Anatomy and Injuries to the Spine

Adapted from Connie Rauser

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

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)

Anatomy of spine

Parts of vertebrae Spinous process Transverse process Body

Cervical vertebrae

Thoracic vertebra

Lumbar Vertebrae

Sacrum and coccyx

Posture

Neutral spine Normal alignment

Thoracic curve Excessive--kyphosis

Lumbar curve Excessive--lordosis

Discs

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

Discs

Nucleus pulposus Jelly-like core

Annulous fibrosus Cartilaginous outer

rings

Muscles Provide movement &

stability Deep—erector

spinae Attach to vertebrae,

ribs, pelvis 3 groups (ERECTOR

SPINAE) Spinalis, iliocostalis,

longissimus

Muscles

Abdominal muscles play big role in stabilizing back

Trunk flexion, lateral flexion, rotation Rectus abdominus External oblique Internal oblique Transverse abdominus

Muscles

Trapezius Upper portion aids in

cervical extension Sternocleidomastoid

Lateral flexion, rotation Scalenes

Flexion of cervical area Multifidis

Rotation of spine

Muscles

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

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

Brachial Plexus

Brachial Plexus

Lumbosacral plexus

Lumbosacral plexus

Dermatomes

Area of body that has nerve sensation for each nerve root

Dermatomes

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

finger & forearm T1-medial arm

Dermatomes

Thoracic At the level of the respective thoracic

vertebrae

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

Myotomes

Area of the body that has motor function

Myotomes

C5-deltoid—shoulder abduction C5-6-biceps—elbow Flexion C6-wrist extensors—extension C7-triceps & wrist/finger flexors—

elbow extension, wrist/finger flexion C8-finger flexors—finger flexion T1-finger Abductors--abduction

Myotomes

L1,2,3-iliopsoas—hip flexion L2,3,4-Quads—knee extension L4-tibialis

anterior—dorsiflexion/inversion at ankle

L5-Extensor hallicus longus, extensor digitorum longus/brevis, extension/inversion at ankle

S1-peroneus longus/brevis-eversion S1,2-gastroc/soleus—plantar flexion

Posture

Normal Slight curve at thoracic and lumbar

areas, ears in line w/ shoulders

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

Posture

Preventing poor posture Don’t 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)

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

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!!!

Lumbar spine injuries

Sprain Strains Fractures Spinal Cord Injury Dislocation Disc injury

Lumbar Sprain

MOI: forced into excessive trunk flexion and rotation at some time

Posterior aspect of vertebral joints separate and stretch ligaments

Lumbar Sprains

S/S: localized pain to one side of spine

Limited ROM Pain Spasms Push each vertebra

anteriorly to attempt to reproduce pain

Lumbar Sprains

TX: RICE After 48 hours—heat Active rest Maintain comfortable neutral spine Stretching Strengthening and stability exercises

Lumbar Strain

Mild/moderate strains very common MOI: same as for sprains S/S:

pain on one side spasms decreased ROM pain moves up and down length of

muscles

Lumbar Strains

TX: RICE Gentle stretch Heat Strengthening Flexibility

Fractures

MOI: Severe compression

type force Direct blow Extreme flexion

Fractures

S/S: Severe pain Pt. Tender over vertebra, especially

spinous process Muscle spasm LOM Possible tingling, numbness, etc.

Secondary Complication: Spinal Cord Involvement

Fractures

TX: Be conservative Call 911 Neurological exam

(dermatomes/myotomes) Don’t move athlete Spineboard prior to transport

Fractures

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

Disc Injury MOI:

Improper lifting Poor posture Poor body mechanics

(excessive flexion over prolonged time frame)

Trauma due to direct fall

Disc

S/S: Pain radiating down leg Numbness Tingling down leg Increased pain with sitting/flexion

motion Decreased/absence of reflex

Disc

TX: Active rest Work on posture Extension exercises Proper mechanics Core stability—especially lumbar area Traction Surgery if rehabilitation doesn’t work

Herniated disc

Disc injury

Lumbar traction

Cervical Injuries

Similar to those in lumbar area May have to treat differently due to

the increased mobility in that area

Cervical Sprains MOI: move beyond normal ROM

Hyperextension or hyperflexion of neck Whiplash type MOI

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

Cervical Sprain

Sprains S/S:

Neck and arm pain Pain between scapula Possible numbness or

tingling Decreased ROM due to

Pain Pt. Tender over the

cervical area, usually localized

Cervical Sprain

Sprains

TX: Check for nerve injury Ice Soft neck collar Medical referral if severe Traction Stretching strengthening

Cervical Strains

MOI: Whiplash type –same as for sprains

S/S: Muscle spasms, Decreased ROM,

Muscle weakness, pain along the muscle, Pt. Tender over muscles

TX: same as for sprains Return to Activity: No symptoms,

full ROM & strength, Dr. release

Cervical Strain

Cervical sprains/strains

Cervical Traction

Cervical Fractures/Dislocations

Can result in permanent disability/death

MOI: axial loading—neck flexion with force to top of head (fracture) or flexion w/ rotation (dislocation)

Cervical Fx

Cervical FX/Dislocations

S/S: Pain & Pt. Tender 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

Situations in Which Cervical Spine Injury Should be Suspected

Neck pain or stiffness Cervical muscle spasm Asymmetrical or Abnormal head position Respiratory difficulty (chest not moving) Unconsciousness Numbness, tingling, burning Muscle weakness or paralysis Loss of bowel or bladder control

Cervical Fx/Dislocation

Cervical Fx

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

Spinal Cord Injury

Decerebrate vs. Decorticate Posturing

Decerebrate

The worse of the two posturings Disruption of nerve pathway

between brain and spinal cord

Decorticate

Damage to nerve pathway between brain and spinal cord

May occur on one or both sides of the body

Spine Boarding

Observation: ( On the way to athlete) If athlete is unconscious ALWAYS assume

spinal injury. Arrival and Primary Survey

Stabilize head and neck Check for level of consciousness

If unconscious call 911 If conscious and able to communicate

signs/symptoms of neck injury call 911

Spine Boarding Continued

If unconscious: Look, listen and feel If not breathing either you (if alone) or

another member of medical use pocket mask or remove face mask and begin rescue breathing/CPR

If breathing continue to maintain stabilization and assess athlete

Spine boarding continued

If athlete is supine with neck turned to side, maintain stabilization and rotate head in align with neck. If athlete is able to communicate, if movement increases symptoms STOP.

Reasons not to move neck: Increased pain Neurological symptoms Muscle spasm Airway compromise If it is physically difficult

to reposition the spine Resistance is

encountered Patient expresses

apprehension

Disc injury

Not as common as in lumbar area MOI: 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

Brachial Plexus Nerve Injury

Also called Burner Stinger

Brachial Plexus Nerve Injury

MOI: 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

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

Brachial Plexus Nerve injury