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SpinalInjurySpinalInjury

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Watmough willhavecortisoneinjectedintohisspinethismorningtospeeduptherecovery fromaninjurythat hasplaguedhimsincetheclashagainsttheBulldogsinroundeightandwillmisstheteam'sfirstfew trainingsessionsasaresult.

Watmough willhavecortisoneinjectedintohisspinethismorningtospeeduptherecovery fromaninjurythat hasplaguedhimsincetheclashagainsttheBulldogsinroundeightandwillmisstheteam'sfirstfew trainingsessionsasaresult.

'Paralysed'Watmoughvowshe'llhavethebackboneforGameTwoaftertreatmentforneckinjury

'Paralysed'Watmoughvowshe'llhavethebackboneforGameTwoaftertreatmentforneckinjury

neuroprotectiveneuroprotective

Watmough mayhave acortisoneinjection.Heunderstands thismaybeatemporisingmeasure thataddresses the symptomsbutnotthecauseoftheproblem.He understandsthat heshouldrestafter theinjectionandmiss6weeksoftrainingreflecting theslowrecovery ofnerves toregenerate.

Watmough mayhave acortisoneinjection.Heunderstands thismaybeatemporisingmeasure thataddresses the symptomsbutnotthecauseoftheproblem.He understandsthat heshouldrestafter theinjectionandmiss6weeksoftrainingreflecting theslowrecovery ofnerves toregenerate.

Watmough vowshewillinvestigateoptionsbeforeGameTwo

Watmough vowshewillinvestigateoptionsbeforeGameTwo

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Whentheheadisintheneutralposition, withthenormalcervicallordotic curve,forcestransmittedtotheheadaredissipatedinthecervical

musclesandligaments.

Whentheheadisintheneutralposition, withthenormalcervicallordotic curve,forcestransmittedtotheheadaredissipatedinthecervical

musclesandligaments.

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Compressionfractures

haveanintactposterior

vertebralbodythatpreventsinjurytothespinalcord…

Compressionfractures

haveanintactposterior

vertebralbodythatpreventsinjurytothespinalcord…

Cervicalspineinstabilityisdefinedasthelossofabilityofcervicalspineunderphysiologicalloadstomaintainrelationshipsbetweenvertebraeinsuchaway,thatspinalcordornerverootsarenotdamagedorirritatedanddeformityorpaindoesnotdevelop

Cervicalspineinstabilityisdefinedasthelossofabilityofcervicalspineunderphysiologicalloadstomaintainrelationshipsbetweenvertebraeinsuchaway,thatspinalcordornerverootsarenotdamagedorirritatedanddeformityorpaindoesnotdevelop

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q Destructionorlossoffunctionofanteriorelements

q Destructionorlossoffunctionofposteriorelements

q Relativetranslationofvertebrainsagittalplane>3.5mm

q Angulationofonevertebratoanother>11mm

q Damagetothecordq Nerverootdamageq Abnormalnarrowingofdiscspace

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q Destructionorlossoffunctionofanteriorelements

q Destructionorlossoffunctionofposteriorelements

q Relativetranslationofvertebrainsagittalplane>3.5mm

q Angulationofonevertebratoanother>11mm

q Damagetothecordq Nerverootdamageq Abnormalnarrowingofdiscspace

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Low-RiskCriteria forClinical ExclusionofCervicalSpine Injury inAlert StablePatientsNEXUScriteriaNoposterior midline cervicaltendernessNo intoxicationNo focalneurologicdeficitNopainfuldistracting injuriesCanadianC-spine rulecriteriaAge<65yearsNodangerousmechanism, suchas:Fall fromheightof>91cm(>3 ft)Axial loading injury (eg,diving accident)High-speedmotorvehiclecollision (MVC)(>100km/h), rollover, orejectionRecreationalmotorvehicle, motorcycle,orbicycleinjuryNoparesthesiasSittingposition inemergencydepartmentAmbulatory atanytimeNeckrotationof45° leftand right

Low-RiskCriteria forClinical ExclusionofCervicalSpine Injury inAlert StablePatientsNEXUScriteriaNoposterior midline cervicaltendernessNo intoxicationNo focalneurologicdeficitNopainfuldistracting injuriesCanadianC-spine rulecriteriaAge<65yearsNodangerousmechanism, suchas:Fall fromheightof>91cm(>3 ft)Axial loading injury (eg,diving accident)High-speedmotorvehiclecollision (MVC)(>100km/h), rollover, orejectionRecreationalmotorvehicle, motorcycle,orbicycleinjuryNoparesthesiasSittingposition inemergencydepartmentAmbulatory atanytimeNeckrotationof45° leftand right

IntheNEXUSstudy,fracturesweremissed in

only8of818casesbyusingtheclinicaldecision tool,withanegativepredictive

valueof99.8%

IntheNEXUSstudy,fracturesweremissed in

only8of818casesbyusingtheclinicaldecision tool,withanegativepredictive

valueof99.8%

Clearance referstotheconfident

exclusionofunstablecervicalspineinjuries

thatcouldotherwiseresultinneurologicinjuryor

death.

