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The Spine

Axial load w/ degree of cerv flex, neck pt tenderness, restricted ROM, cerv pn/spasm, chest/extremity pn, numbness/weakness in trunk and/or limbs, loss of bladder/bowel control Cervical Fracture
Usually result of violent cerv flex & rotation of head, considerable pn, numbness, weakness, paralysis, head tilted toward dislocated side/ muscle tightness on elongated side Cervical Dislocation (more likely to cause spinal cord injury than fracture)
Sudden turn of head, forced flex,ext, or rot, involves UTs, scalenes, solenoid capitis, & cervicis; localized pn & point tenderness, restricted ROM, reluctant to move neck Acute Strains on Neck & Upper Back
Same mechanism as strain but more violent, snapping of head & neck, s & s same as strain but last longer, pain arises day after trauma (muscle spasm) Cervical Sprain (Whiplash)
Pn on one side of neck upon wakening, result of sunovial capsule impingement w/in facet, palpable point tenderness & muscle spasm, restricted ROM, muscle guarding Acute Torticollis (Wryneck)
Caused by lacerations, hemorrhage, Contusion, neuropraxia & shock; various degrees of motor/sensory paralysis (level of injury), above C3 = death, below C4 = some return of nerve root func Cervical Cord & Nerve Root Injuries
Syndrome w/ narrowing of cerv spinal canal that impinges on spinal cord, cogenital cond or changes in vertebrae - bony outgrowth (bone spurs, osteophytes, or disk bulges) Cervical Spine Stenosis
Stretching/compression of brachial plexus, disrupts peripheral nerve func w/out degenerative changes, transient quadriplegia may occur from axial load/hyperflex/hyperext, neck pn absent initially, sensory/motor deficits recover in 10-15mins Brachial Plexus Neurapraxia (Burner/Stinger)
Herniation from extruded posterateral disk fragment/degeneration, sustained rep cerv loading; neck pn w/ some restricted ROM, UE radicular pn & motor weakness Cervical Disk Injuries
Middle section of the disk (“jelly”) Nucleus Pulposus
Outer ring of the disk Annulus Fibrosus
Wedge fractures of 5° or greater in 3 or more consecutive vertebrae w/ disk abnormalities/irregular endplates; kyphosis, lordosis w/out pain, point tenderness at spinous process, tight HS, young athlete w/ back pn at end of active day Scheurmann’s Disease (Dorsolumbar Kyphosis)
Cogential anomalies, mechanical deficits of spine, back trauma, can be chronic Low Back Pain
Compression fracture (trunk hyperflex or falling) or fracture of spinous/transverse processes (direct blow), dislocations rare Lumbar Vertebrae Fracture & Dislocation
Sudden ext contraction overload (generally w/ some rotation), chronic comes from posture & mechanics, pn may be diffuse or localized, pn w/ active ext & passive flex, no radiating pn in butt (no neural component) Low Back Muscle Strain
Erector Spinae Muscles Iliocostalis, longissimus, & spinalis
Nerve root compression from intervertebral disk protrusion, structural irregularities w/ vert foramina, tight piriformis; arises abruptly or gradually, sharp/shooting pn, tingling/numbness, sensitive to palpation, SLR increases pn Sciatica
Caused by abnormal stresses & degeneration due to fwd bending & twisting; centrally located pn radiates laterally, worse in morning, fwd bending/sitting increase pn, ext reduces pn, SLR to 30° is painful, decreased muscle strength & tendon reflexes, vals Herniated Disk
3 Types of Herniated Disks Prolapsed (nuc pro pushing on ann fib), extruded (piece of nuc pro is dislodged), sequestrated (ann fib torn & nuc pro leaking out)
Degeneration of vert due to congenital weakness (stress fracture results), begins unilaterally, extension, pars Spondylolysis
Slipping of one vert above or below, anterior slippage usually, “Scotty Dog” Spondylolisthesis (often associated w/ spondylolysis)
Pain & persistent aching, low back stiffness with increased pn after activity, frequent need to change position, full ROM (hesitant to flex), localized tenderness, possible segmental hyper mobility, step off deformity may be present Signs & Symptoms of Spondy’s
Twisting w/ both feet in ground, stumble fwd, fall bwd, step too far down, heavy landing on one leg, bend fwd with knees locked while lifting, irritate & stretch sacrotuberous or sacrospinous ligs, ant or post rot Etiology of SI Joint Dysfunction/Sprain
Palpable pn & tenderness over jt (medial to PSIS w/ muscle guarding), pn may radiate post, lat, or ant down thigh/groin, unilateral stance increases pn, pn with sit to stand, sitting uncomfortable S & S of SI Joint Dysfunction/Sprain
Result of direct impact by sitting, falling, or being kicked, pn prolonged/ maybe chronic, may cause irritation to coccygeal plexus, x-ray or reveal exam may be required, relieve pressure w/ analgesics or ring seat Coccyx Injuries
Created by: natamccl