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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Transcript 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.

Anatomy and Injuries to the
Spine
Adapted from Connie Rauser
Function of anatomy
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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
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Vertebrae
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7 cervical (flexion, extension, lateral
flexion, rotation)
1st-atlas
 2nd-axis
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12 thoracic (little movement)
5 lumbar (less flexion than extension,
some rotation
5 sacral (fused)
3-4 coccyx (fused)
Anatomy of spine
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Parts of vertebrae
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Spinous process
Transverse process
Body
Cervical vertebrae
Thoracic vertebra
Lumbar Vertebrae
Sacrum and coccyx
Posture
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Neutral spine
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Thoracic curve
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Normal alignment
Excessive--kyphosis
Lumbar curve
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Excessive--lordosis
Discs
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Fibrocartilaginous
Shock absorbers
Resist compression
Keep vertebrae separated
Allows movement & flexibility
Provides space for nerves to exit
No blood supply
Discs
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Nucleus pulposus
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Jelly-like core
Annulous fibrosus
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Cartilaginous outer
rings
Muscles
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Provide movement
& stability
Deep—erector
spinae
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Attach to vertebrae,
ribs, pelvis
3 groups (ERECTOR
SPINAE)
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Spinalis, iliocostalis,
longissimus
Muscles
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Abdominal muscles play big role in
stabilizing back
Trunk flexion, lateral flexion,
rotation
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Rectus abdominus
External oblique
Internal oblique
Transverse abdominus
Muscles
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Trapezius
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Sternocleidomastoid
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Lateral flexion,
rotation
Scalenes
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Upper portion aids in
cervical extension
Flexion of cervical
area
Multifidis
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Rotation of spine
Muscles
Nerves
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Each vertebrae has a nerve that
exits either below or above it
31 pairs of spinal nerves
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8 cervical nerves
12 thoracic nerves
5 lumbar
5 sacral
1 coccygeal
Spinal Cord
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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
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Brachial, lumbosacral
Brachial Plexus
Brachial Plexus
Lumbosacral plexus
Lumbosacral plexus
Dermatomes
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Area of body that has nerve
sensation for each nerve root
Dermatomes
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Cervical
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C4-shoulder
C5-lateral arm
C6-lateral forearm
C7-middle finger
C8-medial half of ring
finger & forearm
T1-medial arm
Dermatomes
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Thoracic
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At the level of the respective thoracic
vertebrae
Dermatomes
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Lumbar/Sacral
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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
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Area of the body that has motor
function
Myotomes
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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
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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
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Normal
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Slight curve at thoracic and lumbar
areas, ears in line w/ shoulders
Posture
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Problems
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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
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Preventing poor posture
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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
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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
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Learn to lift properly
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Maintain slight curve in lumbar spine
Lift with knees and hips (legs)
Keep head up
Keep your butt behind you!!!
Lumbar spine injuries
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Sprain
Strains
Fractures
Spinal Cord Injury
Dislocation
Disc injury
Lumbar Sprain
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MOI: forced into excessive trunk
flexion and rotation at some time
Posterior aspect of vertebral joints
separate and stretch ligaments
Lumbar Sprains
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S/S: localized pain to one
side of spine
Limited ROM
Pain
Spasms
Push each vertebra
anteriorly to attempt to
reproduce pain
Lumbar Sprains
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TX:
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RICE
After 48 hours—heat
Active rest
Maintain comfortable neutral spine
Stretching
Strengthening and stability exercises
Lumbar Strain
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Mild/moderate strains very common
MOI: same as for sprains
S/S:
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pain on one side
spasms
decreased ROM
pain moves up and down length of
muscles
Lumbar Strains
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TX:
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RICE
Gentle stretch
Heat
Strengthening
Flexibility
Fractures
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MOI:
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Severe compression
type force
Direct blow
Extreme flexion
Fractures
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S/S:
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Severe pain
Pt. Tender over vertebra, especially
spinous process
Muscle spasm
LOM
Possible tingling, numbness, etc.
Secondary Complication:
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Spinal Cord Involvement
Fractures
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TX:
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Be conservative
Call 911
Neurological exam
(dermatomes/myotomes)
Don’t move athlete
Spineboard prior to transport
Fractures
Disc Injury
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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
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MOI:
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Improper lifting
Poor posture
Poor body mechanics
(excessive flexion over
prolonged time frame)
Trauma due to direct fall
Disc
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S/S:
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Pain radiating down leg
Numbness
Tingling down leg
Increased pain with sitting/flexion
motion
Decreased/absence of reflex
Disc
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TX:
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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
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Similar to those in lumbar area
May have to treat differently due to
the increased mobility in that area
Cervical Sprains
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MOI: move beyond normal ROM
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Hyperextension or hyperflexion of neck
Whiplash type MOI
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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
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S/S:
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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
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TX:
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Check for nerve injury
Ice
Soft neck collar
Medical referral if severe
Traction
Stretching
strengthening
Cervical Strains
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MOI:
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S/S:
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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
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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
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S/S:
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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
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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
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TX:
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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
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Decerebrate vs. Decorticate Posturing
Decerebrate
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The worse of the two posturings
Disruption of nerve pathway
between brain and spinal cord
Decorticate
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Damage to nerve pathway between
brain and spinal cord
May occur on one or both sides of
the body
Spine Boarding
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Observation: ( On the way to athlete)
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If athlete is unconscious ALWAYS assume
spinal injury.
Arrival and Primary Survey
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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
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Spine Boarding Continued
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If unconscious: Look, listen and feel
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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
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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.
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Reasons not to
move neck:
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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
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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
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Also called
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Burner
Stinger
Brachial Plexus Nerve Injury
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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
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TX:
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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