Updated: 6/27/2018

Neck Injuries in Athletes

Topic
Review Topic
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Questions
2
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Evidence
3
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https://upload.orthobullets.com/topic/3114/images/xray-cervical-lateral_-_shows_torg_ratio_small.jpg
https://upload.orthobullets.com/topic/3114/images/spear_tackler.jpg
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
        • burners/stingers
          • complete resolution of symptoms
          • normal strength and range of motion
        • transient quadriplegia with normal MRI findings
        • congenital stenosis (Torg-Pavlov ratio <0.8) without instability (but patients should be counseled regarding the risks)
    • NO return to play (contraindications to RTP)
      • transient quadriplegia with severe stenosis
        • spear tackler's spine
        • cervical neuropraxia with ligamentous instability
        • upper C spine abnormalities (C0 to C2) are absolute contraindications for RTP
          • odontoid hypoplasia 
          • os odontoideum
          • atlantooccipital fusion
        • Torg 1 Klippel-Feil anomaly (long fusion mass) absolute contraindication to play
        • Torg 2 Klippel-Feil (only 1 or 2 segments) with limited motion, secondary degenerative changes or instability
          • Torg 2 Klippel-Feil below C3, asymptomatic, is a relative contraindication to RTP
  • Operative
    • treatment is the same as for other traumatic injuries to the spine

 

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Questions (2)

(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? Review Topic

QID: 214
1

Transfer player to emergency room

1%

(34/2827)

2

Remove the helmet and shoulder pads

0%

(14/2827)

3

Remove helmet and sit the player upright to help with breathing

0%

(7/2827)

4

Remove the facemask, leaving the helmet in place, followed by appropriate airway managment

98%

(2760/2827)

5

Perform tracheostomy

0%

(5/2827)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(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? Review Topic

QID: 3499
1

Axial loading of the subaxial spine that occurs with spear tackling

95%

(2826/2965)

2

Traction injury leading to nerve-root avulsion from arm tackling

1%

(24/2965)

3

Excessive lateral bending from high impact shoulder tackling

1%

(30/2965)

4

Flexion-distraction injuries due to a whiplash mechanism during cut blocking

2%

(59/2965)

5

Rotational injuries from pulling on the face mask during a tackle

1%

(15/2965)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 1
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