Transcript CH10_PPT - acasportsmedicine

Chapter 10
Injuries to the Thoracic Through Coccygeal Spine
Pre-Write
• Take out a sheet of paper and write whatever
you want about the following question. Please
write as much as you want but no less than 3
complete sentences
• How has learning about how the body works
and heals itself help strengthen your faith in
God? If it hasn’t write about that as well.
Anatomy Review of the
Thoracic Spine
• Thoracic spine is
composed of 12
vertebrae that
articulate with the
cervical and lumbar
spines.
• The thoracic spine,
corresponding 12
pairs of ribs, and
sternum form the
thoracic cage.
Common Sports Injuries
• Are rare but consist of both soft and skeletal
injuries.
Skeletal Injuries of the Thoracic Vertebrae
• Compression fractures of the vertebral body
are most common injury.
• Such fractures usually occur at junction of
thoracic and lumbar spine.
• Athlete with recent history of trauma to the
region in conjunction with pain or numbness
should be referred to a physician.
Common Sports Injuries
• Scheuermann’s
disease is
adolescent
condition
characterized by
kyphosis. Children
with chronic
thoracic pain
should be
evaluated.
Scoliosis
Lordosis
Vertebrate Fractures
Rib Fractures
• Such fractures are associated
with direct blows to lateral or
posterior thorax and can occur
anywhere along the rib.
• The ribs commonly fracture
near the anatomic angle, which
is the weakest point.
Rib Fractures (cont.)
Signs and symptoms
include:
• Painful respiration.
• Deformity in the
region of the
injury, including a
protruding rib or
depression where
the normal
contour of the rib
should be.
Rib Fractures (cont.)
• Pain when rib cage is
gently compressed
• Swelling and
discoloration
• Posterior rib fractures
can potentially result in
a pneumothorax
(collapsed lung)or a
hemothorax. (blood in
pleural cavity)
Hemothorax
Pneumothorax
Rib Fractures (cont.)
First Aid
• Immediate
application of RICE.
• Treat for shock.
• Refer athlete to
physician.
Sprains
Sprains occur whenever a
joint is forced beyond its
normal ROM resulting in
damage to ligaments and
joint capsules.
• Evaluation of a sprain to
the thoracic spine is
difficult.
• A consistent symptom is
painful respiration.
Sprains
First Aid
• Apply RICE.
• If dyspnea (difficulty
or painful breathing)
persists for more than
24 hours, refer the
athlete to a physician.
Strains
Strains:
• Involve contractile tissue and their
support structures, such as the erector
spinae and intercostals.
• Are related to maximal exertions.
• Result in muscle spasm and point
tenderness.
• First Aid
• Application of RICE to the injured area.
Lumbar Spine Region
Anatomy Review
• Five vertebrae
are
in lumbar spine.
• Lumbar
vertebrae are
the largest
moving
vertebrae.
• The major
ligaments are
the anterior and
posterior
longitudinal.
Lumbar Spine Region
• The sacrum consists of
five fused vertebrae.
• The sacrum connects the
spinal column to the
pelvis.
• Right and left sacroiliac
(SI) joints are formed by
the union of the sacrum
and pelvis.
• Coccyx (tailbone) is most
distal portion of the
vertebral column.
3 Major Joints in the Lumbar Spine.
1. The lumbosacral
2. The sacroiliac
3. Sacrococcygeal.
Spondylolysis and
Spondylolisthesis
• Spondylolysis is a defect in
the neural arch (pars
interarticularis). Such
defects compromise the
articulation between two
vertebrae.
• If the condition is bilateraI,
the affected vertebra can
slip forward resulting in
spondylolisthesis.
Spondylolysis and
Spondylolisthesis
• Symptoms include
(cont.)
lower back pain that
worsens during
hyperextension, and
radiating pain to the
buttocks and upper
thighs.
• Treatment includes
rest, drug therapy,
lumbar bracing,
exclusion from certain
sports, and surgery.
Traumatic Fractures: Lumbar
Spine
• Such fractures are uncommon
in sports.
• External blows may result in
internal injury.
• Deep abdominal pain,
hematuria (blood in the
urine), and shock are signs
and symptoms of internal
injury.
• Immobilize on spine board
and transport to medical
facility.
Broken Coccyx
• Blows to the coccyx can
result from landing on the
buttocks.
• Fractures of the coccyx
result in severe pain, point
tenderness, swelling, and
bruising. Refer athlete to
physician for evaluation.
Lumbar Region -- Strains &
Sprains
• Strains and sprains
are the most common
soft-tissue injuries in
the lumbar spine.
• Major joints include:
• Lumbosacral.
• Sacroiliac.
• Sacrococcygeal.
Lumbar Strains & Sprains
(cont.)
Signs and symptoms include:
• Localized muscle spasm.
• Pain that does not radiate into buttocks or
lower extremity.
• Acute postural abnormalities associated
with recent trauma.
First Aid
• Have athlete maintain a supine position
with soft support for lumbar region and
application of ice.
• If not improved in 24 hours, refer to
physician.
Lumbar Disk Injuries
• A serious form of soft
tissue injury is a
“herniated disk.”
• Most commonly occurs
at L4 or L5.
• Anatomy of a disk
includes annulus fibrosis
(outer ring) and nucleus
pulposus (inner ring).
Lumbar Disk Injuries (cont.)
• Herniation
results from a
weakened
annulus that
allows nucleus
pulposus to
protrude
through the wall
of the annulus.
Herniated Disk
• Protrusion may put
pressure directly on spinal
nerves resulting in:
• Intense local or
radiating pain.
• Sensory loss or
burning/tingling
sensation in lower
extremity.
• Muscle spasm and
postural abnormalities.
Lumbar Disk Injuries (cont.)
First Aid
• Place athlete in supine or most comfortable
position. Support lumbar region with rolled
towel or other soft material.
• Apply crushed ice to lumbar region.
• Arrange for transport to medical facility.