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Neck Injuries in Athletes

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Topic updated on 05/13/14 7:52pm
Introduction
  •  Injuries to the cervical spine can occur in all sports and range from soft tissue injuries to quadriplegia
    • spectrum of injuries include
      • ligament sprains in cervical spine
      • burners / stingers 
      • spear tackler's spine 
        • definition
          • developmental narrowing (stenosis) of the cervical canal
          • persistent straightening or reversal of the normal cervical lordotic curve
          • concomitant posttraumatic roentgenographic abnormalities of the cervical spine
          • documentation of having employed spear tackling techniques 
        • treatment
          • contraindication to play in contact sports
      • cervical fxs
      • transient quadriplegia
        • neuropraxia of the cervical cord 
        • bilateral upper and lower extremity pain, parasthesias, and weakness
        • symptoms resolve within minutes to hours
      • quadriplegia
  • Epidemiology
    • injuries to the cervical spine are primarily seen in contact sports
      • common among football and rugby players
      • evolution of protective gear has decreased incidence
  • Mechanism
    • axial load (compression) with flexion of the spine
    • most injuries in contact sports occur during tackling of another player 
      • "spear tackling" 
        • is the most common mechanism of neck injury in football 
        • can lead to gradual cervical stenosis and loss of cervical lordosis
  • Associated conditions
    • underlying conditions of the cervical spine can increase the severity of neck injuries and be contraindications to play. They include
      • previous trauma to cervical spine (fractures, ligamentous injuries)
      • cervical stenosis 
      • congenital odontoid hypoplasia
      • os odontoideum 
      • Klippel-Feil anomalies 
Anatomy
  • Cervical spine 
Presentation
  • History
    • evaluate mental status
    • spinal injuries should be assumed in the athlete with loss of or altered consciousness
  • Symptoms
    • neck pain
    • neurological symptoms such as numbness, tingling or weakness
  • Physical exam (on-field evaluation)
    • when cervical spine injury is suspected in the field
      • stabilize the head and neck
      • log roll to supine position
      • remove facemask to protect airway as needed
        • do not remove helmet or shoulder pads 
      • CPR as indicated
      • log roll place on backboard
      • transport to location to perform complete physical exam
    • inspection
      • look for deformities of cervical spine
    • palpate 
      • spinous processes for step off or pain
    • neurological exam
      • muscle testing of all 4 extremities
      • test sensation throughout extremities
      • test reflexes
Imaging
  • Radiographs
    • indications
      • burner / stingers with recurring symptoms
      • neurologic symptoms and transient quadriplegia
    • recommended views
      • cervical spine trauma series
    • findings
      • canal diameter of < 13mm (normal is ~17mm)
      • Torg-Pavlo ratio (canal/vertebral body width) of < 0.8 (normal is 1.0)  
        • Torg ratio is technique dependent, not predictive, and not accurate in large athletes
  • MRI
    • indications
      • bilateral neurologic symptoms
    • findings
      • look for spinal stenosis or loss of CSF around the spinal cord
Treatment
  • Nonoperative
    • return to play criteria
      • indications
        • specific to diagnosis
          • burners/stingers
            • may return to play when 
              • complete resolution of symptoms
              • normal strength and range of motion
    • NO to return to play
      • indications (contraindications to return to play)
        • transient quadriplegia with severe stenosis
        • spear tackler's spine
        • cervical neuropraxia with ligamentous instability
        • odontoid hypoplasia and os odontoideum
          • are absolute contraindications to play
        • Klippel-Feil anomalies
          • mass fusion of the cervical and thoracic vertebrae is an absolute contraindication to play
  • Operative
    • treatment is the same as for other traumatic injuries to the spine


 

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Qbank (2 Questions)

TAG
(OBQ11.76) Proper tackling techniques should be taught to adolescent football players to prevent catastrophic cervical spine injury. These injuries most commonly occur through which of the following mechanisms? Topic Review Topic

1. Axial loading of the subaxial spine that occurs with spear tackling
2. Traction injury leading to nerve-root avulsion from arm tackling
3. Excessive lateral bending from high impact shoulder tackling
4. Flexion-distraction injuries due to a whiplash mechanism during cut blocking
5. Rotational injuries from pulling on the face mask during a tackle

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TAG
(OBQ06.203) A college football receiver is unconscious and in respiratory distress after sustaining a helmet to helmet collision. What is the correct initial management of this patient? Topic Review Topic

1. Transfer player to emergency room
2. Remove the helmet and shoulder pads
3. Remove helmet and sit the player upright to help with breathing
4. Remove the facemask, leaving the helmet in place, followed by appropriate airway managment
5. Perform tracheostomy

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