[ musculoskeletal imaging ]

FIGURE 1. Lateral radiograph demonstrating C5-6 inter­ FIGURE 2. Axial computed tomography image demon- FIGURE 3. Sagittal, T2-weighted magnetic resonance im-
spinous fanning (arrow), suggesting posterior longitudinal strating bilateral C6 lamina fractures. age demonstrating complete disruption of the interspinous
ligamentous disruption with probable fracture. and supraspinous ligaments at C5-6.

Cervical Fracture With Posterior

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Ligamentous Injury While Skydiving

WARREN FLAUTT, PT, DPT, SCS, CSCS, US Army, Fort Eustis, VA.
ROBERT ROWLAND, PT, DPT, OCS, RMSK, CSCS, E XOS, Phoenix, AZ.
RICHARD B. WESTRICK, PT, DPT, DSc, OCS, SCS, M
 GH Institute of Health Professions, Boston, MA; US Army Research Institute
of Environmental Medicine, Natick, MA.

A
46-year-old male soldier re- than 45° bilaterally. The patient denied magnetic resonance imaging, and a neu-
ported to an emergency depart- neurologic symptoms, and the neurologi- rosurgery consultation. The computed
ment with severe acute neck pain cal exam was unremarkable. tomography and magnetic resonance im-
immediately following a hyperflexion in- Although neck pain is a relatively aging confirmed bilateral C6 lamina frac-
J Orthop Sports Phys Ther 2019.49:113-113.

jury from an unusually rapid parachute
opening during recreational skydiving.
He was evaluated in the emergency de-
partment, including radiographs, and
released with a diagnosis of “acute neck
strain.” Six days after the injury, he fol-
lowed up with a primary care provider,
presenting with continued neck pain
(rated as 10 on the numeric pain-rating
scale), and was sent for a same-day con-
sultation with a physical therapist. The
physical therapist evaluation found ex-
quisite tenderness with light palpation
over the C5-6 spinous process and in-
ability to actively rotate the neck more
common complaint following parachute
opening shock in skydivers,2 the patient’s
levels of severity and irritability were in-
consistent with those of typical skydiving
or military airborne patients. Due to lack
of access to the original radiographs, the
dangerous rapid hyperflexion mechanism
of injury, midline tenderness, and limited
active cervical rotation, the physical thera-
pist ordered cervical spine radiographs,1,3
which revealed findings consistent with
cervical fracture and ligamentous disrup-
tion (FIGURE 1). The radiologist contacted
the physical therapist with the results and
recommended computed tomography,
tures and multiple ligamentous disruption
at C5-6 (FIGURES 2 and 3). Sixteen days fol-
lowing the injury, the patient underwent
open reduction internal fixation surgery,
with posterior tension band and supraspi-
nous ligament repair (FIGURE 4, available
at www.jospt.org). One month following
surgery, he began physical therapy and a
modified strength and conditioning pro-
tocol, while wearing a rigid cervical col-
lar for 12 weeks. Eight months following
surgery, he returned to full military duties
and deployed to combat operations. t
J Orthop Sports Phys Ther 2019;49(2):113.
doi:10.2519/jospt.2019.8360

References
1. Belot M, Hoens AM, Kennedy C, Li LC. Does every patient require imaging after cervical spine trauma? A knowledge translation project to support evidence-informed practice
for physiotherapists. Physiother Can. 2017;69:280-289. https://doi.org/10.3138/ptc.2016-32
2. Nilsson J, Fridén C, Burén V, Westman A, Lindholm P, Äng BO. Musculoskeletal pain and related risks in skydivers: a population-based survey. Aviat Space Environ Med.
2013;84:1034-1040. https://doi.org/10.3357/ASEM.3570.2013
3. Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286:1841-1848. https://doi.org/10.1001/
jama.286.15.1841
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Army or Department of Defense.

journal of orthopaedic & sports physical therapy | volume 49 | number 2 | february 2019 | 113