Anatomy and Injuries to the Spine Adapted from Connie Rauser Function of anatomy Protects spinal cord Holds body upright Site for muscle & ligament attachment (support.
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Anatomy and Injuries to the Spine Adapted from Connie Rauser Function of anatomy Protects spinal cord Holds body upright Site for muscle & ligament attachment (support spine) Discs provide shock absorption Nerves provide sensation and motor function Bony anatomy Vertebrae 7 cervical (flexion, extension, lateral flexion, rotation) 1st-atlas 2nd-axis 12 thoracic (little movement) 5 lumbar (less flexion than extension, some rotation 5 sacral (fused) 3-4 coccyx (fused) Anatomy of spine Parts of vertebrae Spinous process Transverse process Body Cervical vertebrae Thoracic vertebra Lumbar Vertebrae Sacrum and coccyx Posture Neutral spine Thoracic curve Normal alignment Excessive--kyphosis Lumbar curve Excessive--lordosis Discs Fibrocartilaginous Shock absorbers Resist compression Keep vertebrae separated Allows movement & flexibility Provides space for nerves to exit No blood supply Discs Nucleus pulposus Jelly-like core Annulous fibrosus Cartilaginous outer rings Muscles Provide movement & stability Deep—erector spinae Attach to vertebrae, ribs, pelvis 3 groups (ERECTOR SPINAE) Spinalis, iliocostalis, longissimus Muscles Abdominal muscles play big role in stabilizing back Trunk flexion, lateral flexion, rotation Rectus abdominus External oblique Internal oblique Transverse abdominus Muscles Trapezius Sternocleidomastoid Lateral flexion, rotation Scalenes Upper portion aids in cervical extension Flexion of cervical area Multifidis Rotation of spine Muscles Nerves Each vertebrae has a nerve that exits either below or above it 31 pairs of spinal nerves 8 cervical nerves 12 thoracic nerves 5 lumbar 5 sacral 1 coccygeal Spinal Cord Part of the CNS along with brain Contained within vertebral canal Extends from cranium to 1st-2nd lumbar vertebrae Lumbar roots & sacral nerves for a “horse-like tail” called cauda equina 2 plexuses Brachial, lumbosacral Brachial Plexus Brachial Plexus Lumbosacral plexus Lumbosacral plexus Dermatomes Area of body that has nerve sensation for each nerve root Dermatomes Cervical C4-shoulder C5-lateral arm C6-lateral forearm C7-middle finger C8-medial half of ring finger & forearm T1-medial arm Dermatomes Thoracic At the level of the respective thoracic vertebrae Dermatomes Lumbar/Sacral L1-upper anterior thigh L2-middle anterior thigh L3-lower anterior thigh L4-medial side of leg L5-lateral side of leg, dorsum of foot S1,2-lateral malleolus, plantar surface of foot S2,3,4-nerve supply for bladder, intrinsic muscles of toes Myotomes Area of the body that has motor function Myotomes C5-deltoid—shoulder abduction C5-6-biceps—elbow Flexion C6-wrist extensors—extension C7-triceps & wrist/finger flexors— elbow extension, wrist/finger flexion C8-finger flexors—finger flexion T1-finger Abductors--abduction Myotomes L1,2,3-iliopsoas—hip flexion L2,3,4-Quads—knee extension L4-tibialis anterior— dorsiflexion/inversion at ankle L5-Extensor hallicus longus, extensor digitorum longus/brevis, extension/inversion at ankle S1-peroneus longus/brevis-eversion S1,2-gastroc/soleus—plantar flexion Posture Normal Slight curve at thoracic and lumbar areas, ears in line w/ shoulders Posture Problems Forward head position-ears in front of line with shoulder Kyphosis-excessive curve of thoracic spine Lordosis-excessive curve of lumbar spine Scoliosis-lateral curve of spine Posture Preventing poor posture Don’t be lazy Walk and stand as if something is pulling you up straight Carry bags/backpacks on both shoulders/alternate Carry bags at small of back (lumbar area) Prevention of Injuries Most injuries to cervical/lumbar area Maintain adequate strength and flexibility of hip flexors and back Maintain strong abdominals/core strength Work on proper posture Prevention Learn to lift properly Maintain slight curve in lumbar spine Lift with knees and hips (legs) Keep head up Keep your butt behind you!!! Lumbar spine injuries Sprain Strains Fractures Spinal Cord Injury Dislocation Disc injury Lumbar Sprain MOI: forced into excessive trunk flexion and rotation at some time Posterior aspect of vertebral joints separate and stretch ligaments Lumbar Sprains S/S: localized pain to one side of spine Limited ROM Pain Spasms Push each vertebra anteriorly to attempt to reproduce pain Lumbar Sprains TX: RICE After 48 hours—heat Active rest Maintain comfortable neutral spine Stretching Strengthening and stability exercises Lumbar Strain Mild/moderate strains very common MOI: same as for sprains S/S: pain on one side spasms decreased ROM pain moves up and down length of muscles Lumbar Strains TX: RICE Gentle stretch Heat Strengthening Flexibility Fractures MOI: Severe compression type force Direct blow Extreme flexion Fractures S/S: Severe pain Pt. Tender over vertebra, especially spinous process Muscle spasm LOM Possible