Back injury


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Back injury

  1. 1. Back injury
  2. 2. Back component <ul><li>Skeletal </li></ul><ul><li>Non Skeletal </li></ul>
  3. 3. Skeletal
  4. 4. SPINE Coccyx C 7 T 12 L 5 Sacrum
  5. 5. Function of the Spine <ul><li>Strength and Support </li></ul><ul><li>Movement </li></ul><ul><li>Protection of Nerves </li></ul><ul><li>Blood Supply </li></ul><ul><li>Protection of Major Organs </li></ul><ul><li>Absorption of Impact </li></ul>
  6. 6. Non Skeletal <ul><ul><li>Intervertebral Discs </li></ul></ul><ul><ul><li>Muscles, Tendons and Ligaments </li></ul></ul><ul><ul><li>Spinal Canal and Spinal Cord </li></ul></ul><ul><ul><li>Spinal Nerves </li></ul></ul>
  7. 7. 1 I ntervertebral Disc
  8. 8. 2.Muscle, Ligament and Tendon <ul><li>Back muscle </li></ul><ul><li>is complex, with several different roles </li></ul><ul><li>support and stabilize the spine </li></ul><ul><li>movement of organ e.g. </li></ul><ul><ul><li>head with Sternocleidomastoid muscle </li></ul></ul><ul><ul><li>flexion of the thigh with Psoas Major muscle </li></ul></ul><ul><ul><li>muscles in the vertebral column serve to flex, rotate, or extend the spine </li></ul></ul>
  9. 9. <ul><li>Ligament </li></ul><ul><li>is fibrous tissue </li></ul><ul><li>connects bone to bone at or near a joint </li></ul><ul><li>providing stability for a joint and preventing or limiting a certain amount of joint motion. </li></ul><ul><li>Pain occurred if they are strained or torn. </li></ul>
  10. 10. <ul><li>Tendon </li></ul><ul><li>s everal layers of fibrous connective tissue called fascia cover muscles , extends beyond the muscle to become the tendon </li></ul><ul><li>connects muscles to bones </li></ul><ul><li>composed of parallel collagen fibers that are non-elastic and transmit force generating from a muscle to enable body movement </li></ul><ul><li>injured tendons heal slowly due to their limited blood supply </li></ul>
  11. 11. 3 Spinal canal and Spinal cord
  12. 12. 4 Spinal nerve
  13. 13. Level of Dermatomes
  14. 14. Common causes of back injury
  15. 15. <ul><li>R oad traffic accident </li></ul><ul><li>S lip </li></ul><ul><li>T rip </li></ul><ul><li>F all </li></ul><ul><li>S ports injury </li></ul><ul><li>S udden force of impact from a blunt object. </li></ul>
  16. 16. Signs and Symptoms <ul><li>S udden onset of pain </li></ul><ul><li>H igh levels of pain </li></ul><ul><li>S welling </li></ul><ul><li>B ruising </li></ul><ul><li>D eformity </li></ul><ul><li>W eakness, numbness, or paralysis i n severe cases, where the fractured bone is pushed into the spinal cord or n erve. </li></ul>Note: acute injury, pain should last no longer than 6 weeks
  17. 17. Investigation <ul><li>X-ray : diagnose vertebral fractures, scoliosis, spondylosis, bone spur formation (osteophytes), spondylolisthesis </li></ul><ul><li>CT scan : produce clear pictures of bone, soft tissue, organs, intervertebral discs and the spinal cord </li></ul><ul><li>MRI: produce highly detailed images that are adept at identifying soft tissue pathologies </li></ul>
  18. 18. Types of Back Injury <ul><li>Back Contusions </li></ul><ul><li>S trained / S prained , causing the muscles to spasm in an effort to protect the delicate structures of the spinal canal. This can happen in any region of the spine and can be very serious </li></ul><ul><li>Spinal fracture , a result of a fall </li></ul><ul><li>Nerve damage can be the outcome of a fall, road traffic accident or from a physical assault. </li></ul><ul><li>H erniated disc may result after lifting something that is too heavy. </li></ul>
  19. 19. <ul><li>Usually </li></ul><ul><ul><li>mild </li></ul></ul><ul><ul><li>u ncomplicated </li></ul></ul><ul><li>Back Contusions </li></ul>
  20. 20. Strains and Sprains <ul><li>Pain is usually </li></ul><ul><ul><li>sharp </li></ul></ul><ul><ul><li>acute </li></ul></ul><ul><ul><li>occurs immediately </li></ul></ul>
