COMMON BACK INJURIES

Here are a few of the more common back injuries resulting from car crashes:

A. TORN ANNULUS - The Annulus is the disc tough outer ring which is composed of connective tissue. A sudden movement or blunt trauma may cause a spinal tear in the annulus which may also cause a nearby ligaments to stretch which will cause back pain.

B. BULGING DISC - As a disc wears out or there is a sudden trauma to the disc, the spongy center of the disc “nucleus” may force the disc to push out and put pressure on the spinal nerve causing back and leg pain.

C. HERNIATED DISC OR RUPTURED DISC - Is where the jelly-like material of the disc (nucleus) has pushed through the annulus and is pinching on the spinal nerves. This usually results in pain radiating down the spinal nerve. With a herniated disc in the neck, the radiated pain usually travels down the arms. With a herniated disc in the low back, the pain, numbness and tingling usually travels down the injured persons leg.

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TREATMENT OF BACK INJURIES

Depending on the severity of the herniated disc and the number of herniated discs, there are several different types of surgery set forth as follows:

DISCECTOMY - This is where the neurosurgeon or orthopedic surgeon will remove the herniated disc material that presses on the nerve or spinal cord, which relieve the pressure on the nerve root, which should relieve the symptoms of pain, numbness and tingling.

LAMINECTOMY -This procedure is where the neurosurgeon or orthopedic surgeon will remove some of the bone that forms a protective arch over the spinal cord to allow easier removal of the herniated disc. In some circumstances, a surgeon will perform a discectomy and laminectomy at that same time.

SPINAL FUSION SURGERY - This procedure is done when the orthopedic surgeon or neurosurgeon takes medical rods and plates and screws them in the vertebrae to hold two or more vertebrae together to prevent movement so bone can grow between the fused discs. After a spinal fusion surgery patients usually have restricted range of motion in the spine.

EPIDURAL STEROID INJECTION. An epidural steroid injection is when the surgeon injects steroid medication into the epidural space. The doctor sometimes performs this procedure with the use of a fluoroscope to make sure he inserts the needle in the correct spot and not to injure the spinal cord. The epidural space is the area that surrounds the spinal cord. The purpose of the epidural steroid injection is to reduce the swelling of the nerves in the epidural space. If the swelling of the nerves in an epidural space are reduced, the pain, numbness and tingling should also be reduced. Usually the epidural steroid injection is done with local anesthesia. The person is usually sitting upright or flat on their stomach or on the side. Epidural steroid injections usually work better for people who have numbness and pain shooting down the leg as opposed to people who have generalized low back pain.

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TORN MENISCUS OF THE KNEE

Lateral and Medial meniscus of the knee are two crescent moon shaped discs of fibercartilige that lie between the ends of the upper leg bone and the lower leg bone that form the knee joint. A meniscus tear, either medial or lateral commonly occur when the knee is twisted and the foot is planted firmly on the floor. The treatment options for meniscus tears generally start with anti inflammatory medication, followed by physical therapy, then injection therapy and finally surgery. If the tears in the meniscus are small, they are usually repaired arthroscopically. If the meniscus tear or tears are large, then the orthopedic surgeon will perform an open surgical procedure where the torn edges of the meniscus are stitched together to preserve their form and function.

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ACL INJURY (ANTERIOR CRUCIATE LIGAMENT)

The Anterior Cruciate Ligament is inside the knee joint and forms an “x” towards the front of the knee. The Cruciate ligaments connect the thigh bone to the shine bone (tibia) and are made up of many strands that function like short ropes that hold the knee joint tightly in place when the leg is bent of straight. Stability is necessary for proper knee joint movement. Common work injuries to the ACL result from changing directions rapidly, slowing down when running, landing from a jump, or a direct contact if something falls on a workers leg or knee. A partial tear of the ACL may not require surgical treatment, however, a complete tear usually requires a complete ACL reconstruction. Treatment options for a ACL joint usually begin with conservative treatment such as anti inflammatory medication, then physical therapy followed by work hardening or muscle strengthening to provide stability to the knee. If surgery is required to repair a partial ACL tear, most surgeons will try to make that repair arthroscopicaly , if a complete ACL reconstruction is necessary, then the only way to perform that surgery is through an open procedure.

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Rotator Cuff Tear

The rotator cuff is a network of four (4) tendons or muscles that surround the top of the shoulder. The rotator cuff keeps the arm in place in the shoulder joint and allows the arm to move. The four (4) muscles that make up the rotator cuff are: supraspinatus, infraspinatus, subscapularis, and the teres minor muscles. These muscles are attached to tendons which are attached to the bones. The most common rotator cuff tear is a tear in the supraspinatus, tendon and muscle.

Rotator cuff tears are usually caused by a single traumatic event like a car crash or a work injury, or overuse of the shoulder joint by repetitive movements. Statistically, most repetitive trauma rotator cuff tears occur in individuals over 40 years old.

The diagnosis of a rotator cuff tear is confirmed through MRI (magnetic resonance imaging) after an examination by a physician. This test allows the doctor to see what part of the rotator cuff is damaged. If a person has a rotator cuff tear, non-surgical treatment options include anti-inflammatory medication, physical therapy and steroid injections. The surgical treatment options for a rotator cuff tear are either arthroscopic or an open repair. When a person has a partial thickness rotator cuff tear, as opposed to a full thickness rotator cuff tear, the surgeon may surgically repair the damage by a debridement procedure where the surgeon trims the tear through an arthroscopic procedure.

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CARPAL TUNNEL SYNDROME

Carpal Tunnel Syndrome is a compression of the median nerve at the wrist and the carpal tunnel. The median nerve and the tendons that bend the fingers pass through the carpal tunnel which is formed by wrist bones on three sides with a thick ligament as the roof. When pressure increases in the carpal tunnel, the nerves are compressed. The pressure on the nerve can produce tingling, numbness, weakness and pain. Treatment options for carpal tunnel are splinting, injections, medications and finally surgery.

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Cubital Tunnel Syndrome

Cubital Tunnel Syndrome is where there is pressure placed on the ulnar nerve usually at the outside of the elbow. The ulnar nerve runs from the spinal cord through the arm around the elbow and into the fingers. The ulnar nerve passes over the outside edge of the elbow as it heads toward the fingers. If a person hit the outside of his elbow, (this area is commonly known as the funny bone), it irritates the ulnar nerve and gives a brief tingling feeling. Cubital Tunnel Syndrome occurs when the ulnar nerve is stretched, causing pressure on the nerve, usually when a person bends his arm and the ulnar nerve is stretched against a boney bump on the outside of the elbow.

If conservative treatment options fail to correct the problem, then surgery is required to fix this condition, and there are generally two types of surgeries:

1. An ulnar nerve transposition. In that procedure, the surgeon surgically moves the nerve away from the outside of the elbow so when the elbow is bent, it is not stretched over the boney area of the elbow.

2. The other type of surgery is called a medial epicondylectomy. In that procedure, the surgeon will remove part of the boney material on the outside of the elbow which causes the nerve to stretch when a person bends their elbow.

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TORN LABRUM (The shoulder)

An unstable joint or dislocated shoulder can result in a torn labrum which may be seen as an acute injury. A torn labrum is usually characterized by a painful catch or pop to it. The Labrum is located under the shoulder near the humerous bone. The general treatment for a torn labrum is orthopedic surgery. Orthopedic surgery is usually effective in removing the torn labrum, if the surgeon is unable to remove the torn labrum, or must reattach the same, then an open procedure may be required to reattach the tissue and stabilize the joint.