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Sport Prep > Spine Injuries > Flashcards

Spine Injuries Flashcards

1
Q

What are the 2 best lifts (for spine boarding) for reducing cervical spinal motion post suspected cervical trauma, SCI?

A
  • eight person lift technique

- lift and slide technique

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2
Q

Which parts of the athletes equipment should be removed with ACUTE management of cervical trauma?

A
  • LEAVE EQUIPMENT IN PLACE

- can remove FACEMASK for airway access

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3
Q

Why use the Canadian C-spine rules?

A
  • to reduce unnecessary imaging

- identify those with increased likelihood of c-spine injury

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4
Q

What HIGH risk factors would warrant radiographs per Canadian C-Spine rules?

A
  • dangerous MOI
  • > 65 years old
  • numbness and tingling into extremities

*radiographs if YES to any

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5
Q

What LOW risk factors would rule out need for radiographs per Canadian C-spine rules?

A
  • NO cervical midline tenderness
  • delayed onset cervical pain
  • ambulatory
  • sits up in ER
  • simple rear end MVA

*if NONE present = perform radiographs

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6
Q

What is the 3rd step for determining need for cervical x-rays after HIGH and LOW risk factors have been ruled out per Canadian C-spine Rules?

A
  • if unable to achieve Cervical rotation ~45 degrees L and R = X-RAY
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7
Q

What is the CLAY SHOVELERS FRACTURE? What is the MOI?

A
  • Spinous Process Avulsion Fracture
  • forceful contraction of upper traps, rhomboids
  • forceful flexion of cervical spine

*C7, T1 most common

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8
Q

What is the MOI for a vertebral compression fracture?

A

Hyperflexion

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9
Q

What is one CONCOMITANT injury that you must be concerned of with VERTEBRAL COMPRESSION FRACTURE?

A
  • Posterior aspect of vertebrae and posterior ligaments
  • may require SURGICAL STABILIZATION with >50% anterior body fx and posterior disruption and instability

*<25% = conservative

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10
Q

What are the RTP requirements post VERTEBRAL COMPRESSION AND AVULSION fractures?

A
  • stable
  • no neuro symptoms
  • full and pain-free cervical ROM and strength

*increased risk of injury if deficits in ROM, biomechanics

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11
Q

What types of spinal fractures may require surgery and why?

A
  • Unstable fractures or dislocations (severe comminuted vertebral body, type 2 odontoid, unstable posterior elements - pedicle, lamina, facet, transverse process)
  • need to prevent development or progression of neurological deficit (Canal or SC compromise)
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12
Q

What is the most common type of THORACIC fracture? What is the MOI?

A
  • Compression fracture (wedge)

- MOI = axial load or axial load with flexion or traumatic sidebend forces

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13
Q

What is the difference between a WEDGE and BURST fracture?

A
  • both are types of COMPRESSION fracture
  • similar MOI but higher forces with burst (eg MVA)
  • more structures affected with BURST (anterior and posterior columns)
  • Burst = may not be unstable
  • severe Burst = bone may be retropulsed into spinal canal = neuro injury
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14
Q

What is a SEATBELT fracture? What is the MOI? What structures can be affected?

A
  • FLEXION-DISTRACTION fracture
  • MOI= hyperflexion
  • posterior ligaments can be disrupted and facet joints can be injured
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15
Q

What diagnostics should be utilized to achieve maximum accuracy for bone injuries?

A

CT and radiographs = 99% accuracy

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16
Q

With THORACIC FRACTURE conservative treatment, how should these athletes be braced? For how long?

A
  • TLSO, or clamshell brace
  • 8-12 weeks
  • wean from brace - depends on severity
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17
Q

When should SURGICAL STABILIZATION be considered with THORACIC fracture?

A
  • UNSTABLE fractures
  • kyphotic deformities > 30 deg
  • ligamentous injuries

*injuries at TL junction increase risk of neuro injury = fusion may be beneficial

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18
Q

With an athlete who has permanent neurological injury post cervical injury/fracture - what are the RTP recommendations?

A
  • Avoid competition or activity that may increase risk for further injury
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19
Q

What are the RTP recommendations for multi-level cervical fusions, C1-C2, or C2-C3 fusions?

A
  • contact sports are CONTRAINDICATED

- may allow non-contact, low injury risk sports

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20
Q

What are the SYMPTOMS of a BURNER/STINGER?

A
  • unilateral arm - transient loss of sensation or motor function (seconds to minutes)
  • non-dermatomal pattern
  • favoring of UE (e.g. hanging by side)
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21
Q

What are the RTP guidelines post STNIGER?

A
  • RTP if symptoms resolved, full ROM and strength
  • if unresolved symptoms = refer for imaging
  • if >3 stingers or symptoms >24 hours = refer for radiographs
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22
Q

What is a common MOI for CERVICAL SPRAINS?

A
  • rapid acceleration-deceleration force causing sudden flex-ext neck movement
  • may result in INSTABILITY - if suspected = IMMOBILIZE
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23
Q

What is CERVICAL CORD NEUROPRAXIA? What is the most common MOI?