  21. 21. <ul><li>A strain is a muscle or tendon injury </li></ul><ul><li>Caused by twisting or pulling a muscle or tendon. </li></ul><ul><ul><li>Falling down </li></ul></ul><ul><ul><li>Overload </li></ul></ul><ul><ul><li>Overuse </li></ul></ul><ul><ul><li>Poor posture </li></ul></ul><ul><li>Chronic strains are usually the result of overuse </li></ul><ul><li>Common Types of Strains </li></ul><ul><ul><li>Back Strain </li></ul></ul><ul><ul><li>Hamstring Strains </li></ul></ul><ul><ul><li>Tendonitis </li></ul></ul>Strain
  22. 22. Symptoms of Back Muscle Strain <ul><li>Back pain </li></ul><ul><li>Muscle weakness </li></ul><ul><li>Back muscle spasms to reduce motion to prevent further injury </li></ul><ul><ul><li>Muscle spasms are more likely to be a problem for the first couple of days after an injury when inflammation is at its worst. </li></ul></ul><ul><ul><li>Though not serious, back muscle spasms can cause significant pain. Inflammation also causes pain. </li></ul></ul>
  23. 23. Strain severity <ul><li>Grade I Strain : mild </li></ul><ul><ul><li>some muscle fibers jury </li></ul></ul><ul><ul><li>h ealing within 2-3 weeks. </li></ul></ul><ul><li>Grade II Strain: moderate </li></ul><ul><ul><li>more extensive damage to muscle fibers, but the muscle is not completely ruptured. </li></ul></ul><ul><ul><li>h ealing within 3 - 6 weeks. </li></ul></ul><ul><li>Grade III Strain : severe </li></ul><ul><ul><li>a complete rupture of a muscle. </li></ul></ul><ul><ul><li>this typically requires a surgical repair of the muscle </li></ul></ul><ul><ul><li>healing period can be up to 3 months. </li></ul></ul>
  24. 24. Sprain <ul><li>A back sprain is a ligament injury </li></ul><ul><li>Typically occurs when people fall </li></ul><ul><li>R esults in an overstretch or tear of the ligament(s) supporting that joint </li></ul>
  25. 25. Ligament Injury (sprain) <ul><li>- Can happen in any region of the spine </li></ul><ul><li>- Can be very serious even when there is no fracture </li></ul><ul><li>A hard cervical collar is needed to protect </li></ul><ul><li>the spinal cord. </li></ul><ul><li>To bend the neck forward, a subluxation may occur </li></ul><ul><li>Detected with MRI scanning or carefully controlled flexion and extension spine X-rays </li></ul><ul><li>Torn ligaments can take up to 12 months to heal fully </li></ul><ul><li>Can permanently overstretched leading to long-term spinal weakness. </li></ul>Torn ligament
  26. 26. Sprain s everity <ul><li>Grade I Sprain : mild </li></ul><ul><ul><li>minimal pain, swelling, and little or no loss of functional ability </li></ul></ul><ul><ul><li>b ruising is absent or slight, </li></ul></ul><ul><li>Grade II Sprain : moderate </li></ul><ul><ul><li>partial tearing of the ligament </li></ul></ul><ul><ul><li>moderate pain, bruising, and swelling. </li></ul></ul><ul><ul><li>usually has some difficulty putting weight </li></ul></ul><ul><ul><li>some loss of function. </li></ul></ul><ul><ul><li>x-ray or MRI may be needed. </li></ul></ul><ul><li>Grade III Sprain : severe </li></ul><ul><ul><li>complete tear or rupture a ligament. </li></ul></ul><ul><ul><li>severe p ain, severe swelling, and bruising </li></ul></ul><ul><ul><li>unable to put weight </li></ul></ul><ul><ul><li>x-ray is usually taken to rule out a broken bone. </li></ul></ul><ul><ul><li>o ften requires immobilization and possibly surgery </li></ul></ul>
  27. 27. Treatment Back strain and sprain Step 1 Rest Step 2 <ul><li>Medications </li></ul><ul><ul><li>Analgesics </li></ul></ul><ul><ul><li>A nti-inflammatory medications </li></ul></ul><ul><ul><li>Muscle relaxing medications </li></ul></ul><ul><ul><li>Creams, ointments and salves </li></ul></ul>Step 3 Physical Therapy / Exercises Step 4 Further Evaluation x-rays or MRI , CT scan, bone scan, laboratory studies
  28. 28. Spine Fracture
  29. 29. Classification of Spine Fractures <ul><li>classification systems is based on the &quot;three-column&quot; theory </li></ul>(Modified from: Garfin S, Blair B, Eismont F, Abitbol J. Thoracic and upper lumbar spine injuries. In: Browner B, Jupiter JB, Levine A, Trafton P, editors. Skeletal trauma. 2nd ed. Philadelphia: W.B. Saunders Company; 1998. p 967--981.)
