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Ligament Pathology with Alteration of Motion Segment Integrity

A good read to understanding alteration of motion segment integrity (AOMSI) is the article โ€œBiomechanical Analysis of clinical instability in the cervical spineโ€ White et al., Clin Ortho Relat Res, 1975;(109):85-96.

AOMSI is a biomechanical analysis. Itโ€™s all about numbers that have clinical meaning and significance. Threshold values have been determined to quantify whether the patient has a serious injury. It tests the structural integrity of the ligaments interconnecting the motion segments. In this case, structural integrity has to do with the material properties of ligament tissue. Those properties include strength and flexibility. When a material is both strong and flexible, itโ€™s called a semi-rigid material. Strength is related to the composition of the material. Strength might be thought of as load-carrying capacity before failure.

Mechanism of Injury: Ligaments

Ligament tissue has previously been bench tested to describe its physical characteristics of stress/strain. Given so much load (stress), how much elongation will occur (strain)? During normal physiologic loads, the ligament remains intact and recoils to its original length when the load is removed. If the load becomes too large, the materials (ligaments) begin to yield. They go past their elastic limit. When this happens, the (strained) ligament fibers will not return to their original shape. The ligament loses its restraining capacity to hold the joint in normal stabilization, and hypermobility occurs.

The ligaments, if sufficiently strained or avulsed, result in AOMSI. The following paragraphs illustrate that if AOMSI is found, there must be gross destruction or yielding of multiple ligaments. We need to build a BIG motion segment with Velcro ligaments. When you tear them off, they make a really nice ripping noise. That drives home the point.

The White et al. work found that the motion segment stayed intact, i.e., less than 11 degreesโ€™ rotation (angular motion) and less than 3.5 mm translation until they transected over 50% of the ligaments from an anterior or posterior approach. And when they transected from either approach, the loss of stability was not linear but suddenly catastrophic. And they meant that suddenly the two vertebrae totally separated in rotation or translation.

Suddenly Separated: pulled apart, head off the body, all neural components compromised, paralysis. Keeping that in mind, what are the injuries of someone just under the threshold? Severe to very severe. They stand the possibility of a serious event with much less force.

Prevalence of Ligament Injury: AOMSI

If AOMSI is detected, think about more than 50% of ligaments transected. That will start to explain the seriousness of the finding. In a patient/child that demonstrates hypermobility everywhere, you take a statistical average of all segments and look at the aberrant statistical finding to see if it exists. There are clues to injury everywhere when you understand what the numbers mean in reference to stability and function.

To diagnose ligament laxity, it is imperative that imaging be performed, and a basic flexion-extension x-ray is all that is required. In todayโ€™s medical economy, advanced imaging of MRI or CT Scan, although accurate, becomes an unnecessary expenditure, and an x-ray renders very accurate demonstrative images to conclude a definitive diagnosis. In determining if there is an impairment, it is necessary to follow the AMA Guides to the Evaluation of Permanent Impairment, as the 4th, 5th, and 6th editions all render an impairment for AOMSI as sequella to ligament laxity, which is damage to the ligament from trauma.

This document is intended to serve as a simple explanation as to the severity of ligament damage and how to demonstrably diagnose the injury. It is also critical to remember that ligaments do โ€œwound repair.โ€ In normal physiology, ligaments grow during puberty from cells within the ligaments called fibroblasts. They produce collagen (white) and elastin (yellow) tissue, which gives the ligaments both tensile and elastic strength. Upon puberty, the cells stop producing tissue and remain dormant. Upon injury, the fibroblast reactivates but can only produce collage leaving the joint wound repaired in an aberrant juxtaposition (place) with poor movement abilities due to the lack of the requisite elastin. According to Hauser et al. (2013), this leads to permanent loss of function of the ligament and arthritis of the joint. This is not a speculative statement; it is based upon Wolffโ€™s that dates back to the late 1800s and has been a guiding principle in healthcare for more than a century.

References:

White et al., Clin Ortho Relat Res, 1975;(109):85-96
Hauser, Dolan, Phillips, Newlin, Moore Woldin, B.A.(2013) Ligament injury and healing: A review of current clinical diagnostics and therapeutics.The Open Rehabilitation Journal, 6,1-20.

Additional Topics: Weakened Ligaments After Whiplash

Whiplash is a commonly reported injury after an individual has been involved in an automobile accident. During an auto accident, the impact’s sheer force often causes the victim’s head and neck to jerk back and forth, causing damage to the complex structures surrounding the cervical spine. Chiropractic care is a safe and effective alternative treatment option to help decrease whiplash symptoms.

 

 

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The information herein on "Ligament Pathology with Alteration of Motion Segment Integrity" is not intended to replace a one-on-one relationship with a qualified health care professional, or licensed physician, and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional.

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Our information scope is limited to Chiropractic, musculoskeletal, physical medicines, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions.

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Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

phone: 915-850-0900

Licensed in Texas & New Mexico *

Dr. Alex Jimenez DC, MSACP, CIFM, IFMCP, ATN, CCST
My Digital Business Card

Post Disclaimer

Professional Scope of Practice *

The information herein on "Ligament Pathology with Alteration of Motion Segment Integrity" is not intended to replace a one-on-one relationship with a qualified health care professional, or licensed physician, and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional.

Blog Information & Scope Discussions

Our information scope is limited to Chiropractic, musculoskeletal, physical medicines, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions.

We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.

Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez DC or contact us at 915-850-0900.

We are here to help you and your family.

Blessings

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

Dr. Alex Jimenez DC, MSACP, CIFM*, IFMCP*, ATN*, CCST
My Digital Business Card

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