Neck And Spine

1. Neck And Spine Sports Medicine Chapter 20

2. Vocabulary I knew that word!! • Annulus Fibrosis- periphery of the intervetebral disk, strong fibrosis tissue • Axial Loading -Direct blow to the top of your head • Cervical nerve stretch syndrome- brachial plexus injury • Cyanosis- blue/gray color of the face • Kyphosis-Thoracic curvature of the spine, humpback • Nucleus Pulposus- the inside of the intervetebral disk. Jelly like substance • Paraplegia- paralysis of the lower extremity • Quadriplegia- paralysis of the upper/lower extremities • Sciatica- inflammation of the sciatic nerve in your lumbar spine • Scoliosis- lateral curvature of the spine • Spondylolisthesis- forward slipping of the vertebrae L5 most common • Spondylolysis- stress fracture of the pars interarticuylaris of the vertebrae

3. Anatomy • Characteristics • 33 indiv. Bones or vertebrae • 24 moveable • 9 immovable • The spine allows for a high degree of flexibility • Cervical • 7 vertebrae, first 2 = atlas and axis. Function is to support the head and permit cervical rotation • Thoracic • 12 vertebrae. #1-10 articulate with the ribs. Muscles that attach to the thoracic vertebrae= trapezius, rhomboid, latissmus dorsi • Lumbar • 5 vertebrae and is considered the largest and strongest • Sacrum • As a child grows up, the bottom 5 vertebrae fuse together. Weight is transmitted through the sacroiliac joint • Coccyx • consist of 4 separate vertebrae which the lower 3 fuse together in adulthood.

10. Brachial Plexus • Sensory • Muscle movement • C5 • lateral upper arm (deltoid) • Shoulder abduction (deltoid), elbow flexion (biceps • C6 • Lateral forearm 1st/2nd phalange • Elbow flexion (biceps), wrist extension • C7 • 3rd phalange • Elbow extension (triceps), wrist flexors, finger extensors • C8 • 4th/5th phalange, medial forearm • Finger flexors, finger abduction/adduction • T1 • medial elbow • finger abduction/adduction

12. Nerve Roots

13. Brachial plexus injury Nerves that could be involved and should be evaluated: C5-T1 nerve roots Peripheral nerves Radial nerve Wrist/thumb extension Dorsal web space between thumb and index finger Ulnar nerve: Abduction of 5th phalange Distal ulnar aspect of little finger Median Nerve Thumb pinch Distal radial aspect of 2nd phalange Axillary nerve Deltoid movement Lateral arm silver dollar patch in the middle of the deltoid Musculocutaneous nerve Biceps Lateral forearm Injuries to neck

14. Neurological ExamSensation TestingIf there is nerve root compression, sensation can be disrupted

15. Lumbar Plexus • Sensory • Muscle movement • L3 • Distal anterior thigh • Knee extension • L4 • Patella and medial surface of tibia • Dorsi flexion (anterior tibialis) • L5 • Top of foot • Great toe extension • S1 • Lateral surface of foot/5th metatarsal • Ankle Eversion

16. Mechanism of Injury pg 413 • An axial load to the top of the head • a flexion force • a hyperextension force • a flexion-rotation force • a hyperextension-rotation force • a lateral flexion force

17. Evaluation of neck and spine injuries.

18. Postural Malalignments

19. Low Back Injuries My aching back • History • radiating pain • pain when? • weakness • loss of function • tingling or numbness • check posture • constant pain

20. Lumbar plexus nerve roots • Sensory • Muscle movement • L1,2,3,4 • Upper to Mid to lower thigh • Quadriceps: Knee extension • L4 • Medial lower leg • Tibialis anterior: Foot dorsiflexion/inversion • L5 • Lateral leg and dorsum of foot • Extensor hallicus longus: great toe extension • S1 • Lateral foot • Peroneal longus/brevis: foot eversion

21. Rehabilitation for your low back • Williams low back exercises • Laying down, sitting, driving, standing, lifting, and carrying

22. Injuries • stingers • burners • strains/sprains • fractures • disc problems • spondylolisthesis • spondylolysis • sciatica • scoliosis • kyphosis

23. Cervical sprain or whiplash S/S= Pain in the neck like a muscle strain but is pt tender over the spinous processes (lig.). Pain may appear the day after the trauma RX: Dr., collar, RICE, NSAID’s, contrast therapy and possibly traction Acute Torticollis (wryneck) S/S= Pt tender, muscle spasm, head ROM is limited Rx: Contrast therapy, gentle traction, rotation and lateral bending stretching, wear a soft collar possibly, usually lasts for 2-3 days Injuries to neck

24. Injuries • Low back strain: • 2 causes: sudden extension and trunk rotation • Chronic strain associated with poor posture • S/S= pain in the low back • Rx: ice, ice massage, massage, stretching and rest. Work on good posture

25. Spondylolysis and Spondylolisthesis • Common is activities that cause hyperextension. • Gymnastics, lifting weights, blocking in football, serving in tennis, spike in volleyball, butterfly stroke • S/S= pain over the low back after exercise not during. • Rx: rest and exercises to stabilize the area

26. Lumbar sprains and/or herniated lumbar disc • Mechanism of injury: • bending forward and twisting while lifting. • S/S= • pain is localized but radiates if lumbar disc is herniated down the back of your legs • RX: • RICE to reduce pain, strengthening exercises for abdominals and back extensors. Stretching and good posture need to be preformed daily

27. Low back special evaluation tests • Straight leg raise (SLR) • Used for evaluation of sciatic nerve problem, sacroiliac joint, and lumbar spine • Compression distraction tests • For sacroiliac (SI) joint