HK 302 Exam 3 Pathology

majority of problems in the spine occur

where secondary curves meet the primary curves

lld - leg length discrepancy

one leg longer than the other causes never pelvis then corrected higher up at neck

scoliosis

lateral curvature of spine

kyphosis

excessive curvature of the spine, causing hunching of the back

- anterior concave

lordosis

excessive curvature of the lumbar spine

- posterior concave

intervertebral disc injury: micro tears in the annulus fibrosis

lead to changes in nucleus pulposus

micro tears in annulus fibrosis occur with

flexion and rotation with force

- commonly L4-L5 and L5-S1

bulging disc

slight deformity in the nucleus

prolapsed disc

deformity extends through the annulus

extruded disc

nuclear material moves into the spinal canal

sequestrated disc

nuclear material separates from the disc

signs and symptoms of disc injuries

- pain does not occur until other structures are impinged upon (disc is aneural)

- suppressions of deep tendon reflex

- sharp shooting pain and muscle spasm

compression of the spinal nerve against the pedicle causes

sensory and motor deficits reflective of the associated dermatome and myotome

disc injuries can cause pain with

flexion and straight leg raise. more comfortable in extension or standing

management of intervertebral disc injuries

- ice/heat, muscle stim for spasms

- NSAIDs or muscle relaxant

- extension exercises (prone press-up cobra)

- spinal stabilization exercises

- mechanical traction

lateral stenosis

narrowing of the intervertebral foramen

- from bone spurs, dehydrated disc

central stenosis

narrowing of the spinal cord (vertebral) canal/foramen

scoliosis full definition

abnormal curve in the frontal plane through the lumbar and thoracic spine

two types of scoliosis

- idiopathic adolescent scoliosis

- adult scoliosis

idiopathic adolescent scoliosis

typically found during onset of puberty

- can be treated if caught early

adult scoliosis

- can be from untreated adolescent scoliosis

- can be from aging and degeneration of the spine

+ golfing to the right every day

scoliosis treatment

- rehab only if curves measure less than 25 degrees

- bracing for curves of 25-40 degrees

- surgery recommended for curves greater than 60 degrees

scoliosis surgery

for curve more than 60 degrees

- you lose mobility with a rod

spondylolysis

unilateral stress fracture of the pars interarticularis

- scottie-dog on x-ray fracture is collar

- hairline or complete

spondylolysis is

unilateral ONE SIDE

- still stable

spondylolysis mechanism

extension injury

- high jump - extend and rotate to one side over and over

spondylolisthesis

bilateral stress fracture of the pars interarticularis

- vertebral body instability and anterior translation

spondylolisthesis is

bilateral BOTH SIDES

- surgery

signs and symptoms of spondylolysis and spondylolisthesis

- diffuse pain increased by activity and extension

- commonly L5-S1 or L4-L5

management of spondylolysis and spondylolisthesis

- referred to doctor

- bone scan vs MRI for imaging

- bracing

- rest from activity

- therapeutic exercises for flexion and stabilization

transverse or spinous process fractures of lumbar spine

caused by a direct blow to the back or extreme forced motion

vertebral body compression fractures

- commonly seen at the thoracic lumbar junction

- dangerous due to the possibility of impingement on spinal canal

rule of thumb for spine compression fracture

stabilize until otherwise

- flexion could damage spinal cord and paralyze

costal chondritis

inflamed costal cartilage with chest pain

thoracic spine/rib fractures

- wedge fractures

- rib fractures

wedge fractures

occur with axial compression through the thoracic spine

- females with osteopenia are more likely to sustain fracture

rib fractures

occur either compression of the rib cage or from direct blow

- hurts to lay sown

- soft tissue injured when bone injured

Scheuermann's Disease - thoracic spine

- degeneration of the epiphyseal end plates of the vertebral bodies in adjacent segments

- creates thoracic kyphosis (flexion)

- 8-12 years old

scheuermann's disease is like

multiple wedge fractures in the thoracic spine

if under stress, accessory inhalation muscles assist diaphragm and external muscles

- stenoclidomastoid

- scalenes

- serratus anterior

- pec major

- serratus posterior superior

stabilize upper body allows accessory help (hands on knees)

if under stress accessory exhalation muscles will contract to force airflow

- internal intercostal muscle

- serratus posterior inferior

atlantoaxial ("no") instability occurs in

10 to 30% of children with Down syndrome

- x-ray may be needed to see if stable enough to play sports safely

cervical fractures

can range from minor to life-threatening based on type and location

- axial loading or extreme cervical flexion

hangman's fracture

bilateral pars interarticularis fracture of C2 - leaves dens unstable

- like a spondy in lumbar but in cervical

signs and symptoms of cervical fractures

- painful palpation over spinous processes

- radiation of pain, weakness, and numbness into dermatome/myotome

most common cervical fracture site is

C4, C5, and C6

signs of severe cervical fracture

paralysis and/or loss of bowel and bladder control

phrenic nerve significance (C3-C5)

