- A bursa is a fluid-filled sac that acts as a cushion between bones, muscles, and ligaments near joints. Injury to a bursa can cause pain, limited motion, and decreased mobility.
- The cervical vertebrae are the smallest and most movable part of the spine. Injuries can occur from direct or indirect trauma and include fractures, dislocations, and ligament injuries.
- Treatment depends on the injury but may include immobilization, traction, steroids, and surgery to stabilize or fuse the spine to preserve neurological function and spinal stability.
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Cervicolumber Injury.pptx
1. Bursa/Bursae
⢠A bursa is a small, fluid-filled sac within your
body that lies near bony prominences and
joints. The bursa acts as a cushion between
muscles, ligaments, and bones and allows
structures to glide and slide past one another
with ease and with minimal friction. Injury to
a bursa may cause pain, limited motion, and
decreased functional mobility.
2. Types of bursa
⢠Synovial. Near the synovial membrane of the
joints
⢠Adventitious. The accidental bursa occur only
after continued shearing or repeated pressure
over a bony prominence. A bunion is an
example of an adventitious bursa.
⢠Subcutaneous. These bursae lie between your
skin and a bony prominence
7. ⢠The cervical vertebrae are the smallest of the
moveable vertebrae, and are characterized by
a foramen in each transverse process.
8.
9.
10. ⢠Readily identified by the foramen
transversarium perforating the transverse
processes. This foramen transmits the
vertebral artery, the vein,and sympathetic
nerve fibres
⢠Spines are small and bifid (except C1,C7 which
are single)
⢠Articular facets are relatively horizontal
11. ⢠Nodding and lateral flexion movements occur
at the atlanto-occipital joint
⢠Rotation of the skull occurs at the atlanto-
axial joint around the dens, which acts as a
pivot
14. PRINCIPLES OF DIAGNOSIS AND
INITIAL MANAGEMENT
⢠Diagnosis and management go hand in hand
⢠Inappropriate movement and examination can
irretrievably change the outcome for the worse
⢠Early management
⢠â Airway, Breathing and Circulation
⢠â Slightest possibility of a spinal injury in a
trauma patient, the spine must be immobilized
until the patient has been resuscitated and other
life-threatening injuries have been identified and
treated.
15. ⢠A stable injury is one in which the vertebral
components will not be displaced by normal
movements;
⢠In a stable injury, if the neural elements are
undamaged there is little risk of them becoming
damaged.
⢠An unstable injury is one in which there is a
significant risk of displacement and consequent
damage â or further damage â to the neural
tissues.
17. TREATMENT
⢠HARD COLLAR IMMOBILIZATION FOR 12
WEEKS AND AVOIDANCE OF FLEX/EXT
ACTIVITIES FOR ANOTHER 12 WEEKS HAS NOT
BEEN ASSOCIATED WITH RECURRENT INJURY
18. PRINCIPLES OF DEFINITIVE
TREATMENT
ďThe objectives of treatment are:
⢠to preserve neurological function;
⢠to minimize a perceived threat of neurological
compression;
⢠to stabilize the spine;
⢠to rehabilitate the patient
19. The indications for urgent surgical
stabilization
⢠(a) an unstable fracture with progressive
neurological deficit and MRI signs of likely
further neurological deterioration; and â˘
⢠(b) controversially an unstable fracture in a
patient with multiple injuries
23. ď ⢠Occipital condyle fracture:
⢠⢠This is usually a high-energy fracture and associated
skull or cervical spine injuries must be sought.
⢠⢠The diagnosis is likely to be missed on plain x-ray
examination and CT is essential.
⢠⢠Impacted and undisplaced fractures can be treated
by brace immobilization for 8â12 weeks.
⢠Displaced fractures are best managed by using a halo
vest or by operative fixation.
24. ďOccipito-cervical dislocation:
⢠⢠This high-energy injury is almost always
associated with other serious bone and/or
soft-tissue injuries, including arterial and
pharyngeal disruption, and the outcome is
often fatal.
⢠⢠Patients are best dealt with by a
multidisciplinary team of surgeons and
physicians.
26. ⢠The injury is likely to be unstable and requires
immediate reduction (without traction!) and
stabilization with a halo-vest, pending surgical
treatment.
⢠After appropriate attention to the more serious soft
tissue injuries and general resuscitation, the dislocation
should be internally fixed;
⢠specially designed occipito-cervical plates and screws
are available for the purpose.
⢠In severely unstable injuries, halo-vest stabilization
should be retained for another 6â8 weeks.
27. ⢠Posterior ligament injury
if it is certain that the injury is stable, a
semirigid collar for 6 weeks is adequate;
⢠⢠if the injury is unstable then posterior
fixation and fusion is advisable
28. ⢠Wedge compression fracture
A pure flexion injury results in a wedge
compression fracture of the vertebral body â˘
The middle and posterior elements remain
intact and the injury is stable.
⢠⢠All that is needed is a comfortable collar for
6â 12 weeks.
29. SPRAINED NECK (WHIPLASH INJURY)
⢠Soft-tissue sprains of the neck are so common
aftermotor vehicle accidents.
⢠There is usually a history of a low velocity rear-
end collision in which the occupantâs body is
forced against the car seat while his or her head
flips backwards and then recoils in flexion.
⢠This mechanism has generated the imaginative
term whiplash injury, which has served effectively
to enhance public apprehension at its occurrence
32. Clinical features
⢠Often the victim is unaware
⢠Pain and stiffness of the neck
⢠Pain sometimes radiates to the shoulders or
interscapular area
⢠Neck muscles are tender and movements
often restricted;
33. ⢠X-ray examination may show straightening out
of the normal cervical lordosis, a sign of
muscle spasm
34. ď⢠Proposed grading of whiplash-associated
injuries
⢠Grade Clinical pattern
⢠0 No neck symptoms or signs
⢠1 Neck pain, stiffness and tenderness, No physical
signs
⢠2 Neck symptoms and musculoskeletal signs
⢠3 Neck symptoms and neurological signs
⢠4 Neck symptoms and fracture or dislocation
35. Treatment
⢠⢠Collars are more likely to hinder than help recovery.
⢠⢠Simple pain-relieving measures, including analgesic
medication, may be needed during the first few weeks.
⢠However, the emphasis should be on graded
exercises,
⢠⢠beginning with isometric muscle contractions and
postural adjustments, then going on gradually to active
movements and lastly movements against resistance.
⢠⢠The range of movement in each direction is slowly
increased without subjecting the patient to
unnecessary pain.