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CashS Textbook Of Neurology For Physiotherapists Pdf Free Download are so. Cash Textbook Of Neurology For Physiotherapists Pdf To Excel. Get Textbooks on Google Play. Cash's Textbook of Neurology for Physiotherapists. Lippincott, 1986.

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When refering to evidence in academic writing, you should always try to reference the primary (original) source. That is usually the journal article where the information was first stated. In most cases Physiopedia articles are a secondary source and so should not be used as references. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article).

If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Contents • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Definition/Description Most thoracic spine fractures occur in the lower thoracic spine, with 60% to 70% of thoracolumbar fractures occurring in the T11 to L2 region, which is the biomechanically weak for stress. The majority of these fractures occur without spinal cord injury.

Twenty to forty percent of the fractures are associated with neurologic injuries. Major (high-energy) trauma, is the most common cause of thoracic fractures. Minor trauma can also cause a thoracic spine fracture in individuals who have a condition associated with loss of bone mass. There are four major types (based on the mechanism of injury): - Compression (wedge fractures):caused by axial compression alone or flexion forces, when the spine is bent forward or sideways at the moment of trauma. It is a stable fracture and patients rarely show neurologic deficits.

- Burst: Similar to compression, except that the entire vertebra is evenly crushed. It is a very severe fracture, accompanied with retropulsed bone fragments into spinal canal.

Neurologic injury and posterior column injury can occur more frequently. - Flexion-distraction (seatbelt injury/ Chance fracture): Involves the separation (distraction) of the fractured vertebra. It occurs by primary distractive forces on the spine. The axis of rotation is located within or in front of anterior vertebral body. - Fracture-dislocation: Are found in combination with displacement of adjacent vertebrae.

It is caused by various combinations of forces. It is very unstable and can cause complete neurologic deficit. The three-column spine and its significance in the classification of acute thoracolumbar spinal injuries. 1983;8:817-831 There are several classification systems. The most frequently used is the Denis classification, but this is based on the so-called middle column, which is anatomically unidentifiable.For this reason, the AO Group has developed a new classification system, which is based on the severity of the injury. The severity is defined by the pathomorphological findings, the prognosis in terms of healing and potential of neurological damage. FIG.2 Vaccaro et al.

Proposed the thoracolumbar injury classification and severity score (TLICSS). This new classification is based on the integrity of the posterior ligament complex (PLC), the patient's neurologic status and the fracture morphology, instead of the mechanism of injury. This TLCIS is the most effective classification system for the treatment of thoracolumbar fractures and it has a good reliability. Normal Thoracic Spine MRI. Epidemiology /Etiology Compression Failure of the anterior column of the spine due to compression forces, mainly in flexion. The most common causes in younger patients are falls and motor vehicle accidents.

The most common causes in older patients are minor incidents during normal activities of daily living secondary to or metabolic bone diseases. Associated neurological complications are rare. Burst Fracture of the anterior and middle columns of the spine due to axial loading such as from a fall landing on the buttocks or lower extremities. The concentration of axial forces is to the thoracolumbar junction. Flexion-distraction (seat belt injury) Failures of the posterior and middle columns of the spine under tension usually from a trauma involving sudden upper body forward flexion while the lower body remains stationary.

Often associated with abdominal trauma due to compression of abdominal cavity during injury. The anterior column may be mildly affected, but the annulus fibrosis and anterior longitudinal ligament are intact, preventing dislocation or subluxation. A gap between the spinous processes is often present upon palpation. Fracture-dislocation Failure of all three spinal columns under compression, flexion, rotation, or shear forces. The most unstable of all thoracolumbar spine injuries, they are highly associated with neurological deficits. They can be caused by a severe flexion force similar to that of a seat belt injury, or an object falling across the back.

Clay-Shoveler's Fracture Rare, fatigue fracture of the upper thoracic spinous process. Seen in power lifters or in patients that are involved in hard labor causing shear forces on the vertebra, hyperflexed spine, or direct trauma. Characteristics/Clinical Presentation Over 65% of vertebral fractures are asymptomatic.

