Pathology
Signs of spinal cord injury after an accident likely include one or more of the following symptoms and accurate medical assessment is advised. 1 pressure in the head, neck, back; 2 twisted neck or back; 3 intense back pain; 4 impaired breathing; 5 paralysis, lack of coordination; 6 loss of control of bladder/ bowels; 7 loss of sensation, numbness or tingling; 8 trouble walking and balancing Spinal cord injury, quadriplegia also known as tetraplegia, means damage to the spinal cord causing changes in function, either temporary or permanent. These translate into loss of muscle function, sensation, or autonomic function in parts of the body served by the spinal cord below the level of the lesion. if a spinal cord injury happens between T1-T8 there will be paralysis downwards from the upper chest, so will include poor trunk control. If the injury occurs at L1 and below there will be paralysis and poor control from the waist downwards The two types of injury : quadriplegia, paraplegia Pressure sores (bedsores or pressure ulcers) are a result of unrelieved pressure due to loss of sensation, voluntary movement or impaired circulation which break down the skin and underlying tissue. Areas at risk when in a wheelchair and when lying Stages of pressure sores: Signs to look for include red or pink areas; bumps or hardness under the skin, as well as ‘hot spots’. Areas of skin that feel warm to the touch may indicate the early stages of a pressure sore. If an established pressure area is present, complete pressure relief is essential until healing has occurred and this may involve a period of bed rest, otherwise there is a risk of infection, sepsis and death. Tissue damage, stage 1: redness of skin and whitening when pressure applied Tissue damage, stage2: blistering and breakdown of skin; Tissue damage, stages 3 and 4: weeping wound; involvement of sub cutaneous tissue; involvement of muscle tissue Tissue damage, unstaged: thickness of tissue loss obscured by dying skin tissue Complete spinal cord injury means there is no function or feeling below the level of injury. Incomplete spinal cord injury means some function and/or feeling below the level of injury A contracture is a shortening of muscles, tendons, or ligaments after a spinal cord injury (SCI) Contractures limit movement of a joint, such as the wrist, elbow, shoulder or ankle. Contractures can start to develop very soon after a SCI. They limit function, slow progress and can cause pain. tightened tendons; paralysed, atrophied muscles, with little counter pull Causes of contractures: Nerves that control a muscle may have stopped working after a SCI. So nerves to one muscle may be stronger than to another muscle. This imbalance can make a muscle on one side of a joint stronger, causing it to bend inward. contracted, stronger muscles are pulling; paralysed, atrophied muscles, with little counter pull Autonomic dysreflexia: may be caused by a simple irritation felt below injury level and lead to emergency action if not checked in time. An example might be a full bladder that leads to... 1: initial irritation; 2: blood vessels constrict; 3: blood vessels dilate (sweating) ; 4: alarm experienced (brain); 5: severe headache, dizziness; 6: blurred vision; 7: emergency (hospital) Autonomic dysreflexia: If these signs are showing, call for assistance, sit upright and lower legs. Check skin for scratches and pressure sores and, if cause is unknown, then 1: take prescribed medication for severe headache; 2: check for constipation; 3: check bladder distension; 4: monitor blood pressure until symptoms have resolved; 5: loosen any tight constriction in clothing / legs straps Heterotopic ossification: the presence of bone in soft tissue where bone does not normally exist identifies heterotopic ossification and, for patients with spinal injuries, may occur 1-4 months after injury . Avoid forcing painful movements when mobilizing the affected joints. spurs are a common feature Heterotopic ossification: Signs and symptoms: Increased temperature and localised swelling, with pain and loss of range of movement in joints. ossification on trochanter processes Neurogenic bladder is a problem resulting from damage to the nerves controlling the muscles around the bladder. This result in either poor emptying or loss of control of urine and can lead to infections, and increase the risk of developing autonomic dysreflexia Spinal fracture, effects of damage: damage to spinal canal at L1 affects nerves, with bowel and bladder dysfunction Spinal cord tumours often cause symptoms by pressing on spinal nerves. These can range from clumsiness and difficulty walking to causing loss of bladder and bowel control if situated in the lower part of the spinal cord Cauda Equina: Areas affected by spinal canal compression at L4 and L5; kidneys; intestines; bladder; reproductive
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