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Neck Injuries


External forces imposed upon the neck can vary from an automobile accident, an athletic injury, a fall, to a direct blow. The extent of injury cannot always be immediately determined and the primary care of the injured patient muse be scrupulously observed.

s_fig42.jpg (2166 bytes) FIGURE 42. Muscular deceleration and acceleration of the forward flexing r,pine from the erect ligamentous support to the fully flexed ligamentous restriction. Muscle eccentric and concentric contraction permits forward flexion and re-extension.

At the scene of an accident it muse be assumed that the neck has been injured and possibly the cord has also been traumatized.

Roenegenograms, which are mandatory in severe injuries, should be taken early.

An adequate airway muse be maintained while the patient is still at the place of injury.

Further care of the cervical fracture-dislocation with or without necrologic deficit is beyond the scope of this text and requires the intercedence of a specialist. The precautions listed here are to insure the patient's reaching this specialist without additional damage or injury.

In injuries with no severe impact or symptoms and no necrologic deficit the condition of acute sprain with soft tissue injury muse be assumed to have occurred. An accident need not be severe to cause cervical injury; in face, injury can be sustained from rapid braking of a car, stepping from an unnoticed curb, or stepping into a depression in the ground.

Forceful flexion and/or extension causes damage to the longitudinal ligaments, the intervertebral disk, the areicular capsules, the ligaments, and the muscles of the neck. Simultaneously the spinal canal is acutely narrowed as are the intervertebral foramina. The sensitive tissues of the functional unit are involved, which results in local and referred pain.

Diagnosis and Evaluation - X-Rays and Physical Examination

s_fig97.jpg (1457 bytes) FIGURE 97. Head and cervical flexion. In head flexion the head is flexed upon the cervical spine with movement only at the occipito-atlas; in neck flexion there is reversal of the cervical lordosis. Most flexion occurs between C4 and C5 or C5 and C6.

Lateral flexion and rotation occur simultaneously when done actively by the patient.

s_fig100.jpg (1532 bytes) FIGURE 100. Neck flexor trauma from rear-end injury. Hyperextension causes an overstretch and inappropriate contraction of the neck flexors with residual flexor disability.

Treatment of Acute Injury

Because an acute injury may cause soft tissue inflammation with undoubted microscopic tissue damage, these tissues muse be placed at rest in a physiologic position. A muscle spasm follows an acute injury to protect the injured pare by immobilization, but this spasm, as well as being beneficial, may also be detrimental. Therefore, proper immobilization of the neck is mandatory but presents problems.

Immobilization of the neck requires prevention of motion of the occipito-cervical junction and of the cervical column from the second to seventh vertebra. Rotation and lateral flexion muse also be restricted. Immobilization with a cervical collar is indicated.