  30. 30. Spinal column <ul><li>The spine can be considered as a three-column structure. </li></ul><ul><li>(Modified from: Garfin S, Blair B, Eismont F, Abitbol J. Thoracic and upper lumbar spine injuries. In: Browner B, Jupiter JB, Levine A, Trafton P, editors. Skeletal trauma. 2nd ed. Philadelphia: W.B. Saunders Company; 1998. p 967--981.) </li></ul> 
  31. 31. Classification of Spine Fractures <ul><li>A. Compression fracture </li></ul><ul><li>B. Burst fracture </li></ul><ul><li>C. Flexion/distraction (Chance) fracture </li></ul><ul><li>D. Fracture-dislocation </li></ul>
  32. 32. <ul><li>Compression Fractures </li></ul><ul><ul><li>Injury to the anterior column </li></ul></ul><ul><ul><li>The most common types of fractures </li></ul></ul><ul><ul><li>Usually result from a fall </li></ul></ul><ul><ul><li>Usually stable </li></ul></ul><ul><ul><li>Rarely associated with neurologic problems </li></ul></ul>
  33. 33. Compression fracture = the downward compression of the superior endplate of the L3 = the anterior portion of the L3 vertebral body has been displaced forward
  34. 34. Compression fracture <ul><ul><li>compression fracture of the L1 vertebral body </li></ul></ul><ul><ul><li>a large fragment of bone projects into the spinal canal </li></ul></ul>
  35. 35. Axial burst fracture <ul><li>Injury to both the anterior and middle column with possible retropulsion of bone into the spinal canal results in a burst fracture </li></ul><ul><li>The vertebra loses height on both the front and back sides. </li></ul><ul><li>Usually occur through a violent compressive load </li></ul><ul><li>Often caused by a fall from a height when a person lands on their feet. </li></ul>
  36. 36. Burst fracture The posterior margin is displaced into the spinal canal
  37. 37. Flexion/distraction (Chance) fracture <ul><li>often caused by seat belts in cars. (the upper body is thrown forward while the pelvis is stabilized by a lap seat belt ) </li></ul><ul><li>all three columns of the vertebral body can fail and there may be injury to bone, ligaments and discs. </li></ul><ul><li>is unstable and required immediate stabilization of the body and medical attention. </li></ul>
  38. 38. Fracture-dislocation <ul><li>Injury to all three columns results </li></ul><ul><li>significant translation which helps to differentiate fracture--dislocations </li></ul><ul><li>This is an unstable injury </li></ul><ul><li>Involving bone and/or soft tissue, in which one vertebra may move off the adjacent one (displaced). </li></ul>
  39. 39. S ubluxation means Partial dislocation of a joint. A complete dislocation is a luxation C 5 /C 6
  40. 40. Treatment for spinal fracture <ul><li>Goals </li></ul><ul><ul><li>obtain a painless </li></ul></ul><ul><ul><li>balanced, stable spine with optimum neurologic function and maximum spine mobility. </li></ul></ul><ul><ul><li>the treatment method based upon the type of fracture and other factors. </li></ul></ul><ul><ul><li>Significant controversy exists about the best method to achieve these goals. </li></ul></ul>
  41. 41. Stable fracture
  42. 42. Unstable fracture loss of 50% of vertebral body height; angulation of thoracolumbar junction > 20  multiple adjacent compression frx; failure of 2/3 of columns of spine ALL SPINAL INJURIES ARE UNSTABLE UNTIL PROVED OTHERWISE
  43. 43. Nonsurgical Treatment <ul><li>Non-operative treatment is indicated for stable injuries without the potential for progressive deformity or neurologic injury </li></ul><ul><li>stable spine was able to protect cord from the forces of the original accident </li></ul><ul><li>compression fractures and some burst fractures can be treat without surgery. </li></ul><ul><li>may be required to wear a hyperextension brace for sitting and standing activities for 6 to 12 weeks. </li></ul><ul><li>should walk and do other exercises while healing </li></ul><ul><li>close monitoring for increased kyphosis </li></ul>
