Anatomy and Injuries to the Spine - PowerPoint PPT Presentation

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Anatomy and Injuries to the Spine

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Anatomy and Injuries to the Spine Sabino Sports Medicine Disc injury Lumbar traction Cervical Injuries Similar to those in lumbar area May have to treat differently ... – PowerPoint PPT presentation

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Title: Anatomy and Injuries to the Spine


1
Anatomy and Injuries to the Spine
  • Sabino Sports Medicine

2
Function of anatomy
  • Protects spinal cord
  • Holds body upright
  • Site for muscle ligament attachment (support
    spine)
  • Discs provide shock absorption
  • Nerves provide sensation and motor function

3
Bony anatomy
  • Vertebrae
  • 7 cervical (flexion, extension, lateral flexion,
    rotation)
  • 1st-atlas
  • 2nd-axis
  • 12 thoracic (little movement)
  • 5 lumbar (less flexion than extension, some
    rotation
  • 5 sacral (fused)
  • 3-4 coccyx (fused)

4
Anatomy of spine
  • Parts of vertebrae
  • Spinous process
  • Transverse process
  • Body

5
Cervical vertebrae
6
First 2 cervical vertebrae
7
Thoracic vertebra
8
Lumbar Vertebrae
9
Sacrum and coccyx
10
Vertebrae and ribs
11
Posture
  • Neutral spine
  • Normal alignment
  • Thoracic curve
  • Excessive--kyphosis
  • Lumbar curve
  • Excessive--lordosis

12
Discs
  • Fibrocartilaginous
  • Shock absorbers
  • Resist compression
  • Keep vertebrae separated
  • Allows movement flexibility
  • Provides space for nerves to exit
  • No blood supply

13
Discs
  • Nucleus pulposus
  • Jelly-like core
  • Annulous fibrosus
  • Cartilaginous outer rings

14
Muscles
  • Provide movement stability
  • Superficialerector spinae
  • Attach to vertebrae, ribs, pelvis
  • 3 groups
  • Spinalis, iliocostalis, longissimus
  • In 3 areas
  • Cervicis, thoracicis, lumborum

15
Muscles
  • Abdominal muscles play big role in stabilizing
    back
  • Trunk flexion, lateral flexion, rotation
  • Rectus abdominus
  • External oblique
  • Internal oblique
  • Transverse abdominus

16
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17
Muscles
  • Trapezius
  • Upper portion aids in cervical extension
  • Sternomastoid
  • Lateral flexion, rotation
  • Scaleneus
  • Flexion of cervical area
  • Multifidis
  • Rotation of spine

18
Muscles
19
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21
Nerves
  • Each vertebrae has a nerve that exits either
    below or above it
  • 31 pairs of spinal nerves
  • 8 cervical nerves
  • 12 thoracic nerves
  • 5 lumbar
  • 5 sacral
  • 1 coccygeal

22
Spinal Cord
  • 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
  • Brachial, lumbosacral

23
Brachial Plexus
24
Brachial Plexus
25
Lumbosacral plexus
26
Lumbosacral plexus
27
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28
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29
CNS
30
Dermatomes
  • Area of body that has nerve sensation for each
    nerve root

31
Dermatomes
  • Cervical
  • C4-shoulder
  • C5-lateral arm
  • C6-lateral forearm
  • C7-middle finger
  • C8-medial half of ring finger forearm
  • T1-medial arm

32
Dermatomes
  • Thoracic
  • At the level of the respective thoracic vertebrae

33
Dermatomes
  • Lumbar/Sacral
  • 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

34
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36
Myotomes
  • Area of the body that has motor function

37
Myotomes
  • C5-deltoidshoulder abduction
  • C5-6-bicepselbow Flexion
  • C6-wrist extensorsextension
  • C7-triceps wrist/finger flexorselbow
    extension, wrist/finger flexion
  • C8-finger flexorsfinger flexion
  • T1-finger Abductors--abduction

38
Myotomes
  • L1,2,3-iliopsoaship flexion
  • L2,3,4-Quadsknee extension
  • L4-tibialis anteriordorsiflexion/inversion at
    ankle
  • L5-Extensor hallicus longus, extensor digitorum
    longus/brevis, extension/inversion at ankle
  • S1-peroneus longus/brevis-eversion
  • S1,2-gastroc/soleusplantar flexion

39
Posture
  • Normal
  • Slight curve at thoracic and lumbar areas, ears
    in line w/ shoulders

40
Posture
  • Problems
  • 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

41
Posture
  • Preventing poor posture
  • Dont 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)

42
Posture
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46
Prevention of Injuries
  • 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

47
Prevention
  • Learn to lift properly
  • Maintain slight curve in lumbar spine
  • Lift with knees and hips (legs)
  • Keep head up
  • Keep your butt behind you!!!