A
  • temporary neurological injury where the spinal cord is compressed due to central canal narrowing
  • MOI = AXIAL loading in flexed or hyperextended position
24
Q

What condition may cause TRANSIENT QUADRIPARESIS? What are the symptoms? How should this be managed?

A
  • Cervical Cord Neuropraxia
  • Temporary paresthesia, nerve pain and/or paresis in B UE and LE
  • After rapid symptom resolution = refer for RADIOGRAPHS and MRI (to screen for injury)
25
Q

What does the TORG RATIO/PAVLOV RATIO measure?

A
  • measure for CERVICAL CANAL STENOSIS = diameter of canal:width of vertebral body
  • normal = 1.0; cervical stenosis = <0.8

*poor predictive value for future injury

26
Q

What are signs of SC compression with cervical disc herniation injury?

A
  • torso or LE tingling/shock
  • stumbling gait
  • difficulty with fine motor skills

*Contraindicated RTP if signs of C/S disc herniation DUE TO increased risk of SCI (from stenosis)

27
Q

What are some COMPLICATIONS of RIB FRACTURES?

A
  • Hemothorax (blood in lung)
  • Pneumothorax (air between lung and chest wall - pleural space)

*Pulmonary complications are most common

28
Q

When would you suspect RIB FRACTURE? How should the athlete be managed ACUTELY?

A
  • signs and symptoms including: PAINFUL COUGHING OR DEEP BREATHING, PALPABLE CLICKING/CREPITUS, SHARP PAIN
  • REMOVE FROM PLAY and REFER for imaging (CT if radiograph negative and still suspicious)

*Can wrap with ACE to stabilize and for patient comfort

29
Q

When can you initiate CARDIO and rehabilitation post RIB FRACTURE? When should these athletes RTP?

A
  • When PAIN-FREE BREATHING
  • progress rehab as tolerated
  • RTP non-contact sports ~ 2-6 weeks as tolerated
  • RTP contact sports = normal ROM and strength; progress from sport specific drills to contact practice/scrimmage first
  • may need extra padding or donut
30
Q

What is a common MOI for lumbar strains?

A
  • high velocity torsion or twisting movement

- chronic repetitive strains can be due to poor posture or faulty mechanics

31
Q

What are some signs and symptoms of acute LUMBAR STRAIN?

A
  • Event that resulted in pain that increased over several hours (due to edema and reflexive muscle spasming)
  • Aggravated by trunk motion (usually flexion, rotation) and passive stretching of muscle
  • maybe: postural shift (from spasming), morning pain and stiffness
32
Q

How can you conservatively manage a LUMBAR STRAIN?

A
  • need to control PAIN to allow for rehab to normalize strength and ROM ASAP (superficial heat, massage, education)
  • encourage normal activities within pain free limits (better recovery vs rest)
  • progressively strength (when pain and spasms are controlled)
  • Graded RTP and sport specific activities

*most athletes have complete resolution within 2 months

33
Q

Where do the majority of lumbar DISC HERNIATIONS occur?

A

95% at L4-L5, L5-S1

34
Q

What are some signs and symptoms of LUMBAR DISC HERNIATION?

A
  • low back pain
  • radicular symptoms (myotomal and dermatomal distribution)
  • positive SLR (Lasegue’s), Slump
  • Aggravated by: axial loading, spinal flexion (sitting)
  • MDT = if centralizes with extension = rules in disc lesion

*MRI can diagnose (use with other signs and symptoms to make official diagnosis)

35
Q

What are some TREATMENT options for LUMBAR DISC HERNIATION?

A
  • Repeated motions
  • Intermittent traction (to treat radic sx)
  • Manual therapy (pain management initially; address mobility issues later - hip and back)
36
Q

What area of the LUMBAR SPINE does SPONDYLOLYSIS affect most?

A

~85-95% L5

  • 80% of lesions are bilateral
37
Q

What is the common MOI for LUMBAR SPONDYLOLYSIS?

A

Repetitive axial loading with rotation in an extended position of the lumbar spine

38
Q

What are the signs and symptoms of LUMBAR SPONDYLOLYSIS?

A
  • localized pain (dull or sharp)
  • worse with extension; limited ext and rotation ROM
  • tenderness at spinous process
  • para spinal muscle spasm
  • hip flexor tightness (increases stress)
  • hamstring tightness (may be compensating for core weakness)
  • +ve single leg hyperextension test (poor sen and spec)
39
Q

What is the best course of action for a young athlete with LBP worsened by extension?

A

Refer for imaging

  • may take 2 weeks for it to be visible
  • if negative but still suspicious = bone scan Or SPECT (single photon emission CT)
40
Q

What are the 3 aspects of conservative rehab for SPONDYLOLYSIS?

