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| Home > Spinal Disorders > Sprains/Fractures |
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SPRAINS/FRACTURES
Overview
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A sprain is an injury to the soft tissues that support the spine, such as muscles, ligaments and tendons. When a bone in the spine cracks or breaks, it is called a fracture. The following text is a general overview of types, symptoms and diagnosis of sprains and fractures.
Anatomy and Function of the Spine
To better understand how a sprains and fractures occur, it is helpful to know some anatomy of the spine and more specifically, the parts of the spine involved. See Spinal Anatomy for more information.
Types of Sprains/Fractures
Sprains to the spine most often occur in the neck. A cervical sprain, commonly known as "whiplash", is a stretch or tear in the ligament resulting from a sudden movement that causes the neck to extend to an extreme position, as in a rear-end car collision.
Fractures, cracks or breaks in the the spinal vertebrae, can occur as a result of osteoporosis, a disease that thins the bones. Trauma to the spinal vertebrae can also lead to minor or severe fractures. Such trauma could come from a fall, a forceful jump, a car accident, or any event that stresses the spine past its breaking point.
Detailed information on common sprains/fractures including treatments and case studies is provided on the following pages:
Symptoms
Common symptoms for a sprain include headaches and pain in your neck, shoulder, arm, or hands. You may experience reduced range of motion in your neck and numbness, weakness, and slower reflexes in your arms, hands, legs, or feet.
If the fracture is caused by a sudden, forceful injury, you will probably feel severe pain in your back, legs, and arms. You might also feel weakness or numbness in these areas if the fracture injures the nerves of the spine. If the bone collapse is gradual - such as a fracture from bone thinning, the pain will usually be milder. There might not be any pain at all until the bone actually breaks.
Diagnosis
Making the diagnosis of a sprain or fracture begins with a complete history of the problem and a physical examination. The main questions your doctor will be interested in are:
- When did the pain begin?
- Was there an injury that could be related to the pain?
- Where do you feel the pain? What is the intensity?
- Does the pain radiate to other parts of the body?
- Have you had problems with your bladder or bowels?
- Have you had any weight loss, fevers, or illnesses recently?
- Is there a history of osteoporosis in your family?
After taking your history, the physician will give you a physical examination. This allows the doctor to rule out possible causes of pain and to try to determine what is causing your problems. The areas of your body that will be examined depend upon where you are experiencing pain - neck, lower back, arms, legs, etc. Neurological problems are rare except in younger patients who have experienced a violent injury, such as a car crash.
Once most of the information is gathered, your doctor will give you a thorough physical exam. In diagnosing a cervical sprain, your doctor will look at your neck to find out how well it is functioning. This includes:
- How well you can bend your neck and roll your head in all directions
- How well you can twist your neck
- If there is tenderness around the neck
- If there are muscle spasms around the neck and shoulders
Tests that examine the nerves that leave the spine are also important. These include:
- Testing for numbness in the arms and hands
- Testing the reflexes
- Testing the strength of the muscles in the arms, hands, and legs
- Testing for signs of nerve irritation
If a fracture is suspected, the doctor will also test for point tenderness near specific vertebrae. Testing specific areas for unusual tenderness allows the doctor to narrow down the cause of your pain.
If a fracture is thought to exist, your doctor may order diagnostic tests. An X-ray of the spine will generally confirm the presence of a fracture. An X-ray is a painless process that uses radioactive materials to take pictures of bone. X-rays show bones, but not much soft tissue, so X-rays will definitely be used if fractures are suspected.
If there is a fracture, your doctor may also suggest a CT scan to make sure that the fracture is stable. The CT scan is an X-ray test similar to both the MRI and a regular X-ray, because it can show both bones and soft tissues. CT scans are also able to produce X-ray "slices" taken of the spine, so each section can be examined separately. The scan forms a set of cross-sectional images. With a compression fracture, an up and down perspective of the spine will be pieced together for examination of stability. The CT scan is usually done to see if the nerves are in danger from the fracture.
A neurological exam will also be given. This allows the doctor to test your neurological responses, such as your reflexes, muscles, and sensory perception. Abnormalities on the neurological examination can point to nerve damage. The nerves of the spinal cord carry messages from the brain to the rest of the body. If there is damage to the spinal nerves, your body movement and neurological responses will be affected.
If there is a chance that nerves are involved in the fracture, or if there is some question about what is causing the pain, an MRI might be recommended. The MRI scan is a fairly new test that does not use radiation. By using magnetic and radio waves, the MRI creates computer-generated images. The MRI is able to cut through multiple layers of the spine and show any abnormality of soft tissues, such as nerves and ligaments.
A nuclear bone scan is another diagnostic test that might be ordered. This test helps determine the age of a fracture. If the fracture is old and there appear to be other fractures that have healed, this may indicate osteoporosis (bone-thinning disease) is causing the fractures. This is important in older patients, particularly women. In this case, treatment of the fracture will include preventive measures to try to stop other vertebral fractures from occurring. Such treatment could include: calcium supplements, increased vitamin D, weight-bearing exercises, and hormone replacement therapy for women.
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Excerpts of this article (text/graphics) were provided by
"AllAboutBackandNeckPain.com" DePuy Spine ©2003.
All rights reserved.
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