Anatomy and Injuries to the Spine

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Anatomy and Injuries to the Spine

• Spain Park Sports Medicine

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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

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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)

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Anatomy of spine

• Parts of vertebrae
• Spinous process
• Transverse process
• Body

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Cervical vertebrae
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First 2 cervical vertebrae
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Thoracic vertebra
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Lumbar Vertebrae
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Sacrum and coccyx
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Vertebrae and ribs
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Posture

• Neutral spine
• Normal alignment
• Thoracic curve
• Excessive--kyphosis
• Lumbar curve
• Excessive--lordosis

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Discs

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

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Discs

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

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Muscles

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

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Muscles

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

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Muscles

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

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Muscles
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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

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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

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Brachial Plexus
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Brachial Plexus
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Lumbosacral plexus
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Lumbosacral plexus
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CNS
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Dermatomes

• Area of body that has nerve sensation for each
  nerve root

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Dermatomes

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

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Dermatomes

• Thoracic
• At the level of the respective thoracic vertebrae

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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

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Myotomes

• Area of the body that has motor function

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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

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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

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Posture

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

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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

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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)

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Posture
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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

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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!!!

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Lumbar spine injuries

• Sprain
• Strains
• Fractures
• Dislocation
• Disc injury

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Lumbar Sprain

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

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Lumbar Sprains

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

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Lumbar Sprains

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

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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

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Lumbar Strains

• TX
• RICE
• Gentle stretch
• Heat
• Strengthening
• Flexibility

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Fractures

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

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Fractures

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

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Fractures

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

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Fractures
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Fractures
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Fractures
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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

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Disc Injury

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

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Disc

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

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Disc

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

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Herniated disc
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Herniated disc
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Disc injury
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Lumbar traction
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Cervical Injuries

• Similar to those in lumbar area
• May have to treat differently due to the
  increased mobility in that area

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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

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Cervical Sprain
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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

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Cervical Sprain
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Sprains

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

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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

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Cervical Strain
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Cervical sprains/strains
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Cervical Traction
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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)

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Cervical Fx
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Cerivcal Fx
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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

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Cervical Fx/Dislocation
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Cervical Fx
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Cervical fx
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Cervical Fx/dislocation
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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

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Cervical Fx Surgery
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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

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Cervical disc injury
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Brachial Plexus Nerve Injury

• Also called
• Burner
• Stinger

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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

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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

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Brachial Plexus Nerve injury