A Pain In The Neck

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A Pain In The Neck - Page #4

Working Diagnosis: Avulsion fracture of C7 (Clay Shoveler's Fracture) with Associated Stinger Treatment: Patient underwent three weeks of conservative therapy with rest, ice, NSAIDs, and soft neck brace along with light activity and home exercises. Outcome: Patient was able to transition out of the brace without an increase in pain. Numbness and tingling down the arm resolved spontaneously. He was able to resume participating in basketball. Author's Comments: Clay Shoveler or avulsion fractures were historically seen in individuals that performed tough labor and forceful contraction of the shoulder muscles. They are most commonly caused by motor vehicle accidents or direct trauma. This case marks an unusual mechanism for the injury to occur however does embody key features of this fracture. The most common location for the spinous process avulsion fracture of C7, due to the superficial location and limited surrounding structures. Further, the patient was forced into flexion while contracting his rhomboids and trapezius muscles, which placed strain on the spinous process resulting in the fracture. Editor's Comments: Clay-shoveler's fracture is a stable avulsion fracture of the vertebral spinous process occurring at any of the lower cervical or upper thoracic vertebrae, classically at the C6 or C7 level. In Australia in the 1930s, men digging deep ditches tossed clay 10 to 15 feet above their heads using long handled shovels. The thick clay sometimes stuck to the shovel causing a pop and sudden pain. The muscles of the upper back pull and transmit through the supraspinous ligaments producing an avulsion fracture. Return To The Case Studies List.		Back
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