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Back Strains, Sprains, and Spasms

Back Sprain = only ligamentous tissue or attachment of ligament to bone is involved
Usually due to excessive extension or rotation of the vertebral column
Back Strain = stretching or microscopic tearing of muscle fibers
Common in sports, due to overly strong muscle contraction
Usually erector spinae muscles of lumbar region
Back Spasms = protective mechanism of the muscles
In response to injury/inflammation


Arterial Anastomoses Around Scapula

Sudden occlusion doesn't allow enough time for adequate collateral circulation to develop and reach the arm/forearm


Compression of Axillary Artery

Axillary artery can be palpated inferior to lateral wall of axilla
Can compress axillary artery against humerus
Axillary artery can be compressed by pushing downward in angle between clavicle and SCM m.


Aneurism of Axillary Artery

Enlargement of first part of axillary artery that may compress the brachial plexus
Common among baseball pitchers and football quarterbacks because of rapid and forcefull arm movements


Cervical trauma: fracture or dislocation of atlas

=Burst fractures (Jefferson fracture)
o Lateral masses of C1 are compressed btwn the occipital condyles and tha axis (C2), fracturing anterior and/or posterior arches of C1
o May involve rupture of transverse ligament (which keeps the dens in place → dislocation
o Causes: sudden, forceful compression of C1 (diving accidenst, roll-over car accidents


Occipital Neuralagia

irritation of greater occipital (dorsal rami C2) and lesser occipital n (ventral rami C2-C3)
o Osteoarthritis of cervical vert
o Neck injury
o Disk disease
o Muscle spasms in neck
o Swollen bvs put pressure on occipital n
o Tumors, infection, gout, diabetes
o Brief episodes of burning/stabbing pian that is triggered by neck mvmt and radiated over the C2 dermatome region
o Scalp tenderness
o Pain behind eye
o Headache


Dislocation of cervical vertebrae

• Articulated cervical vert are less tightly interlocked, making them more prone to dislocation
• Cervical dislocation if severe enough, can cause trauma to the spinal cord


cervical trauma: fracture/dislocation of axis: Fracture of vert arch (hangman’s fracture)

=Fracture of pars interarticularis (traumatic spondylolysis of C2)
• Hyperextension of the neck
• Judicial hanging, some severe cases of acceleration/deceleration syndrome where head and neck are hyperextended, etc


cervical trauma: fracture/dislocation of axis: Fracture of dens

Fracture at base of dens (most common) or along body of axis
• Horiz blow to head
Can happen at multiple locations:
• Type 1 – frac at upper part dens
• Rare, unstable
• Type 2 – frac at base of dens
• Most common
• Unstable – may not heal well - dont repair bc transcverse ligament gets in the way --> lose vascular supply --> avascular necrosis
• Type 3 – frac thru dens and into lateral masses of C2
• best prognosis for healing bc have vascular supply


Cervical trauma: soft tissue injury

• Acceleration/deceleration synd occurs when the head is forced fwd and then snaps back (aka during a rear-end collision)
• Result in whiplash injuries
• These usu only involve damage to soft tissue, may also involve fractures


Vertebral Artery Impingement (specifically, lumbar spinal stenosis)

Reduced blood supply to brainstem
Aka cervical vertigo/vertebral artery compression
Vertebral a becomes blocked/narrowed (stenosis) when head is turned (mvmt at atlantoaxial joint)
May be age related
o Trauma
o Cervical spinal column abnormalities
o Degenerative dis
o Arterial stenosis assoc w CVD
Signs and Symp
o Dizziness/vertigo
o Confusion
o Nystagmus
Treated surgically with laminectomy


