OCCTH 583 - Neck and Trunk 2024 PDF

OCCTH 583 Neck and Trunk Jennifer Krysa, MSc, OT Reg (AB), OTR  Outline  Structure and Function of the neck and back  Bones  Ligaments  Nerves  Muscles  Conditions related to the neck and back The Trunk: Osteology  Skull ...

OCCTH 583 Neck and Trunk Jennifer Krysa, MSc, OT Reg (AB), OTR  Outline  Structure and Function of the neck and back  Bones  Ligaments  Nerves  Muscles  Conditions related to the neck and back The Trunk: Osteology  Skull  Ribs  Sternum  Vertebral Column  Pelvis (Ilium)  Vertebral Column 5 regions:  Cervical (C1-7)  Thoracic (T1-12)  Lumbar (L1-5)  Sacrum (5 fused segments)  Coccyx (4 fused segments)  Vertebra  Vertebral body: structure & support; absorbs compressive forces  Vertebral arch formed by pedicles & laminae; protects spinal cord  Vertebral foramen: the bony canal for spinal cord; posterior to vertebral body Vertebra is singular, vertebrae is plural Vertebra - Processes  Spinous process: projects dorsal & inferior  The first palpable spinous process is C2  Transverse process: projects laterally  Superior facet  Inferior facet Vertebra – Lateral View  Superior & inferior facets joints between the vertebrae  Thoracic vertebra also have costal facets (ribs) Cervical Spine  C1 (atlas)  No body  C2 (axis)  Otontoid process (dens) evolved from body of C1  C-spine more mobile  Atlanto-axiaal facet joints quite shallow C-spine Cont’d  Transverse foramen on C1-C7  Vert a. travels thru C1-C6  C3-C7 called the subaxial vertebra  Bifid spinous process C2-C6  They are morphologically similar  C7 is a transitional vertebra with smaller (or absent) transverse foramen and usually not bifid C-spine: Intervertebral Discs  Approx 25% of the height in C-spine  Nucleus pulposus distributes axial compressive forces  Annulus fibrosus withstands tension in the disc  No disc between occiput & C1 nor C1-C2  Gives the lordotic shape to the C-spine Function of the Vertebral Column  Protection  Support  Provides an axis for the body and pivot for the head  Posture and locomotion Spine Ligaments  Anterior Longitudinal Ligament (ALL): from occipital bone (&C1) to sacrum  Limits extension  Posterior Longitudinal Ligament (PLL): within the vertebral canal from C2 to sacrum; mostly to IV discs Intervertebral Jt Ligaments  Ligamentum flavum: lamina to lamina of adjacent vertebral arches  Supraspinous Ligament: thick; tips of spinous processes C7 to sacrum  Interspinous Ligament: thin: adjoining spinous processes from root to apex  Intertransverse ligaments: adjacent transverse processes Spinal Nerves 31 pairs  Dorsal roots – afferent (sensory) fibers  Ventral roots- efferent (motor) fibers SAME Sensory-Afferent Motor-Efferent Spinal nerve roots  Named for the vertebra below it (C1 to C7)  Rest of spine named for vertebra above starting with T1  C8 spinal nerve root is between C7 and T1 vertebrae Spine Musculature  Spinal muscles surround and support spinal column.  Agonist and antagonist muscles act simultaneously.  Co-contraction:  Exerts force in different directions to stabilize  Acts as synergists for movement Muscles of the Neck  Muscles of the Back Groups of back muscles:  Superficial (Extrinsic)/Intermediate  Responsible for movements of the scapulae and shoulder and respiratory movements  Deep (Intrinsic)  Responsible for movements of the spine and maintaining posture Muscles of the Back Conditions of the Neck and Back Hyperextension Injury of Neck (Whiplash)  MOI: Sudden and forceful hyperextension of head WITH neck – e.g. MVA or sports  Limit neck extension to 70 degrees  There is no anatomic block  Neck sprain or strain  Mm, nn, discs, ligaments  Usually resolves in a few weeks Cervical Dystonia (Spasmodic Torticollis)  A movement disorder  Muscle spasm & involuntary movements  Can be painful or result in headache Congenital Torticollis  Shortened sternocleidomastoid muscle  Appears at or shortly after birth  Cause unknown  Treatment: r/o bony casues; stretching & ROM  Important for typical skull formation  Common Conditions  Kyphosis – abnormal increase in the thoracic curvature  Lordosis- anterior rotation of the pelvis  Scoliosis- abnormal lateral curvature accompanied by rotation of the vertebrae Disc Conditions  Degenerative Disc Disease  Bulging Disc  Herniated Disc  Cervical discs mostly