tingling, numbness, etc. Secondary Complication: Spinal Cord Involvement Fractures TX: Be conservative Call 911 Neurological exam (dermatomes/myotomes) Don’t move athlete Spineboard prior to transport Fractures Disc Injury Common in older people but not so much in younger athletes. Referred to as “slipped” disc Nucleus pulposus pushes through rings of annulous fibrosus causing a “bulge” which can lead to herniation Most are posterior to one side Pressure exerted on nerve root Disc Injury MOI: Improper lifting Poor posture Poor body mechanics (excessive flexion over prolonged time frame) Trauma due to direct fall Disc S/S: Pain radiating down leg Numbness Tingling down leg Increased pain with sitting/flexion motion Decreased/absence of reflex Disc TX: Active rest Work on posture Extension exercises Proper mechanics Core stability—especially lumbar area Traction Surgery if rehabilitation doesn’t work Herniated disc Disc injury Lumbar traction Cervical Injuries Similar to those in lumbar area May have to treat differently due to the increased mobility in that area Cervical Sprains MOI: move beyond normal ROM Hyperextension or hyperflexion of neck Whiplash type MOI Body forced forward by the blow while the head moves backwards, placing the cervical spine into extension stretching the ligaments & muscles at front of neck. When body stops head snaps forward stretching the posterior ligaments & muscles of neck Cervical Sprain Sprains S/S: Neck and arm pain Pain between scapula Possible numbness or tingling Decreased ROM due to Pain Pt. Tender over the cervical area, usually localized Cervical Sprain Sprains TX: Check for nerve injury Ice Soft neck collar Medical referral if severe Traction Stretching strengthening Cervical Strains MOI: S/S: Whiplash type –same as for sprains Muscle spasms, Decreased ROM, Muscle weakness, pain along the muscle, Pt. Tender over muscles TX: same as for sprains Return to Activity: No symptoms, full ROM & strength, Dr. release Cervical Strain Cervical sprains/strains Cervical Traction Cervical Fractures/Dislocations Can result in permanent disability/death MOI: axial loading—neck flexion with force to top of head (fracture) or flexion w/ rotation (dislocation) Cervical Fx Cervical FX/Dislocations S/S: Pain & Pt. Tender over cervical spine Numbness and/or tingling down arms Muscle weakness Loss of motion Visible deformity possible (esp. w/ dislocation) but may not see it due to equipment worn Situations in Which Cervical Spine Injury Should be Suspected Neck pain or stiffness Cervical muscle spasm Asymmetrical or Abnormal head position Respiratory difficulty (chest not moving) Unconsciousness Numbness, tingling, burning Muscle weakness or paralysis Loss of bowel or bladder control Cervical Fx/Dislocation Cervical Fx Cervical Fx/Dislocations TX: Rule out life-threatening situations Call 911 Stabilize/immobilize head/neck If in helmet/shoulder pads, leave those in place Monitor athlete/treat for shock Spinal Cord Injury Decerebrate vs. Decorticate Posturing Decerebrate The worse of the two posturings Disruption of nerve pathway between brain and spinal cord Decorticate Damage to nerve pathway between brain and spinal cord May occur on one or both sides of the body Spine Boarding Observation: ( On the way to athlete) If athlete is unconscious ALWAYS assume spinal injury. Arrival and Primary Survey Stabilize head and neck Check for level of consciousness If unconscious call 911 If conscious and able to communicate signs/symptoms of neck injury call 911 Spine Boarding Continued If unconscious: Look, listen and feel If not breathing either you (if alone) or another member of medical use pocket mask or remove face mask and begin rescue breathing/CPR If breathing continue to maintain stabilization and assess athlete Spine boarding continued If athlete is supine with neck turned to side, maintain stabilization and rotate head in align with neck. If athlete is able to communicate, if movement increases symptoms STOP. Reasons not to move neck: Increased pain Neurological symptoms Muscle spasm Airway compromise If it is physically difficult to reposition the spine Resistance is encountered Patient expresses apprehension Disc injury Not as common as in lumbar area MOI: overuse/previous injury S/S: pain with sitting/flexing neck down back between scapulae, weakness in arms, tingling, numbness TX: Improve neck posture, traction, strengthening, stretching, possible surgery Brachial Plexus Nerve Injury Also called Burner Stinger Brachial Plexus Nerve Injury MOI: head forced to one side & shoulder depressed (they are spread apart) stretching brachial plexus S/S: tingling, burning, numbness down arm that lasts for a few seconds to minutes, muscle weakness in any/all muscles of upper extremity Brachial Plexus Nerve injury TX: Ice Neck collar Physician referral if necessary Strengthening ROM exercises Return to activity when symptom free, full strength, full ROM of neck and shoulders Brachial Plexus Nerve injury