Spine 3 Flashcards
Cervical Sprain/Strain
“Whiplash”
general and MOI
Common complaints
Mechanism:
Rapid hyperextension of the c-spine followed by hyperflexion
Usually from trauma like MVA (rear-ended)
Common complaints/ symptoms:
Pain and stiffness
headache
Cervical Sprain/Strain
PE and imaging
Physical Exam:
Pain and stiffness
Normal neurological exam
Tests:
X-rays will show muscle spasm
Otherwise normal
No need for further testing for simple whiplash
Cervical Sprain/Strain
Tx
Treatment:
NSAIDs
Muscle relaxants
C-collar/ brace (2-3 wks)
soft collar unless instability
May or may not need PT; order if weakness or mild pain persist after collar is no longer in use
Brachial Plexus Injury
Mechanism of Injury
Lateral bending of the head/ neck or forced depression of the shoulder resulting in the overstretching of the brachial plexus nerves
In sports, AKA a stinger
Babies during delivery in setting of shoulder dystocia
Brachial Plexus Injury
Sx
Describe pain
Common complaints/ symptoms:
Usually simple: burning, stinging pain that runs down the arm
Occasionally will have weakness
Brachial Plexus Injury
PE and testing
Physical Exam:
Perform full c-spine and arm MSK and neuro exams
Tests:
None necessary if symptoms improve or resolve after a few hours
Persistent problems need MRI
Brachial Plexus Injury
Tx
Treatment:
Rest, NSAIDs?, PT
Misc:
When this occurs at birth and is severe, it can eventually result in multiple surgeries and severe disability and deformity
Sciatica
Mechanism of Injury (2)
Usually this is an acute flare up of nerve pain related to a chronic problem in the lumbar spine (in the sciatic nerve distribution)
Can also be caused by compression of the sciatic nerve by the piriformis muscle
Sciatica
Sx/complaints
Common complaints/ symptoms:
Unilateral pain, burning, stinging, occasional muscle weakness
Sciatica
PE/tests and imaging
Physical Exam:
+SLR
Usually will have poor AROM at the lumbar spine
Might have decreased strength
Sometimes will have pain with palpation over the sciatic nerve
Tests:
Not needed if it is a known back problem and this is just an acute flare
Only move on to imaging if symptoms persist for more than a few days or there is concern for a more serious problem
sciatica
tx
Treatment:
NSAIDs
Muscle relaxants if coming from muscle spasm
Epidural steroid injection
PT for stretching if related to muscle spasm
Scoliosis
mechanism and Sx
Mechanism:
Abnormal curvature of the spine
Common complaints/ symptoms:
May be asymptomatic or may have pain, trouble breathing, other mechanical problems
Scoliosis
PE and Testing
Physical Exam:
Visible abnormality, especially from behind
Forward flexion reveals one scapula higher than the other
Tests: full spine x-rays (scoliosis series), Cobb angle will be determined with x-rays and will help to determine treatment
Scoliosis
Tx
Serial monitoring
bracing
surgical repair with Harrington rods
Torticollis
general and Sx
AKA wry neck
Rotation and lateral bend at the neck because of SCM problems
Can be a congenital defect in babies or present idiopathically in adults
Common complaints/ symptoms:
Stiffness, neck rotation, difficulty with ADLs
Torticollis
PE and Dx
Physical Exam:
Spasm in SCM
Stiffness with AROM and PROM
Typically do not have radicular symptoms
Tests:
Clinical Dx
Torticollis
Tx
Treatment:
PT and brace
stretching exercises
Rarely results in surgery
Misc:
In kids, parents will often think there is a tumor in the SCM (really just shortening of the muscle causing a hard “ball”)
