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Cervical Spine injury, image - Coggle Diagram
Cervical Spine injury
Cervical Postural Syndrome
Posture
Protracted chin
Increased upper cervical lordosis
Stiff thoracic kyphosis
Rounded shoulders
Tight pectorals
Forward carriage of head
Signs and Symptoms
Burning pain across shoulders and neck
Headaches
Hypomobility of lower cervical spine
Weak neck flexor muscles, serratus anterior, mid/lower traps & rhomboids
Neural tension
Tender myofascial trigger points in levator scapula, trapezius, rhomboids.
Treatment
Education
Postural retraining
Ergonomic correction
Strengthening of postural muscles (esp.
neck flexor muscles
serratus anterior
mid/lower traps
rhomboids
Defects & Abnormalities Secondary to Trauma or Repetitive Stress(OSTEOPHYTES/BONE SPURS)
Mechanism
Occur secondary to degenerative changes
Commonly found posterolaterally, but also found anteriorly
S&S:
↓ ROM,
Postural changes
Neck discomfort
Neurological symptoms
Treatment
Surgery to remove
Initial phase: modalities to ↓ pain
Increase ROM, strength & stability
SPINAL STENOSIS
More common in older adults
Characterized by congenital narrowing of the CS canal
Increased risk of spinal cord compression
Mechanism
Degenerative changes
Possible herniation of disc = pressure on the nerves
Thickened spinal ligaments
Osteophytes
Less common causes: congenital abnormalities, trauma, injury to neck, tumor, infection, calcification of ligaments
S&S
Pain
Stiffness
Numbness
Weakness in the neck, arms, and legs
Poor control of bowels and bladder
Management
X-rays: show narrowing of space between vertebral bodies, or bone spurs
MRI: show condition of intervertebral disc, ligaments, spinal cord & nerves
Conservative treatment: stretching & strengthening
OTC medications
Lifestyle modifications
Acute flare-ups: oral steroids, anesthetic injections
Severe cases: surgery
Removing bone or portion of herniated disc
Fusion with metal rods and screws (laminectomy)
Nerve Root Injuries & Compression Syndromes
INTERVERTEBRAL DISC HERNIATION
Bulging of the nucleus pulposus against or through the annulus fibrosis can apply pressure to a spinal nerve where it exits the vertebral column through the intervertebral foramen
Cervical levels most commonly affected: C4-C5 & C5-C6
Mechanism
1) Acute trauma causing a) compression/b) flexion/c) extension of the CS
2) Chronic/repetitive stress
3) Mechanical stress: poor posture, poor body mechanics, excessive/limited mobility
S&S
Burning, numbness, muscular weakness
Atrophy
Pain & discomfort
↓ ROM
Relieved: distraction
Aggravated: extension & rotation to the side
Management
1) Conservative:
Strengthening for stabilization
Avoid movements which aggravate condition
2) Severe cases:
Surgery: repair/remove/fusion
STINGERS/BURNERS (BRACHIAL PLEXUS INJURIES)
Commonly seen in rugby & American football
immediate sharp, burning pain radiating into the arm at the time of injury
Mechanism
Traction on brachial plexus: downward displacement of shoulder & contra-lateral flexion of neck
Compression of brachial plexus: extension & ipsilateral flexion of neck (or a direct blow)
S&S
Usually involve C5 & C6, may radiate to hand on affected side
Sharp, burning pain
Upper limb pain, paresthesia & weakness
No neurological deficit
Management
Ensure no neurological deficit, concussion or other head injury
Rest
Analgesia (reduce pain)
Gentle exercise program to address any impairment in function
Symptoms may resolve over a varying time period from a few minutes to days
removed from sport until symptoms are fully resolve
Acute Soft Tissue Injuries
Whiplash
Tissues affected:
Muscles
Joints: ligaments & capsular structures
Neural tissue
Bony or soft tissue injury
Can result in ligament sprains and muscle strains
Mechanism of injury
Acute Soft Tissue Injuries
Common in MVA
Two forces involved
Diving into shallow pool/sand bank
Can occur in sports when contact with the ground or by direct blow from opponent
Acute Soft Tissue Injuries
Sprain:
results from moderate to severe trauma; e.g. head snaps
Compression, or jamming of the spine into extension, forceful hyperflexion/ hypertextension/rotational movements (whiplash)
Sprain:
Frequently involved muscles: levator scapulae, trapezius, rhomboids, sternocleidomastoid, scalene & extensor muscle group
Mechanical overload, violent stretching into flexion/extension/rotation (whiplash)
Chronic overuse/poor posture can precipitate acute strains – chronic stress can fatigue postural muscles, making them more susceptible to mechanical overload
Chronic/Overuse Soft Tissue Injuries
DEGENERATIVE DISC DISEASE
Mechanism:
Recurrent sprains
Repetitive injury/stress
S & S:
Initially asymptomatic
Secondary pathology symptoms
Secondary pathologies:
Impingement of facet joints
Degenerative changes of bony surfaces
↑ susceptibility to nerve impingement
Management
Treat secondary conditions
Mild: follow rehab protocols
Severe: surgery (fusion)
Stabilization exercises + muscle strengthening
Cervical Postural Syndromes
APOPHYSEAL WRY NECK (acute torticollis)
Diskogenic wry neck
More common in older group
occurs at C4-C7, thus pain often felt in lower cervical or upper thoracic region (one-sided)
Pain originates from intervertebral discs
Mechanism of injury
Gradual onset
long sleep in an awkward position
Intervertebral disc is displaced and puts pressure on surrounding structures & nerves
Symptoms
Sharp, severe neck pain
Lateral flexion deformity with some rotation and possibly flexion
Decreased ROM
Possible radiation of pain to medial scapular region
Treatment
X-ray, MRI or CT scan: confirm diagnosis
Analgesia/pain killers
Physiotherapy: heat, massage, stretching, ultrasound etc.
Gentle manual therapy/joint mobilization
Strength training of postural muscles
Education regarding sleep position to encourage optimal spinal support
Apophyseal wry neck
More frequent in children & young adults
Commonly at C2/C3 level
Pain originates from facet joints
Cont. factors
Poor posture
Poor ergonomic set-up
Joint stiffness (particularly the neck or upper back)
A sedentary lifestyle
Poor trunk stability
Muscle weakness (particularly the deep neck flexors)
Muscle tightness
Inappropriate lifting technique
A lifestyle or occupation involving large amounts of sitting (computer/driving), bending, slouching or heavy lifting
Inadequate recovery periods
inappropriate pillow during sleep