They are sometimes detected via radiograph when a patient is being screened for another injury. Presentation of symptomatic fractures includes: • Chronic back pain in and/or region • Slower gait • Decreased range of motion • Impaired pulmonary function • Increased kyphosis especially in osteoporotic patients with compression fractures • Neurological deficits due to narrowing of spinal canal - can present as long as 1.5 years post injury Prolonging of these symptoms leads to decreased physical function and performance of activities of daily living, and increased risk of disability.

Vertebral deformities are also associated with significantly increased risk of future fractures, including hip fractures. Patients with non-compression fractures are usually involved in a multi-trauma, and will have various injuries and sources of pain. Clinicians must use their best judgment and employ clinical screening criteria to determine if the thoracic spine is involved. Differential Diagnosis Plain radiographs are historically the 'gold standard' for detecting thoracolumbar fractures, although due to the organs and soft tissue in the region, fractures can be missed on radiographs. A is recommended to visualize thoracic fractures and an to assess soft tissue damage. And other cancers can present as thoracic pain, but will have additional signs such as unexplained weight loss and fever.

Presents as exaggerated kyphosis, anterior body extension and schmorl’s nodes; can be distinguished by vetebral body height parameters on radiograph. Examination Screening for Fracture Algorithms for screening patients for thoracic fractures and the need for imaging have been developed but not fully validated. CASH (left) & Jewett (right) Braces - courtesy of Orthotic & Prosthetic Technologies, Inc., San Marcos, TX • Closed reduction • Pain medication • Physical therapy There is no consensus on the exact duration of treatment. (Level of evidence 3A) Preventative treatment for fractures related to include bisophosphonates, calcium, vitamin D and exercise. (Level of evidence 3B) Wood et al.

Found no significant long-term difference in pain, disability and return to work for non-neurologically involved patients who received surgery compared to those who received bracing or casting. (Level of evidence 1B) This indicates that the higher risk and cost of surgery may not be justified and that bracing/casting would be the preferred treatment in this patient population. Braces are a common component of both post-operative and non-operative thoracic fracture treatment protocols. (Level of evidence 1B) Physical Therapy Management (current best evidence) Management of vertebral fractures remains controversial,, and research is limited on identifying physical therapy intervention.

Until recently, conservative management of fractures consisted of pain medications, rest and bracing to reduce spinal movements,,,. Rehabilitation programs must be designed specifically for the individual based on their physical abilities and impairments. With conservative treatment, the majority of fractures heal with significant decrease in pain in 8-12 weeks. Significant declines in pain (5.9cm on VAS) are experienced 12-24 hours post-surgery.

Therefore, interventions depend largely on whether the patient chose surgery or conservative treatment. Interventions should always be prescribed and progressed based on patient tolerance. Physical Therapy Goals • Reduce pain • Improve posture • Improve thoracic mobility • Strengthen trunk extensors • Improve trunk control • Provide education • Lower extremity strengthening Bennell et al. Found that a multimodal treatment approach over a 10-week period was successful in reducing pain and improving function in patients who suffered from osteoporotic vertebral fractures.

However, because it was a multimodal approach the effectiveness of each treatment is unclear. APTA Preferred Practice Patterns: 4B: Impaired Posture 4G:Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated with Fracture 4I: Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated with Bony or Soft Tissue Surgery General Exercise Recommendations, A major concern is refracture within a year of the initial injury. Researchers agree that strengthening back-extensor muscles can help decrease the rate of refracture or prolong occurance of refracture,. Studies show significant improvement in reported pain levels and increased function in patients with back-extensor exercises as part of their exercise regimen,,,. Therefore, patient should begin strengthening back-extensor muscles as soon as they are physically able. When developing a plan of care, the therapist should consider the individual characteristics of a vertebral fracture and possible secondary limitations. Physiotherapy and Home Exercise Program Adapted from: Bennell et al (2010).

