Acute Cervical Injury Flashcards
OA and AA joints and ligaments
- are supported mainly by the ligaments
- OA joint is convex occiptial condyles on concave facets of C1
- Transverse ligament spans atlas and prevents C1 from sliding
- Alar ligament is the 2nd line of defense
vertebral artery describe anatomy
- VA takes right angle over C1
- gutter invertebrae w/spinal nerve root
- VA gets stretched on oppsite side you are turing to
- palpate facet joints not TP
Disc and nerve root relationship
in the cervcal spine
- Disc is thinner due to less weight bearing in C/S due to uncinate process taking some weight bearing
- no Disc between C1-C2
- NR exits above respective vertebral body
- C8 exits below C7 vertebrae
neck classification system
- neck pain with movement/coordination impairments (whiplash)
- neck pain with headache HA
- Neck pain and mobilty deficits
- Neck pain with radicular symptoms
neck classification system
Neck pain with movement/coordination impairments (whiplash)
- exam
- treatment
- acute/subacute/chronic
Exam:
- posture
- ROM
- Cranio-cervical flexion test of deep flexors
- neck flexor endurance
Treatment:
- minimal use of collar
- E-stim/TENs
- return to activity
- postural training
- ROM muscle reeducation
- strengthening
Aute/subacute/chronic:
- treatment appropriate for each stage with reassurance of recover in 2 months
neck classification system
neck pain with headache
- exam
- treatment
- acute/subacute/chronic
Exam:
- posture
- C/S ROM
- cervical flexion rotation test
- C/S, T/S segmental testing
Treatment:
- posture
- AROM stretching
- C/S and T/S mobs/manipulation
- C/S re-ed
- craniocervical deep neck flexor strength/endurance
Acute/subacute/chronic: based on stage of healing
neck classification system
Neck pain with mobility deficits
- exam
- treatment
- acute/subacute/chronic
hypomobile
Exam:
- C/S, T/S ROM
- cervical flexion rotation test
- C/S, T/S segemntal testing
Treatment:
- C/S T/S mobilization/manipulation
- SNAGs
- AROM
- Scapulothoracic muscle strength and endurance
Stage of healing needs to be considered
neck classification system
Neck pain with radicular symptoms
exam and treatment
Exam:
- repetitive movements
- neurodynamic ULTT
- spurling
- distraction test
- valslva
Treatment:
- repeated motions to centralize
- C/S traction
- T/S mobs/manipulation
Typical Acute cervical injury causes
- MVA: whiplash associated disorders
- Falls
- diving
- sports
- Misc trauma
Whiplash associated disorder
recovery
- most individuals recover in 3 weeks time but 42-50% dont and it becomes chronic
- results in economic, personal and emotional burdens
Whiplash/acceleration injury MVA mechanics
- rear ended: head retract => C/S hyperextends => C/S hyperflexes
- Front collision: 1. head and C/S flexes 2. extends
- struck on R side cuases RSB: compresses R neck tractions L neck => rebound into LSB opposite occurs
whiplash MOI with rear ended MVA
consquences of each component
- retraction: subocciptal muscles spasm, UC ligaments instability
- hyperextension: injury to anterior structures
- hyperflexion: injury to posterior sturcutres
Hyperextension - anterior injury and what the injuries may cause
- muscles: longus colli, and capitis, rectus capitis anterior, supra/infra hyoids and SCM
- anterior longitudinal ligament
- DIsc: anterior annulus
- facets and capsules
May result in…
- loss of C/S lordosis as head gets pulled into flexion
- spasm of longus colli and capitis
- difficulty/pain swallowing from spasm of hyoid
Hyperflexion - injury to posterior structures
- posterior C/S muscles and subocciptials
- posterior ligament: ligamentum nuchae, interspinous, ligament flavum, PLL
- disc posterior annulus
- facets and joint capsules
may result in…
- spasm posterior musculature
- increased C/S lordosis
- subocciptial headache
- disc related symptoms => bulge HNP
Injuires specific to tissue: consequences
- musculature: stretch, torn, muscle guarding/spasm
- ligaments: over-stretched, torn = instability
- Disc: annulus => bulge => HNP
- NR IV narrowing - pinched nerve
- facet joint injury: capsule stretch, torn, pinched, facet joint compression
- fractures: vertebral body, facets, TP, SP, avulsion fx, in UC - life threatening
