Spinal/Catastrophic Injuries

Cards (27)

  • MOI of Catastrophic Neck Injuries
    Axial loading (with flexion = lost of lordosis – decreased capacity to absorb shock) Spearing: illegal in football since 1976 led to huge decrease in catastrophic injuries
  • Red flags for possible spinal injury
    • Pain over spinous process, with or without deformity
    • Unrelenting neck, back or muscle spasm
    • Abnormal sensation in the head, neck, trunk, or extremities
    • Muscular weakness in the extremities
    • Paralysis or inability to move a body part
    • Absent or weak reflexes
    • Loss of bladder or bowel control
  • Cervical sprains
    MOI: Occurs at extremes of motion or in association with violent muscle contraction or external force
    Can occur to major (ex: ligamentum flavum) or capsular ligaments surrounding facet joint
  • Cervical strains
    Usually upper trap or SCM. Same MOI as sprains. Both injuries often occur at the same time
  • Acute burners (stingers)
    Definition: damage to brachial plexus.
    MOI: shoulder depression & contralateral neck lateral flexion or by compression over Erb's point
    S/s: immediate, severe, burning pain down the arm + tingling and numbness (transient); evident muscle weakness in shoulder abduction and external rotation (C5-C6 nerve roots)
  • Sensory function upper extremity nerves
    • Suprascapular n: supra and infraspinatus
    • Musculocutaneous n: coracobrachialis, biceps, brachialis
    • Axillary n: Deltoid
  • Levels of burners
    • Level 1 (Neuropraxia): localized conduction block that causes temporary loss of sensation and/or motor function from demyelination without axonal disruption
    • Level 2 (Axonotmesis): significant motor and sensory deficit >2 weeks. Disruption of the axon leaving the epineurium intact. Axonal regrowth: 1-2mm/ day
    • Level 3 (Neurotmesis): disruption of the endoneurium, motor and sensory deficit > 1 year. Poor prognosis. Surgery might be necessary to avoid imperfect regeneration.
  • Chronic burners
    Characterized by more frequent acute episodes that may not produced numbness. Delayed onset muscle weakness (days later). May lead to muscle atrophy of the shoulder
  • Low back pain (LBP)
    80% of population will have LBP. Lumbar spine supports the weight of the trunk, upper extremities and head. Flexion/extension mostly at L4-L5, L5-S1
  • Sciatica
    Inflammatory condition of the sciatic nerve. Impingement within the piriformis muscles or from lumbar disc pathology. s/s pain with sitting and leaning forward (herniated disc), or with internal rotation of hip (piriformis syndrome). Pain going down the back of the leg
  • Lumbar disc conditions
    • Degeneration
    • Prolapsed disc
    • Extruded disc
    • Sequestrated disc
  • Lumbar disc conditions
    MOI: prolonged mechanical loading of the spine can lead to microrupture in the annulus fibrosus, resulting in degeneration of the disc. Flexion + rotation. Most common L4-L5, L5-S1 in a posterior or postero-lateral direction
  • Lumbar disc conditions
    s/s: disc are not innervated. Pain only occurs when inflammation reaches surrounding tissue or causes pinching of the spinal nerves. Impaired myotomes and dermatomes. Sacral nerves damage: incontinence= emergency. Need to refer to neurosurgeon
  • Non-pathogenic pain

    Neck, upper, or lower back pain not caused by quantifiable structural damage. Typically a result of prolonged poor posture, muscle imbalances, muscle tension and may be exacerbated by other biopsychosocial factors (stress, anxiety, lifestyle, sleep).
  • Effect of poor posture on cervical musculature
    Leads to shorten muscles (structural changes)pulling on the structures of the head and spine.
  • General causes of chronic (non-traumatic) LBP
    • Shortened muscles that attach on spine or pelvis
    • Decrease strength/endurance
    • Poor core stability
    • Overweight individuals
    • Improper technique (lifting)
    • Prolonged sitting with poor postural habits
    • Poor posture
  • General tx of neck and back pain
    • Find the cause
    • Education
    • Sleep position
    • Avoid prolonged position
    • Lifting techniques
    • Stress and anxiety strategies
    • Minimize risk of kinesiophobia
    • Strengthening and endurance
    • Posture
    • Soft tissue release (trigger points, massage)
    • Overall health
  • Red flags for thoracic injuries
    Emergency if: MOI consistent with serious trauma to thorax and: Shortness of breath or difficulty breathing, Anxiety, fear, confusion, or restlessness, Distended neck veins, Bulging or bloodshot eyes, Suspected rib(yellow flag) or sternal fx, Severe chest pain aggravated by deep inspiration, Abnormal chest movement on one side, Coughing up blood, Abnormal or absent breath sounds, Rapid, weak pulse, Low blood pressure, Cyanosis
  • Rib fracture
    MOI: violent muscle contraction or direct blow. Forces applied in anteroposterior plane leading to fracture of the posterior angle of the fifth to ninth rib. Can be associated with lung, kidney, spleen rupture
  • Pneumothorax
    Def: air is trapped in pleural space (punctured lung) from rib fx, severe chest trauma. Air can get in during inspiration but can't get out during expiration, impeding the lung to expand to its full volume. Becomes tension pneumothorax when Shift mediastinum to the opposite side and the air compresses heart and uninjured lung.
  • Commotio cordis
    Ventricular fibrillation of the heart caused by direct blow to chest cavities. Leading traumatic cause of death in youth baseball. Best survival rate if AED is applied within 1 min. Goes down significantly if longer than 2 min. Low survival chance if greater than 4 min.
  • Solar (celiac) plexus impact
    Having the wind knocked out of you. MOI: blow to abdomen with all muscles relaxed leading to inability to catch one's breath (dyspnea). Thought to be caused by spasm to the diaphragm and transient contusion to the celiac plexus
  • Splenic rupture
    Increase chance if following mononucleosis (NO RTP for at least 1 month following illness).
    Most commonly injured abdominal organ and most common cause of death from abdominal blunt trauma. The reason is the spleen can heal itself only to produce delayed hemorrhage days, week, or months later (from coughing!!).
    s/s: Kehr's sign (referred pain to left shoulder), dull pain in upper left quadrant
  • Liver contusion or rupture
    MOI: direct blow to upper right quadrant. s/s: referred pain to lower angle of right scapula
  • Kidney contusion

    MOI: direct blow.
    S/s: LBP, hematuria
  • General assessment
    • Vital signs (pulse, breathing, skin colour & temperature, blood pressure)
    • Palpation: tenderness, rebound tenderness, rigidity
    • Ribs compression
    • Inspection of the neck, veins, & trachea
  • Treatment abdominal injuries

    If you suspect a major internal bleed, call 911
    If a spinal injury is not suspected, you can put something under the knees to relieve tension from the abdominals
    If blood while coughing, vomiting, or in their urine or feces, they should go to the emergency ASAP. If no symptoms after a hit in the abdomen, educate them about what to look for and what to do (ER).