Chapter 10

Injuries to the Thoracic Through Coccygeal Spine

In Your Notebooks:

• How many vertebrae make up the Spine?• How Many ribs make up the rib cage?

In Your Notebooks:

• What three sections is the spine broken down into?

Vertebrae Anatomy Review

• What is the Vertebral Body?• What is the Lamina?• What is the Spinous Process?• What is the Transverse Process?• What are the Facet Joints?• What are the Intervertebral discs?• What are the 2 parts of the Intervertebral

discs?

In Your Notebooks:

• What are the four important parts of the vertebrae we talked about yesterday?

• What are the two parts of the intervertebral discs?

Sacral Anatomy Review

• What is the most distal portion of the vertebral column?

• How many Sacral vertebrae are there?• Are the Sacral vertebrae moveable?

Lumbar Anatomy Review

• How many lumbar vertebrae are there?• What are the names of the large, strong

ligaments that support the spine?• What type of curve do the lumbar vertebrae

create?

Thoracic Anatomy Review

• How many Thoracic Vertebrae are there?• What type of curve do the Thoracic Vertebrae

create?• What three parts make up the “Thoracic

Cage”?• What is the function of the Thoracic Cage?• Is the Thoracic cage very mobile?• Where does most movement of the Thoracic

Cage occur?• Are Thoracic Injuries common in sports?

In Your Notebooks:

• What type of curve does the lumbar spine create? What is the Anatomical name given to this type of curve?

• What type of curve does the thoracic spine create? What is the Anatomical name given to this type of curve?

In Your Notebooks:

• What problems do you think could arise from an excessive kyphotic or lordotic curve of the spine?

Terms:

• Kyphosis• Lordosis• Hyper• Hypo• Scoliosis

Number Your Paper 1-10

1. Student’s Name

Hyper/Hypo Kyphosis?

Hyper/Hypo Lordosis?

Scoliosis? S curve or C curve?

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.

In Your Notebooks:

• What types of injuries do you think can happen to the Thoracic and Lumbar Spine?

• List 3…

Common Sports 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.

• Scheuermann’s disease is adolescent condition characterized by kyphosis. Children with chronic thoracic pain should be evaluated.

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.

• Posterior rib fractures can potentially result in a pneumothorax or a hemothorax.

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.

• Swelling and discoloration.• Pain when rib cage is gently compressed.

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.

First Aid• Apply RICE.• If dyspnea 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.

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

(cont.) • Symptoms include 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, and shock are signs and symptoms of internal injury.

• Immobilize on spine board and transport to medical facility.

• 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.

• 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.