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Spinous Process Fracture
From WikiSM
Other Names
- Clay Shoveler Fracture
- Clay-shoveler fracture
- Navvies’ disease (in British canal diggers)
- Schipper’s disease (in German Autobahn laborers)
- Land grader’s disease (in French land workers)
- Thoracic spinous Proces Fracture
- Schmitt’s disease (adolescent form)
- Thoracic spinous process fracture
- Lumbar spinous process fracture
- Thoracolumbar spinous process fracture
- SPF
Background
- This page refers to stress or avulsion fractures of spinous process of the cervical, thoracic and lumbar spine
- Classically and most commonly occur in the cervical spine
- Can occur in thorax, lumbar segments as well
History
- First described in 1875 (need citation)
- Widely recognized in western Australia in the 1930s where they earned their common name 'clay shoveler's fracture'[1]
Pathophysiology
- Historically, due to laborers shoveling heavy loads (i.e. clay)
- Asymmetrical heavy loads are implicated specifically due to recruitment of upper back muscles along the intraspinal ligaments
- Primarily considered an occupational disease
- Much less common due to industrial revolution, automation and mechanized heavy labor
- C7 and T1 spinous process most commonly involved
- Other causes
- Direct blow to spinous process
- Avulsion of the spinous process after forced flexion of the cervical spine
- Impaction fractures after forced hyperextension
Pathoanatomy
- Spinous Process of vertebrae
- Ligaments
- Ligamentum Nuchae: extends along all cervical SP, acts as intermuscular septum
- Muscles
- Trapezius originates from the ligamentum nuchae
- Rhomboid Minor originates from C7, T1 spinous processes
Risk Factors
- Occupational
- Shoveling
- Metal dipping
- Land grading
- Tree grubbing
- Road construction
- Sports
- Contact sports
- Racket sports
- MVC
Differential Diagnosis
Differential Diagnosis Neck Pain
- Fractures
- Subluxations and Dislocations
- Neuropathic
- Muscle and Tendon
- Pediatric/ Congenital
- Other Etiologies
Differential Diagnosis Back Pain
- Fractures
- Neurological
- Musculoskeletal
- Autoimmune
- Infectious
- Pediatric
Clinical Features
- General: Physical Exam Neck, Physical Exam Back
- History
- Patient will complain of sudden, sharp upper back and neck pain or between the shoulder blades
- Some patients may report a pop
- Activity often not out of the ordinary for patient
- Some my report a milder pain preceding the acute onset
- Physical Exam
- Antalgic posture, neck slightly flexed and scapula elevated
- Pain with shoulder and cervical spine movement
- Point tenderness on the spinous processes of the fracture
- There may be crepitus
- There should be no neurological deficits
Evaluation
Radiographs
- Standard views of C-Spine, T-Spine, L-Spine
- Usually sufficient to make diagnosis
- AP: May see "double shadow" or "double spinous sign"
- Lateral: fracture lines usually visible, extend of displacement
- Fractures tend to run obliquely through the spinous process
CT
- Indicated in the setting of high energy trauma
- Indicated if diagnosis uncertain or other etiology suspected
MRI
- Indicated if diagnosis uncertain or other etiology suspected
Classification
- N/A
Management
Prognosis
- Generally excellent
- Most patients fully recover to preinjury activity levels
Nonoperative
- Considered stable, thus conservative treatment is first line therapy
- Rest
- Activity modification for 4-6 weeks
- Anaglesics including NSAIDS, Acetaminophen
- Immobilization: Cervical Collar
- Reduces fragment movement, pain
- Average duration of immobilization is 4-6 weeks
- Physical Therapy
- Unclear if beneficial, one case report suggested aggravated symptoms[2]
Operative
- Indications
- Persistent pain refractory to conservative measures
- Technique
- Excision of fracture fragments
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- Most individuals return to normal activities between 3 weeks and 4 months
Complications
- Nonunion
- Persistent Pain
- Neck stiffness
See Also
- Internal
- External
- Sports Medicine Review Back Pain: https://www.sportsmedreview.com/by-joint/back/
- Sports Medicine Review Neck Pain: https://www.sportsmedreview.com/by-joint/neck/
References
Created by:
John Kiel on 4 July 2019 09:28:30
Authors:
Last edited:
6 October 2022 23:17:19
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