Broken Neck: X-Ray Diagnosis and Treatment

Fractures in the cervical spine may occur with severe or repetitive trauma. Clay shoveler’s fracture is an avulsion fracture of the spinous process. It happens with abrupt flexion of the head, most commonly from a variety of accidents. It also occurs with stress caused by the pulling of the muscles around the thoracic and cervical spinous processes. The process breaks up and pulls on the avulsion segment from the original spinous procedure.

Clay shoveler’s fracture most frequently results in the lower cervical and upper thoracic spinous processes, namely C6, C7, and T1. Fractures and spinal avulsion can also be brought on by damage or injury as in direct blows to the neck’s base. This is a fracture that is stable and doesn’t produce any neurologic deficits. This part of the bone isn’t near nerve roots or the spinal cord, although patient’s are alarmed when they hear the term fracture or fracture in the neck.

Clay shovelers fracture derives its name from a common event among clay miners in Australia during the 1930s. The workers were digging deep ditches and tossing clay 10-15 feet above their heads with long handled shovels. Instead of having the clay come off the shovel, it would stick. The sticking clay produces a contraction of the trapezius and rhomboid muscles in reaction from the weighted shovel. The muscles react forcefully and immediately, contracting to stabilize the spine and shoulders. The Australian clay shoveler’s will hear a pop and feel a sharp contrast between the shoulder blades. They would feel sharp pain, making them unable to continue working because every time the trapezius or rhomboid muscles could contract. The mechanism of injury is believed to be caused by powerful and abrupt muscle contraction transmitting pressure via the ligaments. The enormous force is concentrated round the spinous processes and creates an avulsion fracture over the cervical and upper thoracic spine’s spinous processes.

Plain Film X-rays and Examination

Regarding lateral (side view) x-rays, a triangular radiolucent fracture line can be seen via the base of the spinous procedure. It is more likely to maintain the distal or trunk tip of the lower cervical and upper thoracic spinous procedure. Rough margins or serrated edges are commonly seen with the acute fractures, which differentiates it from this secondary expansion center of the process.The distal part of the fractured spinous process is frequently displaced down (caudally or inferior). This is due to the pull on the segment of bone.

Frontal x-rays (anterior to posterior) may demonstrate the look of two spinous processes at a single vertebrae, which can be called the “double spinous process sign.” Especially when the cervicothoracic junction is visualized on the view this signal is helpful for determining a clay shoveler’s fracture. An MRI (magnetic resonance imaging) or CT (computed tomography) is not typically required. A bone density scan could be indicated in a person who has undergone prior avulsion, thoracic, or lumbar spinal compression fractures. A bone density scan can evaluate and measure lumbar and cervical spine t-scores; which gauges relative risk of spinal compression fractures if bone density is in question.

Symptoms of Clay Shoveler’s Fracture

Clay shoveler’s fracture can occur with almost any repetitive and forceful activity utilizing the trapezius and rhomboid muscles. It might occur with automobile accident injuries for traumatic blows to both sides and top of the spinous procedure. Generally, pain is associated immediately after the injury and can be described as a burning or “knife-like” traumatic pain. Other symptoms include muscular stiffness and pain which increases with repeated action, similar to muscle strain at the top back joints or muscle strains. The broken spine is very tender, as are the muscles.

Treatment of Cervical Spine Avulsion Fractures

Most cases resolve in a few weeks. Pain or aggravation to the area could be associated with the tendon and muscle junctions that insert on the spinous process or avulsion segment. Some patients do not require treatment apart from remainder or NSAIDS (non steroidal anti medication). Others may benefit from pain medicine or muscle relaxers.

Medications could be applied at the neck and upper back into the muscles to ease soreness and possible rhomboid muscle strains. Bones and ribs shouldn’t be influenced or produce back pain. Some individuals require physical therapy or massage therapy, including chiropractic care, to help decrease muscle pain and stiffness. Ice, heat ultrasound, mild stretching, and range of motion exercises can help relieve neck and upper back pain. Some individuals respond to course IV cold laser treatments (low level laser treatment) to help reduce pain and inflammation in the muscles and tendons. Others might benefit from muscle treatments like Active Release Technique or Graston Technique to break up scar tissue or adhesions associated with years of repetitive activities. Patients may expect some discomfort for several weeks during the healing process.

Symptoms may worsen at the the front of the body with arms and the head, such as driving or working in the computer. With time and some therapy, symptoms will decline with time. Exercise and strenuous activity might need to be avoided for 1-2 months post injury. For patient’s having a history of stress fractures or avulsion fractures, a bone density scan could be indicated. Some kinds of fractures need immediate attention and could be unstable. Fractures must be assessed to make sure they are stable and tracked by an orthopedic surgeon.

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 . 

By Dr. Alex Jimenez

Additional Topics: Automobile Accident Injuries

Whiplash, among other automobile accident injuries, are frequently reported by victims of an auto collision, regardless of the severity and grade of the accident. The sheer force of an impact can cause damage or injury to the cervical spine, as well as to the rest of the spine. Whiplash is generally the result of an abrupt, back-and-forth jolt of the head and neck in any direction. Fortunately, a variety of treatments are available to treat automobile accident injuries.

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