innervation for diaphragm

- can't breath if damaged

- C 3 4 5 keep the diaphragm alive

it is crucial to practice

spine boarding

- communication w/ patient and each other

- tuck straps

skull fractures occur most often from

blunt trauma

- fall from elevation

- hit in head by object

- collisions with player/object

small objects at a high speed are worse than

large mass at slow speed

there is a high complication rate with

skull fractures

- brain injuries

- septic meningitis

septic meningitis

when skin and dura mater are both disrupted in fracture

- opening in head

signs and symptoms of skull fracture

- may not feel a defect with palpation

- CSF or blood coming from ears or nose

- ecchymosis around eyes or ears

- unequal pupil size

remember that signs

we can see as clinicians

remember that symptoms

we may not see and need to be told

how to tell if fluid is CSF

halo with napkin

ecchymosis around eyes or behind ear

raccoon eyes or battle's sign for ear

- bruising

unequal pupils are

fixed and not responsive to light

raccoon eyes are different than a black eye

bilateral from skull impact draining pressure

skull fracture short response

recognize, stabilize, refer

skull fracture management

- immediate EAP and hospital

- stabilize head and neck (issue possible neck injury!)

- treat for shock

- keep patient calm and communicate

concussion terminology does not reflect

- ding, bell rung, little concussed make it unserious

should be called mild traumatic brain injury (mTBI)

concussion can be a very serious injury

serious injury that causes lasting permanent neurological deficits

increased concussion research and more awareness in last 5-10 years

- treatment used to be sit in dark and do nothing

- now gradual progression back to activity and sport with what they can manage without exasperated symptoms

concussion =

widespread injury to brain rather than localized to one area

concussions can range from

mild to severe

- estimated that 1.6-3.8 million concussions occur in sports each year in US

signs of concussion (we can see)

- inappropriate emotions

- sadness

- sensitive to noise

- vacant stare

- glossy eyed

- vomiting

- nervousness

- drowsiness

- excess sleep

- fatigue

- poor balance and coordination

symptoms of concussion

- dizziness

- headache

- blurry vision

- in a fog"

- "slow"

- irritably

- loss of orientation

- nausea

- poor coordination

- ear ringing

- sadness

- seeing stars

- light sensitive

- noise sensitive

- sleep disturbance

- nervous

- memory problems

- personality chance

- distracted easily

different between signs and symptoms

- need athlete to tell us that they're nauseous or dizzy as a symptom

- its a sign when we can see them fall or throw up

post concussion syndrome

- mild to severe

- concussion symptoms last for days or months before resolving

do not allow athlete to return to play or progression of activity with post concussion syndrome until

all symptoms have resolved

second impact syndrome

occurs when a second concussion episode occurs before the first has resolved

- rapid swelling in brain increases intracranial pressure

- likely in teens

- life threatening

second impact syndrome - second hit

does not have to be a big hit for it to happen

focal cerebral injuries

localized

- epidural hematoma

- subdural hematoma

epidural hematoma

- aka extradural hematoma

- blow to the head or a skull fracture tears one of the meningeal arteries

- increased blood accumulation and creation of hematoma occurs quickly

why does epidural hematoma occur quickly

because the blood comes from a pumping artery

- within minutes to a few hours

subdural hematoma location

below dura

subdural hematoma is the most common

cause of death in athletes related to head trauma

subdural hematoma result from

tear in blood vessels that bridge the dura mater and the brain

- usually veinous - slower

- hours, days or weeks after trauma

signs and symptoms of hematoma

- briefly unconscious

- lucid period - still watch them and keep asking questions

as size of hematoma increases

- increasing headache

- drowsiness

- disoriented

- cognitively impaired

- decreased behavioral and motor ability

- cranial nerve dysfunction

- uneven pupil

unilateral dilated pupil

most common sign of epidural hematoma

muscle strains/joint sprains account for the bulk of all

low back injuries

acute back muscle strains or joint sprains

typically result from coupled motions involving rotation and either flexion or extension

chronic injuries of back

posture is the biggest contributing factor

- tightness in hamstrings/hip flexor is often biggest contributing factor

hamstring can effect back pain

tight hamstrings can flex hips too much and make erector spinae tight

treatment of muscle strains and joint sprains

- ice

- passive stretching for muscle spasm

- braces

- medications

- therapeutic exercise

bracing options for back injuries

corset or warm and for brace for posture

medications for back injury

muscle relaxant or NSAIDs

back injury impact on life

huge impact on daily living and function

to stretch out tight erector spinae muscles