commonly ruptured are between C5-C6 and C6-C7 Spinal nerve roots are compressed causing pain & dysfxn Vertebral Fracture  MOI:  Sudden, forceful flexion or extension of the vertebral column  Atraumatic compression fracture (osteoporosis)  T11 or T12 most commonly fractured non-cervical vertebrae due to trauma  Thoracic spine most common place for compression fracture Vertebral Fracture/Dislocation  Cervical vertebrae more stacked, less interlocked so easier to dislocate  Can spare spinal cord  Hangman’s fracture: fracture & dislocation of axis (C2)  MOI: hyperextension of head ON neck  Dens of axis fracture: MOI horizontal blow to head or osteopenia Other Conditions  Spondylosis – OA of the spine  Usually cervical or lumbar  Spinal Stenosis- narrowing of the spinal canal Other Spine Conditions Cont’d  Spondylolysis – stress fracture of vertebra (pars interarticularis is the weakest portion of the vertebra)  Usually L5, sometimes L4  Unilateral or bilateral  Spondylolisthesis – anterior displacement of vertebra due to above fracture  Common Conditions  Muscle Strain  Ligament Sprain  Signs, Symptoms, Sequelae  Foot drop  Sciatica  Cauda Equina Syndrome  Nerve root compression (herniated disc or injury)  Medical emergency requiring Sx  Pain, weakness, urinary retention or incontinence  Clinical Importance  Back pain – most common cause of disability for those under age 45  Majority of people can return to normal function after 4- 6 weeks  7-10% of people will develop chronic back pain  Many factors affect back health  Dermatomes  Surface of the skin is divided into specific areas called dermatomes  Useful in clinical practice to help ax possible injury involving the spine by localizing neurological levels by observing:  Weakness in extremities  Absent deep tendon reflexes  Reports of radiculopathy (symptoms related to irritation of a nerve root i.e. numbness, tingling) Dermatomes Diagnostic Tests  X-rays – electromagnetic radiation  Bone Scan – radioactive tracer injected; bony disruption uptakes the tracer  CT Scan – computed tomography using x ray  MRI- magnetic resonance imaging using strong magnetic gradients and radio waves  Nerve Conduction Studies (NCS) – flow of electrical current through a peripheral nerve  Electromyography (EMG)- amount of electrical activity produced by a muscle contraction EMG & NCS usually performed together, but as separate tests Reflex Testing  Knee – L3/L4  Ankle – S1/S2 Neck Special Tests  Are beyond the scope of OT practice  Refer to physiotherapist colleagues Slump Test  Impingement of dura and spinal cord or nerve roots  Progressively provocative until symptoms repoduced  Start: in sitting Pt flexes spine & sags shoulders forward (slumps)  1: examiner holds head chin too keep head erect  2. flex neck  3. extend knee  4. dorsiflex ankle  Surgical Interventions  Spinal fusion – joining vertebrae together  Laminectomy – removal of spinous process and lamina  Foraminotomy – widen space where nerve root exits  Discectomy – removal of all or part of vertebral disc  Conservative Interventions Treatment: Restore function of the muscles, ligaments and joints.  Most back injuries are treated conservatively Conservative treatments include:  Modalities- heat, ice, ultrasound, TENS machine  Proper posture and lifting techniques  Stretching  Strengthening  Low Impact Aerobic Conditioning Common OT Interventions  Education  Therapeutic exercise  Mobility  Strength  Endurance  Environmental modifications  Adaptive equipment  Prevention (ergonomics) Resource: Occupational Therapy: Body Postures During Daily Activity Case Study 1  Fredo is a 68 y.o. experiencing back pain that radiates down his left leg. He was diagnosed with spinal stenosis by his physician which was confirmed with MRI.  What is spinal stenosis?  Why does it cause pain?  What recommendations do you have for Fredo for his weekly golf game? Case Study 2  Bart is recovering from a laminectomy. At 10 weeks post- op his incision is fully healed and has been back at home with his spouse for a few weeks.  Bart wants to have a soak in his tub, what do you recommend?  His partner has been managing all household tasks and assists Bart with his dressing. What are some tasks that Bart could start to do?  What might limit Bart from fully engaging in ADLs & I- ADLs?