48
Lumbar spine injuries
  • Sprain
  • Strains
  • Fractures
  • Dislocation
  • Disc injury

49
Lumbar Sprain
  • Mxn forced into excessive trunk flexion and
    rotation at some time
  • Posterior aspect of vertebral joints separate and
    stretch ligaments

50
Lumbar Sprains
  • S/S localized pain to one side of spine
  • Limited ROM
  • Pain
  • Spasms
  • Push each vertebra anteriorly to attempt to
    reproduce pain

51
Lumbar Sprains
  • TX
  • RICE
  • After 48 hoursheat
  • Active rest
  • Maintain comfortable neutral spine
  • Stretching
  • Strengthening and stability exercises

52
Lumbar Strain
  • Mild/moderate strains very common
  • Mxn same as for sprains
  • S/S
  • pain on one side
  • spasms
  • decreased ROM
  • pain moves up and down length of muscles

53
Lumbar Strains
  • TX
  • RICE
  • Gentle stretch
  • Heat
  • Strengthening
  • Flexibility

54
Fractures
  • Mxn
  • Severe compression type force
  • Direct blow
  • Extreme flexion

55
Fractures
  • S/S
  • Severe pain
  • POT over vertebra, especially spinous process
  • Muscle spasm
  • LOM
  • Possible tingling, numbness, etc.

56
Fractures
  • TX
  • Be conservative
  • Call 911
  • Neurological exam
  • Dont move athlete
  • Spineboard prior to transport

57
Fractures
58
Fractures
59
Fractures
60
Disc Injury
  • 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

61
Disc Injury
  • Mxn
  • Improper lifting
  • Poor posture
  • Poor body mechanics (excessive flexion over
    prolonged time frame)
  • Trauma due to direct fall

62
Disc
  • S/S
  • Pain radiating down leg
  • Numbness
  • Tingling down leg
  • Increased pain with sitting/flexion motion
  • list
  • Decreased/absence of reflex

63
Disc
  • TX
  • Active rest
  • Work on posture
  • Extension exercises
  • Proper mechanics
  • Core stabilityespecially lumbar area
  • Traction
  • Surgery if PT doesnt work

64
Herniated disc
65
Herniated disc
66
Disc injury
67
Lumbar traction
68
Cervical Injuries
  • Similar to those in lumbar area
  • May have to treat differently due to the
    increased mobility in that area

69
Cervical Sprains
  • Mxn move beyond normal ROM
  • Hyperextension or hyperflexion of neck
  • Whiplash type mxn
  • 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

70
Cervical Sprain
71
Sprains
  • S/S
  • Neck and arm pain
  • Pain between scapula
  • Possible numbness or tingling
  • Decreased ROM due to Pain
  • POT over the cervical area, usually localized

72
Cervical Sprain
73
Sprains
  • TX
  • Check for nerve injury
  • Ice
  • Soft neck collar
  • Medical referral if severe
  • Traction
  • Stretching
  • strengthening

74
Cervical Strains
  • Mxn
  • Whiplash type same as for sprains
  • S/S
  • Muscle spasms, Decreased ROM, Muscle weakness,
    pain along the muscle, POT over muscles
  • TX same as for sprains
  • Return to Activity No symptoms, full ROM
    strength, Dr. release

75
Cervical Strain
76
Cervical sprains/strains
77
Cervical Traction
78
Cervical Fractures/Dislocations
  • Can result in permanent disability/death
  • Mxn axial loadingneck flexion with force to
    top of head (fracture) or flexion w/ rotation
    (dislocation)

79
Cervical Fx
80
Cerivcal Fx
81
Cervical FX/Dislocations
  • S/S
  • Pain POT 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

82
Cervical Fx/Dislocation
83
Cervical Fx
84
Cervical fx
85
Cervical Fx/dislocation
86
Cervical Fx/Dislocations
  • TX
  • 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

87
Cervical Fx Surgery
88
Disc injury
  • Not as common as in lumbar area
  • Mxn 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

89
Cervical disc injury
90
Brachial Plexus Nerve Injury
  • Also called
  • Burner
  • Stinger

91
Brachial Plexus Nerve Injury
  • Mxn 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

92
Brachial Plexus Nerve injury
  • TX
  • Ice
  • Neck collar
  • Physician referral if necessary
  • Strengthening
  • ROM exercises
  • Return to activity when symptom free, full
    strength, full ROM of neck and shoulders

93
Brachial Plexus Nerve injury
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