Presentation on theme: "Cervical Spine Pathologies and Special Tests"— Presentation transcript:
1Cervical Spine Pathologies and Special Tests Orthopedic Assessment III – Head, Spine, and Trunk with LabPET 5609C
2Pathologies Brachial Plexus Pathology: Brachial Plexus Neuropraxia: Common name: “Burner” or “Stinger”Definition:“Transient brachial plexopathy involving the upper trunk”“Temporary episode of unilateral upper extremity burning dysethesia with or without motor weakness”“Stinger” → tingling that occurs in upper extremity after injury
3Pathologies Brachial Plexus Pathology: Epidemiology: (specific studies)50% of a Division I FB team had 1 or more burners/season (Robertson et al.)65% of DIII FB players (201) during careers / 57% > 1 burner (Sallis et al.)70% reported additional burners that they did NOT report↑ occurrence with defensive players (DB’s)
5Pathologies Brachial Plexus Pathology: Mechanism of Injury: Stretch of the brachial plexus:Head forced laterally while opposite shoulder is depressed (common MOI – tackling)C5 and C6 (most commonly affected)Nerve root compression:Combination of neck hyperextension and ipsilateral lateral flexionNerve roots impinged between vertebraeSpinal stenosis - ↑ riskCompression of brachial plexus:Direct blow to Erb’s point (shoulder pads compress plexus)
7(A) Traction to the brachial plexus (ipsilateral shoulder depression and contralateral lateral neck flexion) (B) Direct blow to the supraclavicular fossa (Erb's point) (C) Compression of the cervical roots or brachial plexus (ipsilateral lateral flexion and hyperextension)
9Pathologies Brachial Plexus Pathology: Signs and symptoms: Grading: Numbness and burning of the entire arm, hands, fingersSensation loss over dermatomesComplete transient paralysis of affected nervesTenderness over the brachial plexusGrading:Grade 1 (Neuropraxia): transient signs/sx. last from a few minutes → 2 weeksGrade 2 (Axonotmesis): significant sensory/motor deficits > 2 weeks and less than < 6 monthsGrade 3 (Neurotmesis): symptoms 6 months → 1 year
10Pathologies Brachial Plexus Pathology: Evaluation Inspection: Athlete shakes arm/hand in attempt to regain feelingInspect cervical spine for abnormality (fracture/dislocation)Palpation:Cervical spineClavicle, humerus, scapula, sternum, ribsSC, AC, GH jointsShoulder musculature
11Pathologies Brachial Plexus Pathology: Evaluation Functional Testing: Active and passive ROM (all neck and shoulder movements)RROM – can be performed in conjunction with myotome checkKey muscles tested: deltoid, external rotators, biceps brachiiNeurological Screening:Upper quarter sensory/motor testingSpecial Tests:Brachial plexus stretch testCervical compression and distractionSpurling test
14Pathologies Brachial Plexus Pathology: Return to Play Criteria: Full, pain-free active and passive ROM in the cervical spineFull, pain-free neck strength against resistanceFull strength of all shoulder and arm movementsNormal sensation in all dermatomesCheck shoulder pads/helmet to ensure proper fitRecheck in 3-5 minutes
16Pathologies Research Article #1: Effects of Football Collars on Cervical Hyperextension and Lateral FlexionObjective: Evaluate the effectiveness of 3 football collars in ↓ cervical ROMWhy:MOI for stingersDo the collars ↓ movement?PREVENTION
17PathologiesEffects of FB Collars on Cervical Hyperextension and Lateral Flexion:Methods:Subjects: 15 D1 football playersForce applied (hand-held dynamometer)Motion: 2-dimensional video analysisMovement:AROM and PROMHyperextensionLateral flexion
19Hyperextension Findings: Lateral Flexion Findings: Can be limited by all 3 collars: (rankings)1. Cowboy collar A-Force 3. Neck rollNote: Passive overloading still resulted in additional 190 of hyperextensionLateral Flexion Findings:No collar ↓ passive lateral flexion betterthan the shoulder pads aloneStandard neck roll ↓ active ROM
20Pathologies Research Article #2: Biomechanical Analysis of Football Neck Collars:Objective: Perform a biomechanical analysis of neck collars through dynamic testingWhy:MOI for head and neck injuriesDo the collars ↓ force transmission (upon impact)?
