1. Injuries to the Thoracic Through Coccygeal Spine
Chapter 10
Injuries to the Thoracic Through Coccygeal Spine

2. Anatomy Review of the Thoracic Spine
Thoracic spine consists of * vertebrae
Articulates with the cervical spine at the top and the lumbar spine at the bottom
Cervical and lumbar portions represent * curves, whereas the thoracic portion is *
The curves are important to the overall strength of the spine
Thoracic vertebrae are numbered 1-12 and have an intervertebral disk located between each vertebrae

3. Anatomy Review of the Thoracic Spine
The thoracic vertebrae have a relationship with the 12 pairs of ribs
The thoracic vertebrae, their corresponding ribs, and the sternum form a strong thoracic cage which helps to protect internal organs such as the *
Because of the union with the ribs and costal cartilage, the thoracic spine is much less mobile than the cervical or lumbar regions
The limited movement helps to make injuries to this part of the body *

4. Skeletal Injuries of the Thoracic Vertebrae
*of the vertebral body are most common injury.
Usually related to violent, ballistic movements that are unique to sports involving high velocities
Such fractures usually occur at junction *
Athlete with recent history of trauma to the region in conjunction with pain or numbness should be referred to a physician.

5. Skeletal Injuries of the Thoracic Vertebrae
Scheuermann’s disease is characterized by * (abnormal amount of convexity of the spine)
* (lateral curve)
Lumbar * (swayback)

6. Vertebral Fractures Fractures involving the * are extremely rare
Result from a direct blow to the posterior thorax or extreme flexion of the thoracic spine
Significant soft tissue damage to the area can occur to the skin and underlying muscles
Sports such as football, soccer, or wrestling can have these injuries
S/S: pain in the area, *, flexion, or * will be extremely painful, swelling or discoloration to the area, muscle spasm to the injured area
Treatment: RICE, remove athlete from play and re-evaluate after 24 hours, if * are present refer to physician immediately

7. 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 *, which is the weakest point.
Posterior rib fractures can potentially result in a pneumothorax or a *.

8. Rib Fractures (cont.)
Complications to rib fractures are rare, but when they occur they can be quite dangerous
Traumatic * – collapse of a lung as a result of air in the plural cavity
* – bloody fluid in the plural cavity

9. Rib Fractures (cont.) Signs and Symptoms: Painful respiration.
Deformity in the region of the injury, including a * or depression where the normal contour of the rib should be.
Swelling and discoloration.
Pain when rib cage is *.
Treatment:
Immediately apply RICE (6-8in compression wrap)
Refer for medical evaluation (*)

10. Sprains
Sprains occur whenever a joint is forced beyond its normal * 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 *.
If * (difficult or painful breathing) persists for more than 24 hours, refer the athlete to a physician.

11. Strains
Involve contractile tissue and their support structures, such as the * and intercostals.
Are related to maximal exertions.
Result in muscle spasm and point tenderness.
First Aid
Application of RICE to the injured area.

12. Lumbar Spine Region Anatomy Review: * vertebrae are in lumbar spine.
Articulate superiorly with the thoracic vertebrae and inferiorly with the sacrum
Lumbar vertebrae are the * moving vertebrae.
The major ligaments are the anterior and posterior longitudinal ligaments.

13. Lumbar Spine Region (Sacrum)
The sacrum consists of * fused vertebrae.
The sacrum connects the spinal column to the pelvis.
Right and left * (SI) joints are formed by the union of the sacrum and pelvis.
Coccyx (tailbone) is most distal portion of the vertebral column.
Injuries are more common to the * than to the thoracic

14. Spondylolysis
Spondylolysis is a defect in the * (pars interarticularis).
There are 2 pars interarticularis on each vertebrae (1 left and 1 right)
Such defects compromise the articulation between two vertebrae.
Also known as the “*” defect

15. Spondylolisthesis
A condition in which both neural arches are affected and the involved vertebrae slips forward
Most common site is between * and the *
Symptoms include lower back pain that worsens during hyperextension, and radiating pain to the buttocks and upper thighs.
Treatment includes rest, drug therapy, *, exclusion from certain sports, and surgery in severe cases.

16. Traumatic Fractures: Lumbar Spine
Such fractures are uncommon in sports.
External blows may result in internal injury especially to the *.
Deep abdominal pain, *, and shock are signs and symptoms of internal injury.
Immobilize on spine board and transport to medical facility.
Fractures of the coccyx (*) result in severe pain, point tenderness, swelling, and bruising. Refer athlete to physician for evaluation.

17. Lumbar Region -- Strains & Sprains
Strains and sprains are the most common soft-tissue injuries in the lumbar spine.
Major joints include:
Lumbosacral *
Sacrococcygeal

18. Lumbar Strains & Sprains (cont.)
Signs and symptoms include:
Localized *.
Pain that does not radiate into buttocks or lower extremity.
*(lateral lifting of the truck away from the affected side)
First Aid
Have athlete maintain a * position with soft support for lumbar region and application of ice.
If not improved in 24 hours, refer to physician.

19. Lumbar Disk Injuries A serious form of soft tissue injury is a “*”
Most commonly occurs at L4 or L5.
Anatomy of a disk includes annulus fibrosis (outer ring) and nucleus pulposus (inner ring).

20. 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 * directly on spinal nerves resulting in:
Intense local or radiating pain.
Sensory loss or * sensation in lower extremity.
Muscle spasm and postural abnormalities.

21. 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 * to lumbar region.
Arrange for transport to medical facility.
Not much can be done while in the field, but much can be done to alleviate long term symptoms with physical therapy and drug therapy