A
  • REST and avoid aggravating activities (most important) = may take 3-6 months (~3 months = 16x more likely to have excellent result)
  • BRACE = ~ 3-6 months (as needed based on symptoms)
  • REHAB (address impairments; start flexion based AB exercises, progress to extensors as allowed by symptoms)
41
Q

When is SURGERY indicated for LUMBAR SPONDYLOLYSIS?

A
  • failed conservative tx (6 months)

- * skeletally immature with high grade injury = WANT TO PREVENT FURTHER SLIPPAGE

42
Q

What are the 2 types of surgical intervention for LUMBAR SPONDYLOLYSIS?

A
  • Pars repair (preferred method)= preserves spinal motion

- posterolateral fusion

43
Q

What is the PROTOCOL post Pars repair? What precautions should be taken? How long until RTP?

A
  • ~ 2 weeks post op = start core strengthening and cardio (non impact)
  • higher impact activities ~ 3 months
  • sport specific training ~ 4-6 months
  • RTP ~ 6-12 months (full spine ROM, strong abs, equal SLS balance, pain-free sport specific activities)
  • surgeons use time from surgery and X-rays to determine RTP
  • EXERCISE IN NEUTRAL SPINE FIRST 3 MONTHS
44
Q

What is a SPONDYLOLISTHESIS? Where does it occur most? Who does it affect most?

A
  • Progression of lumbar spondylolysis - fracture with resulting forward slippage of vertebrae
  • most common @ L5-S1
  • affects boys > girls; 10-14 years
45
Q

How is LUMBAR SPONDYLOLISTHESIS managed acutely? Is it a medical emergency?

A
  • monitor for radiating symptoms I distal extremities

- NOT a medical emergency

46
Q

What are signs and symptoms of LUMBAR SPONDYLOLISTHESIS?

A
  • gradual onset (dull achy pain)
  • pain worse with extension and rotation
  • step off deformity
  • hamstring tightness and increase lumbar lourdosis
  • Diagnose via CT (85% positive where X-rays were negative oblique view)
  • AP X-rays can show amount of slippage (grades 1-4)
47
Q

What are the treatment options for LUMBAR SPONDYLOLISTHESIS?

A
  • CONSERVATIVE = important to prevent reinjury with skeletally immature athlete due to HIGH RISK OF PROGRESSION (AB strengthening, core stabilization)
  • SURGERY = high grade lesions or neuro symptoms
  • usually FUSION posteriorly of 1 or more levels
48
Q

What are the RTP criteria s/p posterior fusion for LUMBAR SPONDYLOLISTHESIS?

A
  • CONTROVERSIAL
  • FUSION = negative predictor for RTP
  • some don’t recommend return to CONTACT SPORTS (some allow it, some say wait >1 year, some sports are discouraged - gymnastics, football, wrestling)
  • activities that require extreme spinal motion, handling heavy loads = DISCOURAGED
  • No specific CRITERIA for RTP = should have full ROM, strength, flexibility, endurance and no symptoms
49
Q

What are the 3 areas of potential STENOSIS in the spine?

A
  • Central
  • foraminal
  • lateral recess
  • Can be congenital (primary) or degenerative/space occupying lesion (secondary)
50
Q

What are possible causes of CENTRAL STENOSIS of the lumbar spine ?

A
  • Decreased disc height
  • disc bulge
  • hypertrophy of facet joints and ligamentum flavum (fibrosis from mechanical stress)
51
Q

What are some causes of FORAMINAL STENOSIS in the lumbar spine?

A
  • decreased disc height
  • overgrowth of structures anterior to facet joint capsule
  • posterolateral osteophytes of vertebral endplate
  • lateral disc bulge = compresses nerve against superior pedicle
52
Q

What are the signs and symptoms of LUMBAR FORAMINAL STENOSIS?

A
  • low back pain
  • radicular symptoms
  • +ve Kemp Test (lumbar extension to painful side)
  • neurogenic claudication (symptoms worse with walking, standing)
  • severe = bowel and bladder dysfunction
53
Q

What are the signs and symptoms of CENTRAL CANAL STENOSIS at the lumbar spine?

A
  • decreased lumbar ROM (ext>flex)
  • walking treadmill test +ve
  • +ve neural tension (SLR)
  • possible night cramps
  • symptoms Bilateral and Symmetrical
  • possible UMN symptoms (spasticity at lower legs, neurogenic bladder)
54
Q

How should LUMBAR SPINAL STENOSIS BE TREATED?

A
  • Initially CONSERVATIVE (treat impairments, include manual techniques, lumbar traction though no evidence, core stability, deep abdominals, multifidus, posterior chain)
  • INVASIVE = steroid injection, surgery (if instability or SC encroachment - laminectomy or fusion)
55
Q

What are the RTP recommendations s/p LUMBAR LAMINECTOMY?

A
  • if CONSERVATIVE tx = full pain free motion without neuro symptoms
  • LAMINECTOMY= RTP contact sports ~ 4-6 months (PROHIBITED if continued instability or neuro symptoms)
  • LUMBAR FUSION = contact sports not recommended

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