Clearance referstotheconfident

exclusionofunstablecervicalspineinjuries

thatcouldotherwiseresultinneurologicinjuryor

death.

GlasgowComaScale(GCS)GlasgowComaScale(GCS)

EE

VV

MM

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TheBabinskisign

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LayersoffibrescombinetogetherandascendupthespinalcordeventuallycommunicatingwiththebrainLayersoffibrescombinetogetherandascendupthespinalcordeventuallycommunicatingwiththebrain.

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CentralCordSyndromeisthemostcommonincompletecordsyndrome.Frequentlyassociatedwithextremehyperextensioninjury.

CentralCordSyndromeisthemostcommonincompletecordsyndrome.Frequentlyassociatedwithextremehyperextensioninjury.Notethatupperlimb deficitgreaterthanlowerextremitydeficit.

AnteriorCordSyndromeseeninflexioninjuriesandpresentswith immediateparalysis,becausethetractsarelocatedintheanterioraspectofthecord.

AnteriorCordSyndromeseeninflexioninjuriesandpresentswith immediateparalysis,becausethetractsarelocatedintheanterioraspectofthecord.

Hangman’sFractureusuallythoughtofasahyperextensioninjurybutmayoccurfromforcedflexion.

Hangman’sFractureusuallythoughtofasahyperextensioninjurybutmayoccurfromforcedflexion.

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TheC2fractureaccountsfornearly19percentofallspinalfracturesand55%ofcervicalfractures.TheC2fractureaccountsfornearly19percentofallspinalfracturesand55%ofcervicalfractures.

AsuddenforcefulhyperextensioncentredjustunderthechinAsuddenforcefulhyperextensioncentredjustunderthechin

HangmanFracturescanandhavewalkedoffthefield…

Mostpatientsareneurologicallyintactmeaningthatthereisnoinjurytothespinalcordand/ornervesatthelevelofthefracture.

Typicallythereisneckpain,whichisthemostcommon

symptom.

Mostpatientsareneurologicallyintactmeaningthatthereisnoinjurytothespinalcordand/ornervesatthelevelofthefracture.

Typicallythereisneckpain,whichisthemostcommon

symptom.

BewaretheSideshowAlley

Clown!

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BewaretheMiracleofTransientParalysis..

Playerswhoexperiencethismayhavearapidandcompleteresolution….

BUTthese playersshouldbestronglyadvisedtohaveanXray andMRI

Shouldnever beallowedtoreturntothefieldifsymptomspersist.

Playerswhoexperiencethismayhavearapidandcompleteresolution….

BUTthese playersshouldbestronglyadvisedtohaveanXray andMRI

Shouldnever beallowedtoreturntothefieldifsymptomspersist.

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Q.Thestrongestriskfactorforstingerinjuriesaswellaslastingsymptoms.

BMI

Gradeandpositionofplay

BMI

Gradeandpositionofplay

Ahistoryof stingers in theprevious seasonwasidentified tobethestrongest risk factor

Ahistoryof stingers in theprevious seasonwasidentified tobethestrongest risk factor

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Ifaplayersuffers aTHIRDstingerinthesameseason,theplayershouldsitouttheremainderofthegameEven ifsymptomsresolvecompletely.

Ifaplayersuffers aTHIRDstingerinthesameseason,theplayershouldsitouttheremainderofthegameEven ifsymptomsresolvecompletely.

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UpperLimbDermatomes

C6

C7

C8 8

C3/4Shoulder Shrug

C5Elbow Flexion

C6Wrist Extension

C7Elbow Extension

C8FingerFlexion

T1FingerAbduction

UpperLimbMyotome Testing

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Aplayerwhowalksoffthefieldwithaneckinjuryshouldbequestionedandexaminedinaseatedpositionaway

fromdistractionsandcoaches.

Aplayerwhowalksoffthefieldwithaneckinjuryshouldbequestionedandexaminedinaseatedpositionaway

fromdistractionsandcoaches.

Displacement doesnotexplainadditional traumaticinjury,butratherthattheamountofforceappliedacrossanunstablesegmentisthekeydeterminantofneurologicdeterioration.

Displacement doesnotexplainadditional traumaticinjury,butratherthattheamountofforceappliedacrossanunstablesegmentisthekeydeterminantofneurologicdeterioration.

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Youngchildrensustaininjuryprimarilytothe

uppercervicalspine(C1-C4),whereaschildrenolderthan

8yearsandadolescentstendto

sustainlowercervicalinjury

(C5-C7).

Youngchildrensustaininjuryprimarilytothe

uppercervicalspine(C1-C4),whereaschildrenolderthan

8yearsandadolescentstendto

sustainlowercervicalinjury

(C5-C7).

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Inthefield,childrenwhohavesymptomssuggestiveofspinalinjuryshouldhavetheircervicalspineimmobilizedduringinitialevaluationandmanagement.

