Spinal cord injury
Dr. Tahir Mahmood
Objectives
Mechanism of spinal cord injury
Assessment of SCI
Management of spinal cord injury
Mechanism of spinal cord injury
Neuropraxia
Commonly known as “stingers” or “burners,”
This injury typically involves either a stretching or a
compression of one or more nerves of the brachial plexus
as a result of a combination of cervical and shoulder girdle
motions.
The force imparted to the nerve creates a temporary
disruption of nerve function.
Signs and symptoms include the following: Immediate
onset of burning pain, numbness, or tingling in the
supraclavicular region that typically extends down into the
arm, sometimes as far as the hand.
Neuropraxia
Some degree of motor function disruption in the shoulder and arm,
manifesting along a continuum from mild weakness to complete loss of
function.
Cervical range of motion is typically pain free and full. Two main
characteristics of a stinger distinguish it from a more serious injury to the
spinal cord:
1. Signs and symptoms of a stinger are unilateral and only in the upper
extremity. Bilateral signs and symptoms,or signs and symptoms that are felt
in the upper and lower extremity on the same side, are not consistent with a
stinger and should be regarded as very serious.
2. Signs are symptoms are transient, usually lasting only a few seconds to a
few minutes.
Signs and symptoms that persist longer than several minutes should be
regarded as more serious.
Primary and Secondary Injuries
to the Spinal Cord
PRIMARY INJURIES
Immediate effect on function as a result of:
Compression
Stretching
Laceration
Concussion of the spinal cord
SECONDARY INJURIES
Delayed effect on function, usually as a result of progressive or
ongoing ischemia.
Spinal cord contusion
Spinal cord compression
Spinal cord hemorrhage
Assessment
On-Field Assessment of an Athlete with a Potential
Cervical Spine Injury
1. Determine mechanism of injury if possible.
2. While moving to athlete, determine level of
consciousness of athlete if possible (is the athlete
moving?).
3. Manually stabilize head and neck of injured athlete.
Assessment
4. Determine level of consciousness; if unconscious,
activate EMS.
5. Check ABCs.This may require rolling a prone athlete.
6. Activate EMS, manage airway, and begin rescue
breathing or CPR if necessary.
7. Perform secondary assessment.
8. Continue to monitor vital signs for changes.
Manual stabilization of the head & neck
Manual stabilization of the cervical spine. Hands should be
on both sides of the head with fingers spread to provide the
most control over head and neck movements.
Traction/compression is not recommended
Application of a rigid cervical collar
Manual stabilization is maintained while the second
rescuer applies the collar.
On-Field Secondary Assessment
1. Palpation of neck: pain, obvious deformity, bleeding,
spasm?
2. Motor testing of upper extremities
3. Sensory testing of upper extremities
4. Motor testing of lower extremities
5. Sensory testing of lower extremities
6. Reassessment of vital signs
7. Continued reassurance of injured athlete
Motor assessment
Upper-extremity motor function testing.
Upper left: Bilateral comparison of grip
strength.
Right: Finger abduction/adduction.
Lower left: Wrist extension.
Motor assessment
Finger extension
Sensory assessment
Upper-extremity sensory testing.
Left: Soft brush, repeated over as many
dermatomes as possible.
B: Sharp pin, repeated over as many
dermatomes as possible.
Lower-extremity motor function testing
Lower-extremity motor function testing.
Left:“Pushing on the gas pedal” (ankle plantarflexion).
right: Pulling toes toward the head (ankle dorsiflexion).
Management
Specific equipment required for spine boarding
procedure: long spine board with handles, rigid cervical
collar, head immobilization device, straps.
Log roll method
1. All commands will come from the rescuer controlling the
head of the athlete.
2. The athlete is positioned with arm overhead, straight legs.
3. Rescuers and spine board are positioned.
4. The athlete is grasped by rescuers.
5. On command, the athlete is carefully rolled toward rescuers
until the command to stop is given; the athlete is held
against rescuers’ thighs.
6. The spine board is positioned.
7. On command, the athlete is carefully rolled back to supine
position.
The Log Roll Method
Straddle Slide Method
1. All commands will come from the rescuer controlling the
head of the athlete.
2. The athlete is positioned with straight legs, arms at sides.
3. Rescuers and spine board are positioned.
4. The athlete is grasped by rescuers.
5. On command, the athlete is carefully lifted straight up
until the command to stop is given.
6. The spine board is positioned.
7. On command, the athlete is carefully lowered back down
to the spine board.
The Straddle Slide Method
Log Rolling From a Prone Position
1. All commands come from the rescuer controlling the
head of the athlete.
2. The athlete’s arms and legs are carefully straightened
as directed.
3. Three (or four) rescuers are positioned on the side of
the direction of the roll with the spine board lying
against their upper legs; one rescuer is positioned on
the opposite side of the athlete to help control the roll
and to help prevent the athlete from sliding as the
board is lowered.
Log Rolling From a Prone
Position
4. On command, the athlete is carefully rolled from prone
to sidelying and then down onto the spine board; the
position of the head in relation to the trunk is
maintained throughout the roll.
5. The spine board is carefully lowered to the ground.
6. The head can then be slowly and incrementally returned
to a neutral position as discussed earlier in this chapter.
7. A rigid cervical collar should then be applied. Or, in
cases where the athlete is wearing a helmet, the face
mask should be removed.
Log Rolling From a Prone
Position
Log Rolling From a Prone
Position
Head immobilization devices
Removal of equipment
Protective equipment such as helmets and shoulder
pads should not be removed unless absolutely
necessary
The airway can be controlled and an AED can be
applied with only the helmet face mask removed.
Removal of equipment
Reasons for removing a helmet include inability to
remove the face mask or situations in which the
helmet does not hold the athlete’s head securely
If the helmet is removed, the shoulder pads must also
be removed to prevent potential hyperextension of the
athlete’s cervical spine.
Secondary injury
Secondary injury to the spinal cord can be limited
with the appropriate use of steroid medications
immediately following the traumatic event.
Assignment
Describes equipment removal method
