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
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
3
Q
Why use the Canadian C-spine rules?
A
- to reduce unnecessary imaging
- identify those with increased likelihood of c-spine injury
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
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
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
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
8
Q
What is the MOI for a vertebral compression fracture?
A
Hyperflexion
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
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
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)
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
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
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
15
Q
What diagnostics should be utilized to achieve maximum accuracy for bone injuries?
A
CT and radiographs = 99% accuracy
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
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
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
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
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)
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
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
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
What does the TORG RATIO/PAVLOV RATIO measure?
- 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
What are signs of SC compression with cervical disc herniation injury?
- 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
What are some COMPLICATIONS of RIB FRACTURES?
- Hemothorax (blood in lung)
- Pneumothorax (air between lung and chest wall - pleural space)
*Pulmonary complications are most common
28
When would you suspect RIB FRACTURE? How should the athlete be managed ACUTELY?
- 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
When can you initiate CARDIO and rehabilitation post RIB FRACTURE? When should these athletes RTP?
- 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
What is a common MOI for lumbar strains?
- high velocity torsion or twisting movement
| - chronic repetitive strains can be due to poor posture or faulty mechanics
31
What are some signs and symptoms of acute LUMBAR STRAIN?
- 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
How can you conservatively manage a LUMBAR STRAIN?
- 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
Where do the majority of lumbar DISC HERNIATIONS occur?
95% at L4-L5, L5-S1
34
What are some signs and symptoms of LUMBAR DISC HERNIATION?
- 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
What are some TREATMENT options for LUMBAR DISC HERNIATION?
- Repeated motions
- Intermittent traction (to treat radic sx)
- Manual therapy (pain management initially; address mobility issues later - hip and back)
36
What area of the LUMBAR SPINE does SPONDYLOLYSIS affect most?
~85-95% L5
* 80% of lesions are bilateral
37
What is the common MOI for LUMBAR SPONDYLOLYSIS?
Repetitive axial loading with rotation in an extended position of the lumbar spine
38
What are the signs and symptoms of LUMBAR SPONDYLOLYSIS?
- 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
What is the best course of action for a young athlete with LBP worsened by extension?
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
What are the 3 aspects of conservative rehab for SPONDYLOLYSIS?
- 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
When is SURGERY indicated for LUMBAR SPONDYLOLYSIS?
- failed conservative tx (6 months)
| - * skeletally immature with high grade injury = WANT TO PREVENT FURTHER SLIPPAGE
42
What are the 2 types of surgical intervention for LUMBAR SPONDYLOLYSIS?
- Pars repair (preferred method)= preserves spinal motion
| - posterolateral fusion
43
What is the PROTOCOL post Pars repair? What precautions should be taken? How long until RTP?
- ~ 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
What is a SPONDYLOLISTHESIS? Where does it occur most? Who does it affect most?
- Progression of lumbar spondylolysis - fracture with resulting forward slippage of vertebrae
- most common @ L5-S1
- affects boys > girls; 10-14 years
45
How is LUMBAR SPONDYLOLISTHESIS managed acutely? Is it a medical emergency?
- monitor for radiating symptoms I distal extremities
| - NOT a medical emergency
46
What are signs and symptoms of LUMBAR SPONDYLOLISTHESIS?
- 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
What are the treatment options for LUMBAR SPONDYLOLISTHESIS?
- 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
What are the RTP criteria s/p posterior fusion for LUMBAR SPONDYLOLISTHESIS?
- 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
What are the 3 areas of potential STENOSIS in the spine?
- Central
- foraminal
- lateral recess
* Can be congenital (primary) or degenerative/space occupying lesion (secondary)
50
What are possible causes of CENTRAL STENOSIS of the lumbar spine ?
- Decreased disc height
- disc bulge
- hypertrophy of facet joints and ligamentum flavum (fibrosis from mechanical stress)
51
What are some causes of FORAMINAL STENOSIS in the lumbar spine?
- 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
What are the signs and symptoms of LUMBAR FORAMINAL STENOSIS?
- 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
What are the signs and symptoms of CENTRAL CANAL STENOSIS at the lumbar spine?
- 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
How should LUMBAR SPINAL STENOSIS BE TREATED?
- 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
What are the RTP recommendations s/p LUMBAR LAMINECTOMY?
- 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