Ossification of Clavicle

• First long bone to completely ossify (embryonic weeks 5-6; intramembranous ossification)
• Ends of clavicle then go thru a cartilaginous phase (endochonfdrial ossification)
• Complete fusion of intramembranous and endochondrial portions completes at 25-31 yrs
• Significant bc:
o Congenital pseudoarthritis (“nonunion”; “false joint”) of the clavicle
o Sometimes the fusion of the diff ossification centers of the clavicle fails
o A congenital defect like this can present like a poorly healed fracture
o Most often involves right clavicle but can be bilateral (rare)


frac of clavicle

o Frequent
o Common in children
• Greenstick = look like greenstick on tree breaking
o Weakest parts: btn middle and lateral third
• Lateral frac: 15%
• Middle frac: 80%
• Medial frac: 5%
o Muscular attachments to the clavicle can pull fractured portions out of alignment
• Sternocleidomastoid elevates medial fragment
• Trapezius action is counteracted bt wt of limb
• Adductors of the arm (deltoid, pec major) can pull lateral fragment medially
• Coracoclavicular ligament prevents dislocation of acromioclavicular joint


frac of scapula

o Typically result of injury/trauma:
• Falling on outstretched hand or landing on shoulder
• Direct blow to shoulder/upper back
o Mostly occurs across body of scapula, but scapular neck can also be fractured
• Acromion often involved
o Will just let it heal bc much muscle and soft tissue
o Often, ribs are cracked too


palpation of scapula

o Scapular spine
o Acromial angle
o Medial border
o Inferior border (rim of latissimus dorsi here)


Isolated subscapularis tears =



common injury in pichers (pwrful throwing motion)

Rotator cuff tendonitis


Subscapularis injuries can also lead to

bicipital tendon instability and biceps tendonitis


Paralysis of Serratus Anterior

Injury to the long thoracic n.
Causes winged scapula
May prevent abduction of upper limb above horizontal position
When limbs are elevated (knife fight) long thoracic nerve is vulnerable


Injury of Spinal Accessory Nerve

Ipsilateral weakness of elevating shoulders (shrugging) against resistance


Injury of Thoracodorsal Nerve

Injury in inferior axilla puts thoracodorsal nerve at risk
Also susceptible to injury during mastectomies and surgery on scapular lymph nodes
Pt. unable to raise trunk with upper limbs


Injury to Dorsal Scapular Nerve

Causes scapula on affected side to mover further from midline


Injury to Axillary Nerve

Usually injured during fracture/dislocation of the humerusor from rotator cuff surgery
Can be injured during misuse of crutches
-Loss of sensation on lateral side of proximal arm (Superior lateral cutaneous nerve of the arm)
-Difficulty abducting arm (bc paralysis of deltiod)
-Diminished lateral rotation of arm
-Deltoid m wasting (prolonged injury)


Triangle of Auscultation

Good for listening to posterior segments of lungs
Triangle enlarges when scapluae are drawn anteriorly and trunk is flexed


Fracture-Dislocation of Proximal Humeral Epiphysis

Joint capsule + rotator cuff muscles is stronger than epiphyseal plate
Seen in children


Cervical ribs (supernumerary ribs)

• An extra rib (or pair of ribs) arising fom the 7th cervical vertebra
• 3 common vairities:
o rudimentary
o fused with first thoracic rib
o fully developed
• Can result in thoracic outlet synd (but not always)


thoracic outlet synd

o =impingement of the large vessels and nerve (brachial plexus)
o can attach to the 1st thoracic rib vy dense fibrous band
o elevates the lowest cord of brachial plexus
o Other cuases:
• Fractured clavicle
• Extra muscle.scar tissue in the region of the scalene muscles
• Poor posture of the neck and shoulder regiont


injuries to thoracic vert due to

everyday wear and tear :(


Herniated discs in lumbar region

• most freq occur here Bc region that bears the most wt
• Freq bending, twisting, improper lifting increases load on tedons that reinforce this region, as well as intervertebral discs
• How/where the pain/dysfunction presents itself indicates the level at which a lumbar herniation has occurred


Herniated discs in thoracic region

• Usu as a result of wear and tear; disc degeneration
• Sudden and forceful twisting of the midback region
• Other conds that predispose an indiv (abnormal kyphosis (Schererman’s dis)