Cervical Spine/Neck Injuries

1. Cervical Spine/Neck Injuries

2. Prevention • strength • flexibility • proper protective equipment • proper sport technique

3. Contusions - Neck & Throat • blunt trauma • baseball, hockey puck • larynx - possible fx. of cartilage • severe pain • hoarse voice • difficulty swallowing • contusion to carotid artery • causes a clot to form - stroke

4. Cervical Nerve Stretch Syndrome • brachial plexus injury • stinger, burner, hot-shots • 2 mechanisms • traction (stretch) • head forced one way and pain on other side • compression • entrapment or impingement of cervical nerve roots • at Erb’s Point

5. Signs & Symptoms • immediate pain • numbness or burning sensation down arm • arm may be hanging at side or they may be holding it or shaking it • decreased strength • decreased sensation along dermatomes • s & s can last for a short period of time in mild cases, hours, or even days in severe cases

6. athletes cannot return to play until: • they have full strength compared bilaterally • full sensation • normal ROM of neck and shoulder

7. Cervical Nerve Root Impingement • pressure placed on a cervical nerve root • mechanism • degenerative disk changes (herniated disk) • dislocated cervical facets • degenerated facet joints • exostosis of vertebral foramen • inflammation putting pressure on nerve root • pressure causes pain and spasm in cervical areas and possibly pain & sensation loss along affected dermatomes, muscles weakness, altered reflexes, and atrophy

8. Vertebral Artery Compression • can be caused by same mechanisms that cause cervical root symptoms • can interrupt blood flow to the brain • s & s • dizziness • confusion • nystagmus • Vertebral Artery Test

9. Sprains, Strains, Fx. • mechanisms of injury • compression force (axial force) • flexion force - most dangerous when combined with compression – fractures or dislocations • hyperextension • flexion rotation • hyperextension rotation - dislocations • lateral flexion

10. Always assume the worst!!!! • spinal cord function is only inhibited by 1 of 2 mechanisms: • impingement or lacerations secondary to bony displacement • compression secondary to hemorrhage, edema, and ischemia to the cord

11. Evaluation • don’t move!! • Severe neck pain • numbness or tingling • muscle weakness and spasm • loss of sensation - “can’t feel” • unable to move • loss of bladder or bowel control

12. Other indications of serious injury: • Babinski Test • Oppenheim Test • Decerebrate Posture • lesion of brain stem • extension of extremities and retraction of head • Decorticate Posture • lesion of brain stem • flexion of elbows and wrists, clenched fists, and extension of lower extremity • Flexion Contracture • arms flexed across chest • spinal cord lesion at C5-C6 level

16. an athlete with a cervical fracture or dislocation can walk off of the field • any complaint of cervical pain with or without symptoms radiating into the extremities should always be thought of as a catastrophic injury at first

17. Transient Quadriplegia • athlete shows signs of quadriplegia, but symptoms clear within 15 minutes to 48 hours • neurapraxia of spinal cord • mechanism – blow to head & neck – predisposed by: • stenosis of spinal foramen • congenital fusion of spinal cervical canal • abnormalities of posterior arch • cervical instability