Chapter 10 Spinal Conditions

1. Chapter 10 Spinal Conditions

2. Anatomy of the Spine • Vertebral Column • Cervical (7)convex anteriorly • Thoracic (12)concave anteriorly • Lumbar (5)convex anteriorly • Sacral (5 fused)concave anteriorly • Coccyx (4 fused) Vertebral spine

3. Anatomy of the Spine (cont’d) • Vertebral structure • Body • Vertebral arch • Superior and inferior articular processes • Facet joints • Pedicles • Intervertebral foramina • Spinous process • Transverse processes

4. Anatomy of the Spine (cont’d) The structure of a typical vertebra

5. Anatomy of the Spine (cont’d) • Cervical • 7 vertebrae form curve – convex anteriorly • Atlas • 1st vertebra • No body – filled with odontoidprocess • Function: support the head

6. Anatomy of the Spine (cont’d) • Cervical (cont’d) • Axis • 2nd vertebra • Odontoid process – tooth-like • Allows head to rotate Skeletal features of the cervical spine

7. Anatomy of the Spine (cont’d) • Thoracic • 12 vertebrae form curve • Concave anteriorly • Extra facets for articulation with ribs

8. Anatomy of the Spine (cont’d) • Lumbar spine • Forms convex curve anteriorly • 5 lumbar, 5 fused sacral, and 4 small, fused coccygeal vertebrae • Progressive increase in vertebral size • Change in angulation • Sacrum articulates with ilium – sacroiliac joint

9. Anatomy of the Spine (cont’d)

10. Anatomy of the Spine (cont’d) • Motion segment • Functional unit • Any 2 adjacent vertebrae and soft tissues between them Motion segment of the spine

11. Anatomy of the Spine (cont’d) • Intervertebral discs • Components • Annulus fibrosus • Thick fibrous ring • Nucleus pulposus • Gelatinous interior

12. Anatomy of the Spine (cont’d) • Intervertebral discs (cont’d) • Function • Shock absorption • Allow spine to bend

13. Anatomy of the Spine (cont’d) • Ligaments • Length of the spine • Vertebra to vertebra A superior view of the ligaments of the vertebral column

14. Anatomy of the Spine (cont’d) • Spinal Cord • Extends from the brainstem to the level of the 1st or 2nd lumbar vertebrae • Sensory and motor impulses • Enables reflex activity • 31 pairs of spinal nerves (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal)

15. Anatomy of the Spine (cont’d) • Nerve Plexus • Cervical (C1–C4) • Brachial (C5–T1) Brachial plexus

16. Anatomy of the Spine (cont’d) • Nerve Plexus (cont’d) • Lumbar (T12 – L5) • Sacral (L4 – L5) Lumbar plexus

17. Kinematics and Major Muscle Actions • Movements in all planes • Flexion/extension/hyperextension • Lateral flexion • Rotation • Motion allowed between any two adjacent vertebrae is small. ….spinal movements always involve a number of motion segments

18. Kinematics and Major Muscle Actions (cont’d) Muscles of the neck: Lateral view

19. Kinematics and Major Muscle Actions (cont’d) Muscles of the neck: Posterior view

20. Kinematics and Major Muscle Actions (cont’d)

21. Kinematics and Major Muscle Actions (cont’d) Muscles of the low back

22. Kinematics and Major Muscle Actions (cont’d)

23. Anatomical Variations – Injury Potential • Kyphosis • Excessive curve of thoracic spine • Congenital – deficits in vertebral bodies • Idiopathic • Scheuermann’s disease • Secondary to osteoporosis

24. Anatomical Variations – Injury Potential (cont’d) • Scoliosis • Lateral curvature of spine; “C” or “S” curve • Structural • Inflexible curve, persists with lateral bending • Nonstructural • Flexible, corrected with lateral bending • Commonly idiopathic

25. Anatomical Variations – Injury Potential (cont’d) • Lordosis • Abnormal exaggeration of lumbar curve • Causes include: • Weak abdominal musculature • Congenital deformities • Poor posture • Activities with excessive hyperextension

26. Anatomical Variations – Injury Potential (cont’d) Spinal anomalies. A. Thoracic kyphosis. B. Scoliosis. C. Lordosis

27. Prevention of Spinal Conditions • Physical Conditioning • Strength and flexibility • Protective equipment • Neck roll • Rib protectors • Weight belts/abdominal binders

28. Prevention of Spinal Conditions (cont’d) • Proper Technique • Avoid axial loading (e.g., spearing) • Posture • Lifting

