Chapter 21 Cervical and Thoracic Spinal Conditions Flashcards
(18 cards)
What is a torticollis?
Deformity of the neck in which the head tilts toward one shoulder and simultaneously the chin rotates toward the opposite shoulder
Congenital or acquired
Infants born with torticollis – appear to be healthy at delivery but after 2-8 weeks develop soft-tissue swelling over an injured SCM injury from birth trauma or intrauterine mispositioning
Children – acquired torticollis trauma or secondary to infection of the throat/pharynx/cervical adenitis
Adults – muscular strain, viral infection, psychogenic etiology, vertebral or clavicular fractures, traumatic unilateral facet subluxation or impingement
Wry neck – muscular strain follows exposure to cold air or sleeping with neck in abnormal position
What is a cervical sprains?
Occur at extremes of motion or in association with a violent muscle contraction or external force
Any of the major ligaments traversing the cervical spine as well as to capsular ligaments surrounding the facet joints
S/S – pain, stiffness, restricted ROM, no neurological or osseous injury, cervical distraction test wouldn’t relieve pain but will elicit pain
What is a cervical strain?
Usually involve SCM or upper trapezius, but scalenes, levator scapulae and splenius muscles may be involved
Occur at extremes of motion or in association with a violent muscle contraction or external force
Occurs with a cervical sprain often
What is cervical spinal stenosis?
Narrowing of the sagittal canal diameter of 14 mm or less
May be congenital, acquired or asymptomatic
Athletes – secondary to degenerative osteophyte formation which narrows the the canal acquired stenosis
Most commonly affected – C5-C6
May remain asymptomatic until a direct blow to the forehead or occiput produces neurological signs
S/S – immediate quadriplegia with sensory changes or motor deficits in both arms/legs, bilateral with full recovery in 10-15 minutes until 36-38 hours (neurapraxia – temporary neural changes)
What is a spear tackler’s spine?
Flexion of neck produces a straightened cervical spine that acts like a segmental column, predisposing the spine to permanent neurological injury with further axial loading
S/S – immediate pain with sensory and motor changes distal to injury site
What is a spinal cord injury?
MOI – hyperflexion, hyperextension or rotation of the spinal column
Primary injury – caused by trauma and results in hemorrhagic changes that lead to ischemia and necrosis
Secondary injury – various chemical and vascular changes
Cord is injured loss of conduction due to migration of K+ ions from inside the cells to extracellular spaces
Hypotension, bradycardia, loss of thermoregulation neurogenic shock, seen 4-6 hours after injury in patients with cord lesions above T6
Loss of somatic and autonomic reflex activity below level of neurological damage spinal shock
What is anterior cord syndrome?
damage to the anterior two-thirds of the spinal cord but can also damage the anterior spinal artery, ischemia leads to variable loss of motor function and loss of pain and temperature sensation below the level of injury
What is a posterior cord syndrome?
very rare, involves the posterior third of the spinal cord (dorsal column), senses are lost but motor function, sense of pain and temperature are preserved
What is Brown-Sequard syndrome?
a hemisection of the spinal cord with loss of ipsilateral motor function and contralateral pain and temperature caused by a penetrating injury, motor weakness on one side of the body and decreased pain and temperature on the opposite side
What is central spinal cord syndrome?
most common, incomplete loss of motor function with UE weakness being more pronounced than LE weakness
What are cervical disk injuries?
Less common than lumbar disk injuries, usually affect older, physically active individuals
MOI – sustained, repetitive cervical compression, axial loading, hyperflexion injuries during contact sports
Soft-disk herniation – acute process in which the nucleus pulposus herniates through the posterior annulus, resulting in s/s of cord and nerve root compression (sports uncontrolled lateral bending c/s)
Hard-disk herniation – chronic, degenerative process, with a diminished disk height and the formation of marginal osteophytes
S/S – neck or arm pain, radiates into shoulder/arm, pain with Valsalva maneuver and spurling maneuver, Babinski reflex affected
What are cervical fractures and dislocations?
MOI – axial loading and violent neck flexion
Bilateral pars interarticularis fracture of C2 – hangman fracture cervical collar
Sports – serious injuries occur C4-C6
What is a grade 1 acute brachial plexus injury?
MOI – caused by forceful separation of the neck from the shoulder
S/S – immediate, severe burning pain and prickly paresthesia that radiates from the supraclavicular area down the arm, pain is transient and subsides in 5-10 minutes, but tenderness and weakness may persist for hours or even days after the injury
Grade I – Neurapraxia – temporary loss of sensation and/or loss of motor function – recovery within a few days to a few weeks
What is a grade 2 acute brachial plexus injury?
Grade II – Axonotmesis – significant motor and mild sensory deficits – deficits last at least 2 weeks, regrowth is slow but full function is restored
What is a grade 3 acute brachial plexus injury?
Grade III – Neurotmesis – motor and sensory deficits persist for up to 1 year – poor prognosis, surgical intervention often is necessary
What is a chronic recurrent cervical nerve root neuropraxia?
Involves neck extension with ipsilateral lateral deviation
Chronic burner syndrome associated with cervical canal stenosis, reversal of lordosis, disk disease, foraminal stenosis and a positive Spurling sign
Compression of dorsal nerve roots within the intervertebral foramina
What is a suprascapular nerve injury?
Innervates – supraspinatus, infraspinatus and GH joint capsule
MOI – pitching, spiking, overhead serving, extreme velocity and torque forces generated during the cocking, acceleration and release phases subject this nerve and its adjoining artery to rapid stretching
S/S – supraspinatus and infraspinatus muscles appears to be weak and atrophied
What is a thoracic spinal fractures and apophysitis?
Thoracic fractures lower end of t/s
MOI – axial loading, flexion and rotation
Scheueermann disease – appears to be related to mechanical stress, involves degeneration of the epiphyseal end plates of the vertebral bodies and typically includes at least three disk spaced are narrowed, decrease in spinal height, increased kyphosis
