Cervical Spine


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Cervical Spine

  1. 1. Cervical Spine Injuries Cervical Spine Stenosis Mechanism/Etiology -narrowing of the spinal canal Signs and Symptoms -pain, weakness, and numbness in shoulder and arm -hand clumsiness History -places pressure on the cords -typical results of abnormal bone growth -seen with patients over 50 Inspection –may have a stiff neck Palpation -may see spasms of the scapular muscles Neurological -derm/myo defeciecets Diagnostic Tests -X-rays. -MRI (magnetic resonance imaging) -Computerized axial tomography (CAT scan) Treatment Non-surgical -Consist of medications that helps with pain and swelling -Epiduaral steroid injection (provide temporary relief) -Put on rest and restricted activity Surgical -If found congenital they are forbidden to play collision sports
  2. 2. Cervical Fractures or Dislocations History -acute onset -pain in the cervical spine -numbness, weakness, or paresthesia radiating into the extremities -cervical muscle spasm -chest pain -loss of bladder control Mechanism -fractures commonly seen to an axial load placed on the cervical vertebrae -dislocations most commonly resulting from hyperflexion or hyperextension and rotation Inspection -malalgnment of the cervical spine may be observed -the head may be abnormally tilted and rotated -unilateral cervical dislocations result in the head’s tilting toward the sited of dislocation -the muscles on the side opposite the dislocation (tilt) are in spasm -those muscles on the side of the dislocation are flaccid -swelling maybe present over the ligamentum nuchae Palpation -tenderness, crepitus, or swelling may be present -unilateral or bilateral muscle spasm Functional Tests -ROM testing should not be performed in numbness, weakness, or paresthesia radiating into the extremities ore bowel and bladder signs or present Types of Fractures Atlanto-axial Fracture -results of hyperextension -occur more in children than adults -C1 slips off fractured C2 Jefferson Fracture -compressive fracture -burst fracture - usually seen in C1 ring -bilateral fracture in anterioposterior arches -diving into a shallow pool or pools without water Hangman’s Fracture (C2) -results of hyperflexion, compressive forces or a combination -fractures to pedicles of C2 - anterior slippage of C2 over C3 -fatal
  3. 3. Simple Compression Fracture Clay-Shovelers Fracture -fracture of spinous process of C6 or C7 -results of rotation -no neurological deficits -possible deformity Teardrop fracture -violent extension force -neurological involvement -avulsion of the anterior longitudinal ligament Burst fracture -compressive force along the axis -results of flexion -fracture to the vertebral body -may have neurological symptoms -can be a comminuted fracture Cervical Cord Injury Etiology/Mechanisms Four ways Laceration Hemorrhage Contusion Spinal Cord Shock Signs and Symptoms May be complete or incomplete Complete Incomplete Central Cord Syndrome Brown-Sequard Syndrome Anterior Cord Syndrome Posterior Cord Syndrome Management On-scene Off-scene
  4. 4. Cervical Cord Neuropraxia Intervertebral Disk Herniation Brachial Plexus Neurapraxia History -acute onset -pain in the trapezius and deltoid, radiating into the arm Mechanism Brachial plexus stretch -lateral bending of the cervical spine and depression of the opposite shoulder, resulting in tension on the brachial plexus -symptoms occur on the side opposite the lateral bend Brachial plexeus compression -lateral bending of the cervical spine, resulting in the entrapment of the cervical nerve roots -symptoms occur on the side toward the lateral bend Inspection -the involved arm hangs limply at the patient’s side -inspection of the cervical spine is necessary fro signs of a fracture or dislocation Palpation -rule out dislocation or fracture Functional Tests -AROM is diminished -the patient is unable to complete a manual muscle test -return of motor function usually begins minutes after the onset of injury -RROM possible demonstrating weakness throughout the musculature innervated by the plexeus -strength returns in minutes Special Tests Brachial plexeus stretch test Cervical compression/distraction test Spurling test
  5. 5. Acute Torticollis Acute Cervical Strains Cervical Sprain Cervical Nerve Root Compression History -acute or chronic onset -commonly the lower cervical vertebrae (C4 to C7) -symptoms possibly radiating into the trapezius, scapula, shoulder, arm, wrist, and hand Inspection -head and cervical spine are postured to relieve pressure on the involved nerve root Palpation -point tenderness may be noted at the involved vertebral level Functional test AROM: pain during extension, lateral bending toward the involved side and rotation PROM: pain during extension, lateral bending toward the involved side and rotation RROM: weakness and pain possible for all motions Special Tests Cervical compression test Cervical distraction test Spurling Test Vertebral Artery Test hot bex tube Thoracic Outlet Syndrome -caused by pressure on the trunks and medial cord of the brachial plexus, subclavain artery, or the subclavian vein -may be linked to the presence of the cervical rib, pressure placed on the neurovascular bundle as it is impinged between the clavicle and the first rib, compression between the pectoralis minor and rib cage, or tightness of the anterior and middle scalene muscles Neurological onset -numbness -pan
  6. 6. -parasthesia Arterial onset -coldness of the skin -cyanonsis in the fingers -muscular weakness Venous onset -muscular and joint stiffness -edema -venous engorgement -Thrombophlebitis Larynx Contusion/Fracture