- A bursa is a fluid-filled sac that acts as a cushion between bones, muscles, and ligaments near joints. Injury to a bursa can cause pain, limited motion, and decreased mobility. - The cervical vertebrae are the smallest and most movable part of the spine. Injuries can occur from direct or indirect trauma and include fractures, dislocations, and ligament injuries. - Treatment depends on the injury but may include immobilization, traction, steroids, and surgery to stabilize or fuse the spine to preserve neurological function and spinal stability.

1. Bursa/Bursae
• A bursa is a small, fluid-filled sac within your
body that lies near bony prominences and
joints. The bursa acts as a cushion between
muscles, ligaments, and bones and allows
structures to glide and slide past one another
with ease and with minimal friction. Injury to
a bursa may cause pain, limited motion, and
decreased functional mobility.

2. Types of bursa
• Synovial. Near the synovial membrane of the
joints
• Adventitious. The accidental bursa occur only
after continued shearing or repeated pressure
over a bony prominence. A bunion is an
example of an adventitious bursa.
• Subcutaneous. These bursae lie between your
skin and a bony prominence

3. • pre-patellar bursa
• trochanteric bursa
• olecranon bursa

4. • Bursitis
• Calcification of a bursa
• Infection

5. Treatment
• Physiotherapy
• Medications
• Surgery

6. Cervical spine injuries and its
management

7. • The cervical vertebrae are the smallest of the
moveable vertebrae, and are characterized by
a foramen in each transverse process.

10. • Readily identified by the foramen
transversarium perforating the transverse
processes. This foramen transmits the
vertebral artery, the vein,and sympathetic
nerve fibres
• Spines are small and bifid (except C1,C7 which
are single)
• Articular facets are relatively horizontal

11. • Nodding and lateral flexion movements occur
at the atlanto-occipital joint
• Rotation of the skull occurs at the atlanto-
axial joint around the dens, which acts as a
pivot

12. MECHANISM OF INJURY
• Traction injury
• Direct injury
• Indirect injury
– axial compression flexion
– lateral compression
– flexion-rotation
– Shear
– flexion-distraction
– Extension
• Insufficiency fractures

14. PRINCIPLES OF DIAGNOSIS AND
INITIAL MANAGEMENT
• Diagnosis and management go hand in hand
• Inappropriate movement and examination can
irretrievably change the outcome for the worse
• Early management
• – Airway, Breathing and Circulation
• – Slightest possibility of a spinal injury in a
trauma patient, the spine must be immobilized
until the patient has been resuscitated and other
life-threatening injuries have been identified and
treated.

15. • A stable injury is one in which the vertebral
components will not be displaced by normal
movements;
• In a stable injury, if the neural elements are
undamaged there is little risk of them becoming
damaged.
• An unstable injury is one in which there is a
significant risk of displacement and consequent
damage – or further damage – to the neural
tissues.

16. RADIOLOGY
• X Ray
• Lateral view
• AP View
• Odontoid View
• MRI

17. TREATMENT
• HARD COLLAR IMMOBILIZATION FOR 12
WEEKS AND AVOIDANCE OF FLEX/EXT
ACTIVITIES FOR ANOTHER 12 WEEKS HAS NOT
BEEN ASSOCIATED WITH RECURRENT INJURY

18. PRINCIPLES OF DEFINITIVE
TREATMENT
The objectives of treatment are:
• to preserve neurological function;
• to minimize a perceived threat of neurological
compression;
• to stabilize the spine;
• to rehabilitate the patient

19. The indications for urgent surgical
stabilization
• (a) an unstable fracture with progressive
neurological deficit and MRI signs of likely
further neurological deterioration; and •
• (b) controversially an unstable fracture in a
patient with multiple injuries

20. Initial Treatment
• Immobilization
Rigid cervical collor (philadelphia collor)
Poster braces
Cervico thoracic arthrosis
Halo device
• In unstable injury this is inadequate, cervical
traction required
– Skin (glisson’ traction)
– Skeletal • halo traction or gardner-wells tongs
Crutchfield tongs

22. Pharmacological
• steroids
suppress inflammatory response and
vasogenic edema

23.  • Occipital condyle fracture:
• • This is usually a high-energy fracture and associated
skull or cervical spine injuries must be sought.
• • The diagnosis is likely to be missed on plain x-ray
examination and CT is essential.
• • Impacted and undisplaced fractures can be treated
by brace immobilization for 8–12 weeks.
• Displaced fractures are best managed by using a halo
vest or by operative fixation.

24. Occipito-cervical dislocation:
• • This high-energy injury is almost always
associated with other serious bone and/or
soft-tissue injuries, including arterial and
pharyngeal disruption, and the outcome is
often fatal.
• • Patients are best dealt with by a
multidisciplinary team of surgeons and
physicians.

25. • Diagnosis
X Ray
CT
MRI

26. • The injury is likely to be unstable and requires
immediate reduction (without traction!) and
stabilization with a halo-vest, pending surgical
treatment.
• After appropriate attention to the more serious soft
tissue injuries and general resuscitation, the dislocation
should be internally fixed;
• specially designed occipito-cervical plates and screws
are available for the purpose.
• In severely unstable injuries, halo-vest stabilization
should be retained for another 6–8 weeks.

27. • Posterior ligament injury
if it is certain that the injury is stable, a
semirigid collar for 6 weeks is adequate;
• • if the injury is unstable then posterior
fixation and fusion is advisable

28. • Wedge compression fracture
A pure flexion injury results in a wedge
compression fracture of the vertebral body •
The middle and posterior elements remain
intact and the injury is stable.
• • All that is needed is a comfortable collar for
6– 12 weeks.

29. SPRAINED NECK (WHIPLASH INJURY)
• Soft-tissue sprains of the neck are so common
aftermotor vehicle accidents.
• There is usually a history of a low velocity rear-
end collision in which the occupant’s body is
forced against the car seat while his or her head
flips backwards and then recoils in flexion.
• This mechanism has generated the imaginative
term whiplash injury, which has served effectively
to enhance public apprehension at its occurrence

30. • Women are affected more often than men

32. Clinical features
• Often the victim is unaware
• Pain and stiffness of the neck
• Pain sometimes radiates to the shoulders or
interscapular area
• Neck muscles are tender and movements
often restricted;

33. • X-ray examination may show straightening out
of the normal cervical lordosis, a sign of
muscle spasm

34. • Proposed grading of whiplash-associated
injuries
• Grade Clinical pattern
• 0 No neck symptoms or signs
• 1 Neck pain, stiffness and tenderness, No physical
signs
• 2 Neck symptoms and musculoskeletal signs
• 3 Neck symptoms and neurological signs
• 4 Neck symptoms and fracture or dislocation

35. Treatment
• • Collars are more likely to hinder than help recovery.
• • Simple pain-relieving measures, including analgesic
medication, may be needed during the first few weeks.
• However, the emphasis should be on graded
exercises,
• • beginning with isometric muscle contractions and
postural adjustments, then going on gradually to active
movements and lastly movements against resistance.
• • The range of movement in each direction is slowly
increased without subjecting the patient to
unnecessary pain.