The Sidelines: Evaluation, management and prevention of neck

Injuries

Charles A. Popkin, MDColumbia Sports Medicine Columbia Sports Medicine Center for the Developing AthleteCenter for the Developing Athlete

Bronxville Injury Prevention Seminar January 14, 2013

The Sidelines: Neck InjuriesGoals of the Talk: The Hook

• How to evaluate an athlete with a neck injury on the field

• Identify red flags that you can use to make the correct call with regard to return to play

• Prevention

By the Numbers

• 10% of all cervical spine injuries in the US occur during sports

• Some studies say 10-15% of all football players will sustain a neck injury at some point

• Up to 50% of college freshmen have had a stinger/burner

Case Example

What do you do?

• Player’s down……

Field Evaluation and Early Management

• Be Prepared!!

• This includes: 1) Standard protocol for pre-hospital

care of the injured athlete 2) All necessary equipment for on-

field management and transport 3) Where to go

Always be Prepared

• Necessary equipment includes spine board, tools necessary to remove face masks from helmets and to perform cardiopulmonary resuscitation

Evaluating On Field Neck Injury

• Review your procedure- game plan annually

Start with the ABC’s• Airway• Breathing• Circulation

Evaluation

• 1) Are they conscious?

If they are unconscious- assume a neck injury

• 2) Perform a neuro exam- check extremities

• 3) Do they have Neck pain?

On Field Evaluation

• If they are unconscious or you suspect a neck injury DO NOT REMOVE THE HELMET

• Protect the Airway • Spine Precautions

The Player who comes off on his own

• Sit player• Full neck and neuro exam• Significant neck pain or limited motion

assume neck injury

Evaluation, Management and Prevention of Neck Injury

Case Example

• 18 yo defensive back is down on the field after making a tackle

• You watch him get up slowly, he starts shaking his right hand as he walks toward the sideline

• He tells you his right shoulder and down into his hand feels “numb”

What is a Stinger?

Evaluation and Return to Play Stinger

• Brachial Plexopathy/nerve root injury• Radiates from shoulder down to arm• Three Keys:1)Short duration2)Unilateral arm3)Pain-free neck motion

Evaluation and Return to Play Stinger

• Sideline evaluation of a stinger needs to exclude the following red flags:

• 1) Bilateral symptoms• 2) Lower extremity symptoms• 3) Persistent burning• 4) Painful neck motion• 5) Axial tenderness Any of the above make us worry about a

“Spinal Cord Concussion”

Evaluation and Return to Play

• Athlete may return to play if:– Burning symptoms resolve– Neuro exam is normal with return of

motor strength

Evaluation and Return to PlayChronic Stinger Return to Play

• What do I do with the athlete who has sustained multiple stingers???

• General rules to follow:1) Prohibit play weeks = number of stingers2) If more than 3 occur during the season strongly consider ending that athlete’s season

Prevention

• What can my collision athlete wear to minimize stingers?

• Start with appropriate fitting shoulder pads

• There are a couple options

There are many types

• Compared three commonly used Neck collars

Absolutely NOT

• DO not modify the protective equipment and especially do not attach any type of Strap from the helmet that attaches to the Shoulder pads!!!

See what You Hit

See what You Hit

• USA football website www.usafootball.com

HockeyEliminate Checking from Behind

Prevention- Posture and Strength

• Working with a physical therapist can be very helpful

• Strengthening and range of motion• Posture- chest out, chin in, scapula

retracted opens foramina

• Questions or comments

• cp2654@columbia.edu