Trunk mobility in sitting - extension 5 sec hold x5 reps 1-10 daily Trunk mobility in sitting - Hands on shoulders, gentle rotation in both directions and lateral flexion to each side 5 reps in each direction 1-10 daily Head to wall in standing - Back and heels agaist wall with rolled up towel behind head. Chin retraction 10 sec hold x 5 reps 1-10 daily Standing corner stretch - Face corner, both hands chest height on wall and moving in closer to stretch anterior chest 10-30 sec hold x 3 reps 2-10 daily Walking hands up wall in standing - Facing wall, walking hands up wall until arms upstretched then holding hands off wall 5 sec hold x5 reps 3-10 daily Shoulder flexion in supine - Arms outstretched holding onto cane/towel and taking arms over head to hold at end of range 10- sec hold x5 reps 3-10 daily Standing wall push ups - Face wall, arms in front, shoulder height.

Keep body straight, bend and straighten elbows. Hip extension in prone 8-10 reps x2 3-10 3x/week Half squats - progress to holding dumbbells - Standing in front of chair and squatting down to touch chair with buttocks then standing up 8-10 reps x2 1-2 3x/week Step ups - progress to holding dumbells - Stepping up and down a 10 cm step. Alternate legs 8-10 reps x2 3-10 3x/week Scapular retraction with theraband in sitting - Holding theraband in both hands with elbows tucked into sides and performing wrist extension, supination and shoulder external rotation then scapular retraction. Four-Point Kneeling + TA 8-10 reps x2 3-10 3x/week Prone lying with arm elevation - Arms at shoulder height and bent at elbows. Scapular retraction then lift arms off floor 5-10 sec hold x5 2-3 3x/week Prone trunk extension - Lift head and shoulders off floor while maintaining chin retraction 5-10 sec hold x5 4-10 3x/week *performed by the therapist Complications to Consider,, • Cardiorespiratory compromise • Additional Fractures • Refractures • Osteoporosis • Prolonged Pain • Limited Range of Motion • Limited Strength • Neurological Compromise • Postural Dysfunction • General Deconditioning • Gait/Ambulation Abnormalities • Loss of Balance Resources • Corenman DS.

Thoraco-lumbar spine fractures. Available from: (accessed 20 Sep 2011). • MD Guidelines. Fracture, thoracic spine (without spinal cord injury).

Available from: (accessed 20 Sep 2011). • AO Foundation, Available from: (accessed 20 Sep 2011). • Leahy M and Gellman H. Thoracic spine fractures and dislocation. Medscape Reference.

Available from: (accessed 20 Sep 2011). Clinical Bottom Line There is a lack of high quality evidence for the management of thoracic spine fractures. Physical therapists should be familiar with screening for thoracic fractures and take an impairment-based approach when treating post-operative or non-operative patients. Failed to load RSS feed from There was a problem during the HTTP request: 500 Internal error, see logs for details References • Corenman DS. Understanding an MRI of the Normal Thoracic Spine (Mid Back) from www.neckandback.com Available from: (accessed 20 Sep 2011).

• ↑ O'Connor E, Walsham J. Indications for thoracolumbar imaging in blunt trauma patients: a review of current literature. Emerg Med Australas 2009;21(2):94-101. • ↑ Cite error: Invalid tag; no text was provided for refs named Kandabarow_1997 • Tisot R, Avanzi O.

Laminar fractures as a severity marker in burst fractures of the thoracolumbar spine. J Orthop Surg (Hong Kong) 2009;17(3):261-4. • ↑ Alpantaki K, Bano A, Pasku D, Mavrogenis AF, Papagelopoulos PJ, Sapkas G, et al. Thoracolumbar burst fractures: a systematic review of management. Orthopedics 2010;33(6):422-9. • ↑ Demir S, Akin C, Aras M, Koseoglu F. Spinal cord injury associated with thoracic osteoporotic fracture.

Am J Phys Med Rehabil 2007;86(3):242-6. • ↑ Lentle BC, Brown JP, Khan A, Leslie WD, Levesque J, Lyons DJ, et al.

