Transcript The Spine
Chapter 24 THE SPINE THE NERVOUS SYSTEM Consists of the brain and spinal cord Collects information about external and internal conditions Analyzes the information Initiates appropriate responses aimed primarily toward survival needs 2 parts of the CNS Peripheral Autonomic THE PERIPHERAL NERVOUS SYSTEM Consists of all the nerves and ganglia located outside the brain and spinal cord (CNS) Nerves carry impulses to the brain Sensory (afferent) nerves Motor (efferent) nerves Cranial/Spinal nerves make up the entire peripheral nervous system Cranial nerves provide communication pathways between the head and neck and the brain The spinal nerves provide communication pathways between the rest of the body and spinal cord, which also provides links to the brain The spinal nerves form a network, called a plexus THE AUTONOMIC NERVOUS SYSTEM Divided into 2 systems Sympathetic Prepares action the body for “fight or flight” Parasympathetic Counteracts the sympathetic system to prepare the body for more restful activities The 2 systems operate as a pair REFLEXES The simplest type of nervous response They are unconscious and involuntary As few as 2 neurons are necessary for a reflex, though many involve 3 neurons Every reflex act is preceded by a change in the environment, called a stimulus Special structures called receptors pick up the stimuli REFLEXES (CONT’D) If two nerves are involved, all that is necessary is a sensory receptor, which is the distal end of the sensory neuron that carries the sensation to the CNS The sensory neuron communicates to a motor neuron through a neurotransmitting chemical diffusing across a synapse The motor neuron then sends a signal to an effector, which provides the response (usually a muscle contraction or glandular secretion) THE VERTEBRAL COLUMN Vertebral column is divided into 5 sections Cervical 7 vertebrae including the atlas and axis Thoracic 12 vertebrae that articulate with ribs Lumbar 5 vertebrae that bears most of the body’s weight Sacrum 5 fused vertebrae that serve as an articulation point for the hips Coccyx 4 fused vertebrae that form the tailbone SPINAL CORD Begins at the base of the skull and continues to the second lumbar vertebrae It is surrounded by the 3 meninges and cerebrospinal fluid for protection The spinal cord consists of gray matter internally, which is surrounded by white matter For reflex action and communication with the brain, neuron connections are made within the gray matter, while the white matter consists of neuron fibers. INJURIES TO THE SPINE Cervical Spine Injuries Can lead to serious problems or death Most serious injuries are the result of axial loading or cervical compression, may cause vertebral fracture or the articular facets to slide away from each other Symptoms Unconsciousness, numbness, paralysis and neck pain with movement TREATMENT OF CERVICAL SPINE INJURY Manage airway using jawthrust technique If helmet is work, do no remove Head movements may increase the severity of the injury Check for carotid pulse If absent, begin chest compressions Immobilize until EMS arrives CERVICAL SPRAINS & STRAINS Symptoms Tenderness and pain at the injury site Neck motion not affected Moderate strains/sprains will present with limited motion Severe injuries will have localized pain and muscle spasm But without radiation of pain/parathesia Athlete may complain of an insecure feeling about the neck Treatment Protect the area, exclude from further activity, refer to a physician CERVICAL NECK SYNDROME Caused by forced lateral flexion Causes nerve roots to be stretched or impinged Commonly called a pinched nerve, burner or stinger Symptoms Sharp, burning, radiating pain If brachial plexus is involved, there may be radiating pain, numbness and loss of function of the arm and possible hand Symptoms usually subside in minutes, though it may leave residual soreness and paresthetic (numbness, tingling) areas CERVICAL FRACTURES AND SUBLUXATIONS Not common athletic injuries Can occur in football, diving, and gymnastics Most fatal or paralyzing injuries occur when an athlete’s neck is in flexion and the athlete receives a blow to the head CERVICAL FX/SUBLUXATION SYMPTOMS Swelling within the spinal cord Transitory paralysis Neck pain Muscle spasms Numbness Loss of sensation Weakness Paresthesia Partial or complete limb paralysis Athletes may experience transient quadriparesis or quadriplegia, also called neuropraxia Recovery can occur within a few minutes, but can last 1-2 days. Referral to a physician for further medical attention is necessary CAUSES OF NEUROPRAXIA AND TRANSIENT QUADRIPARESIS Spinal stenosis Congenital abnormality Cervical instability Interverterbal disk herniation Because most mechanisms causing cervical spine injury involve forces to the head, injuries to the head and neck must be considered together THORACIC SPINE INJURIES Include the following Contusions Sprains Strains Symptoms include Tenderness Spasms Increased pain with active contraction or stretching Stiff back Athlete should be referred to a physician for further evaluation LUMBAR SPINE INJURIES Can be aggravated by inadequate or inappropriate conditioning, inflexibility, congenital anomalies, and poor postural habits Contusions are more common in the paraspinal muscles, but may also occur over the subcutaneous spinous process Severe injuries are extremely rare in athletics. SPONDYLOLYSIS A defect in the pars interarticularis of the vertebrae; if bilateral It can allow the vertebrae to slip forward on the vertebrae of the sacrum Known as spondylolisthesis Symptoms Complaint of low back pain associated with increased activity Pain radiating into the buttocks and upper thighs Refer athletes to a physician for diagnosis INTERVERTEBRAL DISC HERNIATION Occurs when the nucleus pulposus herniates, or protudes, through the annulus fibrosus and presses against the spinal cord or spinal nerve Symptoms Extreme pain and stiffness in the lower back Pain in the buttocks Radiating leg pain Pain is usually unilateral and follows the route of the sciatic nerve Possible unilateral weakness, sensory loss, or reflex loss in the affected leg Refer to a physician for further evaluation SACROILIAC INJURIES Usually sprains to the SI joint Occurs as a result of acute or chronic trauma Symptoms Sacroiliac pain Stiffness Soreness of the SI joint that diminishes during activity Returns down as the athlete cools