You are on page 1of 2

Spinal cord compression develops when the spinal cord is compressed by bone fragments from a vertebral fracture, a tumor

, abscess, rupturedintervertebral disc or other lesion. It is regarded as a medical emergency independent of its cause, and requires swift diagnosis and treatment to prevent long-term disability due to irreversible spinal cord injury. Symptoms Symptoms suggestive of cord compression are back pain, a dermatome of increased sensation, paralysis of limbs below the level of compression, decreased sensation below the level of compression, urinary and fecal incontinence and/or urinary retention. Lhermitte's sign (intermittent shooting electrical sensation) and hyperreflexia may be present. Diagnosis Diagnosis is by X-rays but preferably magnetic resonance imaging (MRI) of the whole spine.[1] The most common causes of cord compression are tumors, but abscesses and granulomas (e.g. intuberculosis) are equally capable of producing the syndrome. Tumors that commonly cause cord compression are lung cancer (non-small cell type), breast cancer, prostate cancer, renal cell carcinoma, thyroid cancer, lymphoma and multiple myeloma. Treatment and prognosis Dexamethasone (a potent glucocorticoid) in doses of 16 mg/day may reduce edema around the lesion and protect the cord from injury. It may be given orally or intravenously for this indication. Surgery is indicated in localised compression as long as there is some hope of regaining function. It is also occasionally indicated in patients with little hope of regaining function but with uncontrolled pain. Postoperative radiation is delivered within 2-3 weeks of surgical decompression. Emergency radiation therapy (usually 20 Gray in 5 fractions, 30 Gray in 10 fractions or 8 Gray in 1 fraction) is the mainstay of treatment for malignant spinal cord compression. It is very effective as pain control and local disease control. Some tumours are highly sensitive to chemotherapy (e.g. lymphomas, small-cell lung cancer) and may be treated with chemotherapy alone. Once complete paralysis has been present for more than about 24 hours before treatment, the chances of useful recovery are greatly diminished, although slow recovery, sometimes months after radiotherapy, is well recognised. The median survival of patients with metastatic spinal cord compression is about 12 weeks, reflecting the generally advanced nature of the underlying malignant disease.

Most humeral shaft fractures will heal without surgery. but are most commonly caused by falls. How do humerus fractures occur? Humerus fractures can occur by many different mechanisms. These fractures occur near the elbow joint. This nerve travels from the spinal cord. wraps around the humerus bone. These fractures may involve the insertion of the important rotator cuff tendons. with the ball being the top of the humerus bone. and weakness of some of the muscles of the hand and wrist. although the damage is almost always temporary. but there are some situations that require surgical intervention. fractures in the center of the shaft of the bone rarely require surgery. and travels all the way down to the hand. The majority of patients can be treated with a sling or brace. especially fractures that extend into the joint. This type of fracture is much more common in children. and with time the fracture will heal. Casting is not possible with most types of humerus fractures. When the humerus is injured. even with the bone fragments appear not perfectly aligned. Surgery may be required when the bone fragments are far out of position. Injury to this nerve may cause symptoms in the wrist and hand (see below).  Mid-Shaft Humerus Fractures Mid-shaft humerus fractures occur away from the shoulder and elbow joints. Fractures close to the shoulder and elbow joints. but the treatment is very different in this age group. this nerve is often damaged. the humerus. Over 90% of patients with humerus fractures and radial nerve damage will have complete recovery of the nerve within 3 to 4 months. connects the shoulder to the elbow. The radial nerve is one of the major nerves of the upper extremity. Conversely. Fractures of this ball are considered proximal humerus fractures. . Humerus fractures are generally divided into three types of injuries:  Proximal Humerus Fractures Proximal humerus fractures occur near the shoulder joint. Why does numbness over the back of the hand often occur with humerus fractures? One of the commonly associated problems with humerus fractures is injury to the radial nerve. Patients may notice abnormal sensation over the back of the hand. The shoulder joint is a ball-and-socket joint. The upper arm bone. Because these tendons are important to shoulder motion.  Distal Humerus Fractures Distal humerus fractures are uncommon injuries in adults. treatment may depend on the position of these tendon insertions. are more likely to require surgery. called the radial nerve. Determining when the alignment is acceptable depends on a number of factors. What is the treatment for a humerus fracture? The good news is that most humerus fractures will heal without surgery. These injuries are commonly associated with injury to one of the large nerves in the arm.Humerus Fracture A humerus fracture is an injury to the bone of the upper arm. These fractures most often require surgical treatment unless the bones are held in proper position.