Recognizing and reporting vertebral fractures: reducing the risk of future osteoporotic fractures. Can Assoc Radiol J 2007;58(1):27. • ↑ Marre B, Ballesteros V, Martinez C, Zamorano JJ, Ilabaca F, Munjin M, et al. Thoracic spine fractures: Injury profile and outcomes of a surgically treated cohort. Eur Spine J 2011;20(9):1427-33. • ↑ Singh R, Taylor DM, D’Souza D, Gorelik A, Page P, Phal P. Mechanism of injury and clinical variables in thoracic spine fracture: a case control study.

Hong Kong J Emerg Med. • ↑ Holmes JF et al. Prospective evaluation of criteria for obtaining thoracolumbar radiographs in trauma patients. 2003; 24:1-7. • Friedrich M, Gittler G, Pieler-Bruha E. Misleading history of pain location in 51 patients with osteoporotic vertebral fractures.

Eur Spine J 2006;15(12):1797-800. • Diaz J, Cullinane D, Vaslef S, et al. Practice management guidelines for the screening of thoracolumbar spine fracture. J Trauma 2007;63(3):709-18. • PubMed Health: Multiple myeloma Web site.

Available at:. Accessed April 29, 2001.

• Masharawi Y, Rothschild B, Peled N, Hershkovitz I. A simple radiological method for recognizing osteoporotic thoracic vertebral compression fractures and distinguishing them from Scheuermann disease. Spine 2009;34(18):1995-9.

• Harding IJ. Anterior spinal surgery. Available from: (accessed 20 Sep 2011). • Shaffrey CI, Shaffrey ME, Whitehill R, Nockels RP.

Surgical treatment of thoracolumbar fractures. Neurosurg Clin N Am 1997;8(4):519-40. • ↑ Wood K, Butterman G, Mehbod A, Garvey T, Jhanjee R, Sechriest V. Operative compared to nonoperative treatment of thoracolumbar burst fracture without neurological deficit: a prospective, randomized study.

J Bone Joint Surg Am 2003;85-A(5):773-81. • Weninger P, Schultz A, Hertz H. Download Alguem Tem Que Ceder Dublado Avi here. Conservative management of thoracolumbar and lumbar spine compression and burst fractures: functional and radiographic outcomes in 136 cases treated by closed reduction and casting. Arch Orthop Trauma Surg 2009;129:207-19. • ↑ Giele BM, Wiertsema SH, Beelen A, va der Schaaf M, Lucas C, Been HD, et al.

No evidence for the effectiveness of bracing in patients with thoracolumbar fractures: a systematic review. Acta Orthopaedica 2009;80(2):226-32.

• ↑ Van Leeuwen PJ, Bos RP, Derksen JC, de Vries J. Assessment of spinal movement reduction by thoraco-lumbar-sacral orthoses. J Rehabil Res Dev 2000;37(4):395-403.

• ↑ Dai LY, Jiang LS, Jiang SD. Posterior short-segment fixation with or without fusion for thoracolumbar burst fractures. A five to seven-year prospective randomized study. J Bone Joint Surg Am 20-41. • ↑ Rousing R, Hansen KL, Andersen M, Jespersen SM, Thomsen K, Lauritsen JM. Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebral fractures treated conservatively or with percutaneous vertebroplasty.

Spine 2010;35(5):478-82. • ↑ Cahoj PA, Cook JL, Robinson BS. Efficacy of percutaneous vertebral augmentation and use of physical therapy intervention following vertebral compression fractures in older adults: a systematic review. J Geriatr Phys Ther 2007;30(1):31-40. • ↑ Bennell KL, Matthews B, Greig A, Briggs A, Kelly A, Sherburn M, et al. Effects of an exercise and manual therapy program on physical impairments, function and quality of life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial. BMC Musculoskeletal Disorders 2010;11(36):1-11.

• ↑ Guide to Physical Therapist Practice. Alexandria, Va: American Physical Therapy Association; 2003. • Huntoon EA, Schmidt CK, Sinaki M. Significantly fewer refractures after vertebroplasty in patients who engage in back-extensor-strengthening exercises. Mayo Clin Proc 2008;83(1):54-7.

• Sinaki M, Itoi E, Wahner HW, Wollan P, Gelzcer R, Mullan BP, et al. Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women.

Bone 2002;30(6):836-41.