plexus stretch?

should resolve itself within 24 hours; lingering numbness is an issue; if there is injury anytime there is impact, refer to a neurologist

What is a brachial plexus stretch commonly known as? What causes it?

stinger or burner; forced shoulder depression and lateral flexion of neck (traction) OR compression/pinching

Describe a spinal cord concussion

transient symptoms (they come and go), no fx, swelling present-no true damage to the cord; will fully recover and eventually RTP

What causes C-spine sprain?

whiplash