11 cervical spine tkingman.ppt - office of continuing...
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Cervical Spine Injuries and Neck Pain
Cervical Spine Injuries and Neck Pain
Thomas A. Kingman, M.D.Thomas A. Kingman, M.D.
Cervical Spine Injuries andNeck Pain
Cervical Spine Injuries andNeck Pain
Common problem
Potentially very serious
Injuries may involve multiple structures:• Ligaments, disks, muscle, bone, facet
joints, spinal cord, or nerve roots
Common problem
Potentially very serious
Injuries may involve multiple structures:• Ligaments, disks, muscle, bone, facet
joints, spinal cord, or nerve roots
Cervical SpineCervical Spine
AnatomyAnatomy
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Physical ExamPhysical Exam
C5 Neurologic LevelC5 Neurologic LevelMotorMotor
ReflexReflex
SensationSensation
C5
Deltoid Triceps
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C6 Neurologic LevelC6 Neurologic LevelMotorMotor
ReflexReflex
SensationSensation
C6
Biceps Wrist Extensors
C7 Neurologic LevelC7 Neurologic LevelMotorMotor
ReflexReflex
SensationSensation
C7
Triceps
Wrist Flexors
Finger Extensors
C8 Neurologic LevelC8 Neurologic LevelMotorMotor
Reflex--NoneReflex--None
SensationSensation
C8
Interosseous Muscles Finger Flexors
T1 Neurologic LevelT1 Neurologic LevelMotorMotor
SensationSensation
T1
Reflex--NoneReflex--None
Interosseous Muscles
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Acute InjuriesAcute Injuries
Severe Injuries
Fractures and Dislocations
Severe Injuries
Fractures and Dislocations
Cervical Spine InjuriesUnconscious Patient
Cervical Spine InjuriesUnconscious Patient
Very serious problem Always assume a cervical spine injury Follow spine injury protocol with head and neck support, log roll, and back board
Very serious problem Always assume a cervical spine injury Follow spine injury protocol with head and neck support, log roll, and back board
Cervical Spine InjuriesMechanism of Injury
Cervical Spine InjuriesMechanism of Injury
Axial loading
National Football Head and Neck Injury Registry Formed in 1975
Data led to rule changes: Banning spearing
No head first contact
Axial loading
National Football Head and Neck Injury Registry Formed in 1975
Data led to rule changes: Banning spearing
No head first contact
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Cervical Spine InjuriesFractures and Dislocations
Cervical Spine InjuriesFractures and Dislocations
Dislocations or subluxations: Can be mild or severe, may be associated with
fractures
Involve serious ligament and soft tissue injuries with potential instability
Facet dislocations or jumped facets are very serious
Neurological risk, careful neurological exam
Many will need surgical treatment
Dislocations or subluxations: Can be mild or severe, may be associated with
fractures
Involve serious ligament and soft tissue injuries with potential instability
Facet dislocations or jumped facets are very serious
Neurological risk, careful neurological exam
Many will need surgical treatment
Cervical Spine InjuriesFractures and Dislocations
Cervical Spine InjuriesFractures and Dislocations
Fractures: May involve vertebral body, lamina, facet joint,
or spinous process
Can be mild or very severe
Fracture and dislocation combination usually is the worst case scenario
Neurological risk, careful neurological exam
Many may need surgical treatment
Fractures: May involve vertebral body, lamina, facet joint,
or spinous process
Can be mild or very severe
Fracture and dislocation combination usually is the worst case scenario
Neurological risk, careful neurological exam
Many may need surgical treatment
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General Types of InjuriesCervical Sprain
General Types of InjuriesCervical Sprain
Common injury Ligament, muscle, soft tissue injury Localized neck pain, stiffness No numbness or weakness Treatment: rehab. Return to play: normal ROM
Common injury Ligament, muscle, soft tissue injury Localized neck pain, stiffness No numbness or weakness Treatment: rehab. Return to play: normal ROM
General Types of InjuriesCervical Disk Injuries
General Types of InjuriesCervical Disk Injuries
May include tears or herniations
Radicular pain and/or numbness, weakness
Persistent symptoms
Treatment varies, depends on severity: rehab, medications, injections, or surgery
May include tears or herniations
Radicular pain and/or numbness, weakness
Persistent symptoms
Treatment varies, depends on severity: rehab, medications, injections, or surgery
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Cervical HNPGeneral Types of Injuries
Nerve Root/Brachial PlexusNeuropraxia
General Types of InjuriesNerve Root/Brachial Plexus
Neuropraxia
Burner or stinger Temporary weakness and numbness Cervical nerve root compression (C6) Stretch injury Return to play only when symptoms are COMPLETELY resolved Best prevention is in good shoulder pads
Burner or stinger Temporary weakness and numbness Cervical nerve root compression (C6) Stretch injury Return to play only when symptoms are COMPLETELY resolved Best prevention is in good shoulder pads
General Types of InjuriesCervical Cord NeuropraxiaGeneral Types of Injuries
Cervical Cord Neuropraxia
Rare severe condition
Symptoms usually bilateral or involving the lower extremities, transient quadriplegia
On severe cases may last over one week
Needs evaluation with MRI and frequent neurological examinations
Treatment based on severity and MRI findings
Rare severe condition
Symptoms usually bilateral or involving the lower extremities, transient quadriplegia
On severe cases may last over one week
Needs evaluation with MRI and frequent neurological examinations
Treatment based on severity and MRI findings
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