Inthefield,childrenwhohavesymptomssuggestiveofspinalinjuryshouldhavetheircervicalspineimmobilizedduringinitialevaluationandmanagement.

High-RiskmechanismsHighforce orvelocity (fallsfromheights>1.5mor3timesthebodylengthandmotorvehicle accidents),Divinginjuries,blunttraumaticinjuriesfromcontact orcollisionsports(eg,football,hockey,soccer),anysignificantacceleration-deceleration injury.

High-RiskmechanismsHighforce orvelocity (fallsfromheights>1.5mor3timesthebodylengthandmotorvehicle accidents),Divinginjuries,blunttraumaticinjuriesfromcontact orcollisionsports(eg,football,hockey,soccer),anysignificantacceleration-deceleration injury.

Localizedcervicalspinepain,

Musclespasms,and

Limitedneckrangeofmotion

constitutetheclassicTriadofsymptomsassociatedwith

cervicalspineinjury.

SCIWORASCIWORASpinalCordInjuryWithoutRadiologicAbnormalitySpinalCordInjuryWithoutRadiologicAbnormality

Shouldbesuspectedinpatientsyounger than8years whoexperience blunttrauma andreport immediate, usuallytransient, neurologicsymptoms(paresthesias, numbness,orparalysis) andwhoseXrays andor(CT)imagingstudiesare normal.

Shouldbesuspectedinpatientsyounger than8years whoexperience blunttrauma andreport immediate, usuallytransient, neurologicsymptoms(paresthesias, numbness,orparalysis) andwhoseXrays andor(CT)imagingstudiesare normal.

The onsetofsymptomsinupto25%ofcasesmaybedelayed upto4days.

Upto61%ofpatientswithaclinicaldiagnosisofSCIWORAhave abnormalitiesonMRI;therefore, anMRIshouldbeperformed whenclinicalconcernforSCIWORAispresent.

The onsetofsymptomsinupto25%ofcasesmaybedelayed upto4days.

Upto61%ofpatientswithaclinicaldiagnosisofSCIWORAhave abnormalitiesonMRI;therefore, anMRIshouldbeperformed whenclinicalconcernforSCIWORAispresent.

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Thecomplexanatomyofthehumanneckallowsforhighflexibilityinrotationandtranslationthroughsevencervicalvertebraecontrolledbyover70muscles.

Thecomplexanatomyofthehumanneckallowsforhighflexibilityinrotationandtranslationthroughsevencervicalvertebraecontrolledbyover70muscles.

Analysisofisometriccervical

strengthwithanonlinear

musculoskelealmodel

Analysisofisometriccervical

strengthwithanonlinear

musculoskelealmodel

Thepotentialforrepeatedminorneckinjuriestoleadtopathologicalchangesinthecervicalspineisanareaofconcern.

Thequestionsthenbecome:

Whatcanbedonetopreventtheseinjuriesfromhappening.

Howcanonereducetheseverityoffutureinjuries?

Thepotentialforrepeatedminorneckinjuriestoleadtopathologicalchangesinthecervicalspineisanareaofconcern.

Thequestionsthenbecome:

Whatcanbedonetopreventtheseinjuriesfromhappening.

Howcanonereducetheseverityoffutureinjuries?

** 27%ofcervicalinjuriessustainedduringrugbyunionmatches were recurrent.** 27%ofcervicalinjuriessustainedduringrugbyunionmatches were recurrent.

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Helicopterpilotswererequiredtoisometricallysustaina70%loadforup

to3minutes.Thisprotocolwas

designedtosimulatetheflightenvironmentwherepilotsarerequiredtoisometrically sustain

postureswhilewearingaflighthelmetandnight

visiongoggles.

Helicopterpilotswererequiredtoisometricallysustaina70%loadforup

to3minutes.Thisprotocolwas

designedtosimulatetheflightenvironmentwherepilotsarerequiredtoisometrically sustain

postureswhilewearingaflighthelmetandnight

visiongoggles.

Tosimulate thedynamicmuscularloadingthatoccursduringarugby game, aNewZealand groupdesigned anendurance protocolthatrequired participants tosustain70%oftheirmax

voluntary contraction forcefor7-secondperiods

interspersed with4secondsat 90%ofMVC.

Tosimulate thedynamicmuscularloadingthatoccursduringarugby game, aNewZealand groupdesigned anendurance protocolthatrequired participants tosustain70%oftheirmax

voluntary contraction forcefor7-secondperiods

interspersed with4secondsat 90%ofMVC.

IntheSuper rugby competition,forwardsspendanaverage of7.1+/- 2.7secondsinstaticplay,definedasrucking, mauling,orscrumming,interspersed byrunning,jogging,orwalking.

IntheSuper rugby competition,forwardsspendanaverage of7.1+/- 2.7secondsinstaticplay,definedasrucking, mauling,orscrumming,interspersed byrunning,jogging,orwalking.