Ch 25: The spine - cervical

Acute Strain of the Neck and Upper Back: tx

RICE, cervical collar; ROM, isometrics, progress to full-range isotonics

Acute Torticollis: etiology

athlete usually complains of pain on one side of neck upon awakening. Usually occurs when a small piece of synovial membrane lining joint capsule is impinged or trapped within a facet joint in cervical vertebrae

Incomplete Cervical Cord/Nerve Root lesions: anterior cord syndrome

caused by an injury to the anterior 2/3 of the cord results in loss of motor function and pain & temperature sensation; normal sexual and bladder-bowel function

Cervical Cord/Nerve Root Injuries: S/S

complete cord lesions at or above C3 will impair respiration & result in death; lesions below C4 will allow for some return of nerve root function

Cervical Cord/Nerve Root Injuries: hemorrhage

develops from all vertebral fractures & most dislocations, also strains and sprains. Hemorrhage within cord itself may cause damage (okay in muscles or within arachnoid space)

Cervical Spine Stenosis: tx

diagnostic tests to determine cause of problem; contact sport athletes should be advised of the potential risks of continued participation in that sport

Cervical Fracture: tx

extreme caution must be used in moving an unconscious athlete (can sustain a catastrophic spine injury from improper handling and transportation)

Cervical Cord/Nerve Root Injuries: tx

handle with extreme caution; minimize additional trauma to cord if paralysis present

Cervical Fracture: etiology

incidence is relatively low (spinal cord protected by bony canal, sheath, fat & fluid cushioning). o Axial loading of cervical vertebrae combined with neck flexion - anterior compression fx or dislocation o May occur with forced hyperextension of the neck

Acute Strain of the Neck and Upper Back: s/s

localized pain, point tenderness, restricted motion; muscle guarding from pain

Cervical Cord/Nerve Root Injuries: contusion

may result from sudden displacement of a vertebra that compresses the cord and then returns to its normal position (edematous swelling, resulting in degrees of temporary/permanent damage)

Cervical Spine Stenosis: etiology

narrowing of the spinal canal in the cervical region that can impingement spinal cord.

Cervical Disk Injuries: s/s

neck pain with some restriction in neck motion, radicular pain (nerve root) in UE with associated motor weakness or sensory changes

Cervical Fracture: s/s

neck point tenderness and restricted movement, cervical muscle spasm, cervical pain and pain in the chest and extremities, numbness in trunk and/or limbs, weakness or paralysis, loss of bladder/bowel control

Cervical Dislocation: etiology

occur more frequently than fractures; most injuries happen in pool diving accidents o Cervical vertebrae are more easily dislocated due to their horizontally arranged articular facets o Most often occur in C4, C5, or C6

Brachial Plexus Neuropraxia (Burner): tx

once symptoms resolve, athlete can return to activity. Athlete should begin strengthening and stretching exercises for neck musculature; shoulder pads and cervical neck roll to limit motion during impact

Brachial Plexus Neuropraxia (Burner): s/s

pain and numbness radiating into fingers of the hand (includes roots C6, C7, C8) o If there is associated weakness, it is limited to deltoid & biceps/brachialis (indicating C5 involvement) o Burning sensation, numbness and tingling, pain from shoulder down to hand, some loss of function of arm and hand that lasts for several minutes

Cervical Dislocation: s/s

pain, numbness, muscle weakness/paralysis o Unilateral dislocation causes neck to be tilted towards dislocated side with muscle tightness on elongated side

Acute Torticollis: s/s

palpable point tenderness, muscle spasm, head movement restricted to the side opposite the irritation with marked muscle guarding

Cervical Disk Injuries: tx

rest and immobilization of neck to decrease discomfort. Neck mobilizations to regain ROM, cervical traction to relieve pain.

Cervical Sprain (Whiplash): tx

rule out fx, dislocation, or disk injury; cervical collar to reduce muscle spasm; RICE; cryotherapy, heat and massage; mechanical traction

Cervical Sprain (Whiplash): s/s

signs of a strained neck, but they persist for longer; may be tenderness over transverse and spinous processes; pain from inflammation of injured tissue and protective muscle spasm

Brachial Plexus Neuropraxia (Burner): etiology

transient neuropraxia resulting from stretching or compression of brachial plexus is the most common of all cervical neurological injuries in the athlete. o Neuropraxia causes disruption in normal function of a peripheral nerve without any degenerative changes. o Often occurs when neck is forced laterally to opposite side while shoulder is depressed When neck is extended, compressed, and rotated towards affective side

Cervical Cord/Nerve Root Injuries: cervical cord neuropraxia

transient paralysis followed by ability to move limbs freely and no other symptoms other than a sore neck; caused by cervical spine stenosis

Cervical Spine Stenosis: s/s

transient quadriplegia may occur from axial loading, hyperflexion or hyperextension. Symptoms may be purely sensory or may have a motor component. Complete recovery normally occurs within 10-15 minutes; following recovery, full neck ROM is possible

Cervical Disk Injuries: etiology

usually develops from an extruded posterolateral disk fragment or from degeneration of the disk. Primary mechanism involves sustained repetitive cervical loading during contact sports

Cervical Cord/Nerve Root Injuries: spinal cord shock

usually occurs with severe trauma to spinal cord; immediate loss of function below level of lesion, limbs are flaccid (later spasticity). Total loss of deep tendon reflexes, with later development of hyperreflexia

Acute Torticollis: aka

(Wryneck)

Incomplete Cervical Cord/Nerve Root lesions: central cord syndrome

caused by hemorrhage or ischemia in central portion of cord, results in complete quadriplegia with nonspecific sensory loss, sexual & bowel-bladder dysfunction

Incomplete Cervical Cord/Nerve Root lesions: brown-sequard syndrome

caused by injury to one side of spinal cord results in loss of motor function, touch, vibration, and position sense on one side of the body, and loss of pain and temperature sensation on other side

Incomplete Cervical Cord/Nerve Root lesions: posterior cord syndrome

caused by injury to posterior cord (rare) Motor function is completely intact

Cervical Dislocation: tx

greater likelihood of causing damage to spinal cord - even greater care required in moving patient

Acute Strain of the Neck and Upper Back: etiology

mechanism is usually a sudden turn of the head or forced flexion, extension, or rotation. Muscles involved are typically the upper trapezius, sternocleidomastoid, scalenes, and splenius capitis and cervicis

Acute Torticollis: tx

modalities to break pain-spasm cycle; joint mobilizations; cervical collar for comfort; muscle guarding typically lasts 2-3 days

Cervical Cord/Nerve Root Injuries: laceration

usually produced by combined dislocation & fx (jagged edges cut nerve roots or spinal cord & cause varying degrees of paralysis below the injury site)

Cervical Sprain (Whiplash): etiology

usually results form a violent snapping motion. Frequently muscle strains occur along with ligamentous sprains. Sprain affects anterior & posterior longitudinal ligaments, interspinous & superspinous ligaments