29. Cervical Spine Conditions • Cervical flexion combined with axial loading = danger Axial loading

30. Cervical Spine Conditions (cont’d) • Angular deformation and buckling occurs as load continues and maximum compression deformation is reached • Continued force results in an anterior compression fracture, subluxation, or dislocation Results of cervical spinal compression deformation

31. Cervical Spine Conditions (cont’d) • Acute torticollis (“wry neck”) • Due to muscle strain • S&S • Often awakens with deformity • Presents with the head tilted to one side with the chin pointed to the opposite shoulder • ROM is limited

32. Cervical Spine Conditions (cont’d) • Acute torticollis (“wry neck”) (cont’d) • Management • Heat or cold to reduce spasm • Because ROM is limited, the individual should not be permitted to participate in sport or physical activity • If the condition does not resolve in 2-3 days, physician approval prior to return to activity

33. Cervical Spine Conditions (cont’d) • Cervical strain • Usually, sternocleidomastoid or upper trapezius • MOI: direct or indirect trauma involving tension force • S&S • Pain, stiffness, spasm, restricted ROM •  pain with active contraction or passive stretch of involved muscle

34. Cervical Spine Conditions (cont’d) • Cervical strain (cont’d) • Management: • Application of cold to reduce spasm • No return to activity until pain free and ROM and strength is normal • If the condition does not resolve in 2-3 days, physician approval prior to return to activity

35. Cervical Spine Conditions (cont’d) • Cervical sprain • Extreme motions or violent mechanism • S&S • Pain, stiffness, restricted ROM • Pain can persist for several days

36. Cervical Spine Conditions (cont’d) • Cervical sprain (cont’d) • Management: • Application of cold • If condition doesn’t improve rapidly, physician referral

37. Cervical Spine Conditions (cont’d) • Cervical fracture and dislocation • MOI: axial loading with violent flexion of neck • Dislocation: add rotation Cervical fracture/dislocation

38. Cervical Spine Conditions (cont’d) • Cervical fracture and dislocation (cont’d) • S&S • Pain over the spinous process, with or without deformity • Unrelenting neck pain or muscle spasm • Abnormal sensations in the head, neck, trunk, or extremities • Muscular weakness in the extremities • Loss of coordinated movement

39. Cervical Spine Conditions (cont’d) • Cervical fracture and dislocation (cont’d) • S&S (cont’d) • Paralysis or inability to move a body part • Absent or weak reflexes • Loss of bladder or bowel control • Mechanism of injury involving violent axial loading, flexion, or rotation of the neck

40. Cervical Spine Conditions (cont’d) • Cervical fracture and dislocation (cont’d) • An unstable neck injury should be suspected • In an unconscious individual • An individual who is awake but has numbness and/or paralysis • iIn a neurologically intact individual who has neck pain or pain with neck movement

41. Cervical Spine Conditions (cont’d) • Cervical fracture and dislocation (cont’d) • A cervical fracture or dislocation could be present even if there are no apparent neurological deficits • An individual with a cervical fracture or dislocation could still be able to walk off a playing field/court

42. Cervical Spine Conditions (cont’d) • Cervical fracture and dislocation (cont’d) • Management • Activate emergency plan, including summoning EMS • Do not move the individual • While waiting for EMS, without moving head or neck, assess and manage life-threatening conditions

43. Brachial Plexus Injuries • MOI • Stretch • Head is forced laterally away from the shoulder while the shoulder is simultaneously forced downward • Arm is forced into excessive external rotation, abduction, and extension

44. Brachial Plexus Injuries (cont’d) • MOI (cont’d) • Compression (pinch) • Head is rotated, laterally flexed, and compressed or extended to the same side of the shoulder

45. Brachial Plexus Injuries (cont’d) Common mechanisms of a brachial plexus stretch

46. Brachial Plexus Injuries (cont’d) • Acute S&S • Immediate, severe, burning pain radiates down arm into hand • Pain transient; subsides in 5–10 minutes • Weakness in abduction and external rotation • Symptoms are unilateral

47. Brachial Plexus Injuries (cont’d)

48. Brachial Plexus Injuries (cont’d) • Management • Weakness is present- remove from activity • Strength & function return 1-2 minutes, permit individual to return to activity • If symptoms persist >2 min, do not allow to return to play until seen by a physician

49. Thoracic Spine Conditions • Contusions • MOI: direct blow • S&S: pain, ecchymosis, spasm, & limited swelling • Management • Application of cold • If symptoms persist > 2-3 days or mod-severe injury, physician approval prior to return to activity

50. Thoracic Spine Conditions (cont’d) • Sprains/strains • MOI: overload; overstretch • S&S • Painful spasms of back muscles • May develop as a sympathetic response to sprains • Presence of spasms makes it difficult to determine sprain or strain