Cervical Spine & Spinal Cord Injuries in Athletes
A) Paraspinal tenderness along the right trapezius muscle
B) Normal level of consciousness
C) Inability to abduct arm
D) Normal pupillary response.
On Field Management
Image 1: CT and MRI Demonstrating Severe Cervical Stenosis
CERVICAL SPINE CENTRAL STENOSIS
Image 2: Normal CT and XR of the Cervical Spine
Also known as ‘transient brachial plexus neuropraxia’ is a transient compression or traction of an upper extremity nerve of the cervical spine. Patients will endorse transient weakness, numbness and tingling of one extremity with C5 and C6 nerve roots most commonly affected. On exam patients will have altered sensation and diminished strength. Management generally involves removal from sport until return to full strength and asymptomatic and then they can return to sport. By definition, this injury pattern is transient. If they have persistent symptoms greater than 24 hours or more than 3 episodes then they must be worked up. Workup includes MRI to evaluate the cervical spine and consideration should be made for EMG/NCS to evaluate other peripheral neuropathies.
Image 3: Example of Spear Tackling
Cervical Cord Neuropraxia
Image 4: Illustration of Atlas and Axis
Read More: https://wikism.org/Atlantoaxial_Instability
Image 5: C1 fracture of the anterior and posterior facets on CT
Image 6: Odontoid Fracture on sagittal CT and odontoid view radiograph
Answer C. Cervical spine trauma can be catastrophic. There are several decision making rules which can be used to help sports medicine providers with decision making on the sideline. These are endorsed by the NAEMSP, ACS and NATA.
- No midline cervical tenderness
- No focal neuro deficits
- Normal alertness
- No intoxication
- No painful distracting injury
Indications for C-spine immobilization and transport include:
- Blunt trauma and altered level of consciousness
- Spinal pain or tenderness
- Neurologic complaint (e.g., numbness or motor weakness)
- Anatomic deformity of the spine
- High-energy mechanism of injury and any of the following:
- Drug or alcohol intoxication
- Inability to communicate
- Distracting injury
http://nccsir.unc.edu/files/2014/05/FBAnnual2012.pdf. Accessed September 15, 2015.