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