21Pathologies Biomechanical Analysis of FB Neck Collars: Methods: Collars (3) evaluated:Cowboy collar (McDavid)Bullock collarKerr collarCrash-test dummy:Shoulder pads (raised and unraised), helmet, collarAccelerometers / load cells / angular rate sensorsImpacts:Pneumatic linear impactor5 m/s and 7 m/s
23Pathologies Biomechanical Analysis of FB Neck Collars: Results: Top of Head Impact:Most protection: Kerr collar (Bullock – 2nd)Why? Kerr collar contacts the base of the helmet during impact → redirects some load to shouldersFront Impact:Most protection: Kerr collar (all provided ↑ protection)↓ head and neck movement **Side Impact:Kerr – minimal protectionCowboy and Bullock – no protection
24Peak Values for Front Impact: Normal Shoulder Pad Configuration
25Pathologies Cervical Nerve Root Impingement: History: Onset: Acute of chronicPain: Radiating symptoms into trapezius, scapula, shoulder, arm, wrist, and handMOI: Compression or irritation of nervePredisposing conditions:Disc pathology, narrowing of intervertebral foramina, facet degeneration
26Pathologies Cervical Nerve Root Impingement: Inspection: Palpation: Posture of headPalpation:Point tendernessFunctional Tests:Pain with extension, lateral bending toward same side, and rotationAROM, PROM, RROMNeurological Tests:Upper quarter screen:Muscle weakness, paresthesia, diminished reflexesSpecial Tests:Cervical compression test (↑ symptoms)Cervical distraction test (↓ symptoms)Spurling test / Vertebral artery test / Abduction test
28Special Tests Brachial Plexus Traction Test: Patient position: SeatedATC position:Standing behind the patientProcedure:One hand placed on side of the patient’s head; other hand over the AC joint (same side)Cervical spine is laterally bent and opposite shoulder depressedPositive test:Radiating pain on the side opposite the lateral bendingStretching of brachial plexusRadiating pain on the side toward the lateral bendingCompression of cervical nerve roots between 2 vertebrae
29MOI is duplicated in attempt to replicate the athlete’s symptoms MOI is duplicated in attempt to replicate the athlete’s symptoms. Radiating pain down left shoulder – traction injury / Radiating pain down right shoulder – compression injury. Perform bilaterally and do NOT perform with suspected cervical spine fracture and/or dislocation.
30Special Tests: Cervical Compression Test: Patient position: SittingATC position:Standing behind the athlete with hands interlocked over the top of the patient’s headProcedure:Press down on the crown of patient’s headPositive test:Pain in upper cervical spine and/or upper extremityImplication;Compression of the facet joints and narrowing of the intervertebral foramen
31Special TestsCervical Compression Test: Attempts to duplicate patient’s symptoms by ↑ pressure on cervical nerve roots. Do NOT perform test until cervical fracture, dislocation, or instability has been ruled out.
32Special Tests Spurling Test (Foraminal Compression): Patient position: SeatedATC position:Standing behind the athlete with hands interlocked over crown of patient’s headProcedure:Patient laterally flexes the head while a compressive force is placed along patient’s cervical spinePositive test:Radiating pain down patient’s armImplication:Nerve root impingement
33Special TestsSpurling’s Test: Attempts to compress a cervical nerve root. Do NOT perform until a cervical fracture, dislocation, or instability has been ruled out.
34Special Tests Cervical Distraction Test: Patient position: Supine (relaxes the muscles acting on the cervical spine)ATC position:At head of patient with one hand under the occiput and the other on top of the forehead (stabilizing head)Procedure:Apply traction on patient’s head, causing distraction of cervical spinePositive test:Relief or reduction in symptomsImplications:Compression of the cervical facet joints and/or stenosis of neural foramina
35Cervical Distraction Test: Attempts to relieve patient’s symptoms by ↓ pressure on cervical nerve roots. Do NOT perform test until cervical fracture, dislocation, or instability has been ruled out.
36Special Tests Vertebral Artery Test: Patient position: ATC position: SupineATC position:Seated at head of the patient with hands placed under the occiput to stabilize the headProcedure:Passively extend and laterally flex the cervical spine (1)Head is rotated toward the laterally flexed side and held for 30 seconds (2)Positive test:Dizziness, confusion, nystagmus, unilateral pupil changes, nauseaImplication:Occlusion of the cervical vertebral arteries
37Vertebral Artery Test: Used to assure the competency of the vertebral artery prior to initiating treatment or rehabilitation techniques that may compromise a partially occluded artery. Do NOT perform until the presence of a cervical fracture, dislocation, or instability has been ruled out.Positive Test: Refer to physician