  44. 44. Surgical Treatment <ul><li>candidates for surgery </li></ul><ul><li>unstable, three-column injuries and significant neurologic deficits. </li></ul><ul><ul><li>fracture--dislocations, </li></ul></ul><ul><ul><li>flexion--distraction injuries, </li></ul></ul><ul><ul><li>burst fractures with neurologic deficit. </li></ul></ul><ul><ul><li>Neurologically intact patients with compression fractures and burst fractures that have greater than 50% loss of vertebral body height or greater than 30 degrees of kyphosis </li></ul></ul>
  45. 45. L spine fracture with surgical stabilization
  46. 46. L 2 compression burst fracture : posterior fusion with pedicle screws ( yellow arrow ) joined by a posterior bar ( white arrow ). The pedicle screws should be entirely within the bone of the body and pedicle of the vertebral bodies.
  47. 47. L 2 burst fracture. Pedicle screws have been placed in the L1, L2, and L3 (yellow arrows) vertebral bodies.
  48. 48. <ul><li>CT images of a fixation of the thoracic-lumbar junction. </li></ul><ul><li>A bone graft and fixation plate have been positioned across the T 11 -T 12 -L 1 levels. </li></ul>
  49. 49. <ul><li>a n acute compression fracture (arrow) </li></ul><ul><li>the loss of vertebral body height is less than 50% </li></ul><ul><li>considered for vertebroplasty </li></ul>
  50. 50. the lumbar spine during the performance of a vertebroplasty procedure
  51. 51. Spinal cord injury
  52. 52. Injury occurred <ul><li>by direct pressure from a fractured fragment of bone </li></ul><ul><li>by instability and abnormal motion of the vertebrae that can then narrow the spinal canal </li></ul><ul><li>by bleeding within the spinal canal </li></ul>
  53. 53. S igns and S ymptoms <ul><li>Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord </li></ul><ul><li>Loss of movement </li></ul><ul><li>Loss of sensation , including the ability to feel heat, cold and touch </li></ul><ul><li>Loss of bowel or bladder control </li></ul><ul><li>Exaggerated reflex activities or spasms </li></ul><ul><li>Changes in sexual function , sexual sensitivity and fertility </li></ul><ul><li>Difficulty breathing , coughing or clearing secretions from your lungs </li></ul>
  54. 54. Investigation <ul><li>X-rays </li></ul><ul><li>CT scan </li></ul><ul><li>MRI </li></ul><ul><li>Myelography </li></ul>
  55. 55. Treatment <ul><li>Medications </li></ul><ul><ul><li>Methylprednisolone within 8 hours of injury to reduc e damage to nerve cells and decreas e inflammation </li></ul></ul><ul><li>Immobilization </li></ul><ul><li>Surgery </li></ul><ul><ul><li>to remove fragments of bones, foreign objects that compressing the spine </li></ul></ul><ul><li>Rehabilitation </li></ul>
  56. 56. Disability depend on two factors <ul><li>The location of the injury </li></ul><ul><li>The severity of the injury </li></ul><ul><ul><li>partial spinal cord injury </li></ul></ul><ul><ul><ul><li>retain some sensation and </li></ul></ul></ul><ul><ul><ul><li>possibly some motor function </li></ul></ul></ul><ul><ul><ul><li>below the affected area. </li></ul></ul></ul><ul><ul><li>complete spinal cord injury </li></ul></ul><ul><ul><ul><li>total or near-total loss of motor function and sensation below the area of injury and unable to recovery </li></ul></ul></ul>
  57. 58. Immobilization aid Hard collar Taylor brace