Lecture 18: Neck Injuries and on-field assessment

Question 1

what are the three main questions to be asking yourself when entering the field?

Answer 1

1: is the athlete at risk
- life/limb

2: is the area stable
- talking about the anatomical area
- can they continue without significant injury (safely and effectively)

3: how do I get the athlete off the field?
- walk
- assist
- non-weight bearing
- immobilized/boarded

Question 2

what to do with a C-spine injury

Answer 2

1:stabilize the spine
2: see if they are conscious or unconscious
3: do Primary

Question 3

primary survey

Answer 3

• determine the existence of potentially life-threatening situations
• UABC
• spinal injury (suspected by mechanism or appearance)
• supine - ensure ABC’s and stabilize
• prone - may need to reposition to ensure ABC’s

if answered YES: activate EAP (load and go)
if answered NO: secondary assessment

Question 4

what are the UABC

Answer 4

u responsiveness (alert, verbal, pain or unresponsive)
airway (look, listen, feel)
breathing
circulation

Question 5

the athlete with a suspected neck injury

Answer 5

1:stabilize the C-spine
2: assure athlete and tell them not to move
- be firm and assertive
3: get brief history and subjective report
4: begin your palpation
- looking for pain, sensation, weakness or deformation
- dermatomes, myotomes
- what is our differential diagnosis?

Question 6

the 8 subjective spinal questoins

Answer 6

1: can you tell me what happened? (MOI)
2: do you have pain in your head?
3: do you have pain in your neck?
4: do you have pain in your back?
5: do you have tingling or numbness in any of your arms or legs?
- get specifics
- single arm or leg, both arms, both legs
6: do you have pain anywhere else?
7: can you wiggle your toes?
- check both sides
8: can you wiggle your fingers?
- check both sides

Question 7

stinger/burner (mechanism)

Answer 7

nerve traction or compression particularly involving C5 and C6
1: shoulder distracted down from head and neck (stretch)
2: blow to supraclavicular fossa (wacked)
3: forced neck extension and rotation to injured side (pinched)

Question 8

sings and symptoms of stinger/burner

Answer 8

• rarely neck pain
• unilateral symptoms
• can be transient
• sensory changes C5- C6 distribution
• motor changes C5-C6
  
  • shoulder ABD/ER
  • Elbow flexion

heals quickly, often by the time they reach the sideline

Question 9

Return to play following stinger/Burner

Answer 9

following primary injury, same game return to play if
- quick resolution of all symptoms (seconds to minutes)
- full ROM
- full strength (compared to other side)
- ability to complete sport specific skills (can they protect themselves) without symptoms
- mentally ready

Question 10

C-spine injuries: MOI

Answer 10

usually one of two mechanisms
1: axial load-vertical compression (burst fracture)
2: compression - flexion injury
- anterior portion compresses and posterior portion elongates

Question 11

on field findings of C-spine injuries

Answer 11

• neck pain (spinous process pain, right down the middle)
• pain on central palpation (spinous process)
• bilateral neural findings (myotomes and dermatomes)
• upper and lower extremity findings

Question 12

neck injuries to board or not to board

Answer 12

it is necessary to revise the current practice of cervical spine immobilization

Question 13

palpation of the injured athlete

Answer 13

• need to palpate key structures of the upper back, neck, shoulder, clavicle and sternum
• failure to do so could mean aggravated injury, paralysis or death

Question 14

neurological testing: sensation dermatomes

Answer 14

• cutaneous area receiving the greater part of its innervation from a single spinal nerve
• pin prick for pain or cotton for pressure

Question 15

Neurological testing sensation C1

Answer 15

Top of head

Question 16

Neurological testing sensation C2

Answer 16

Side of head

Question 17

Neurological testing sensation C3

Answer 17

Side of neck

Question 18

Neurological testing sensation C4

Answer 18

above clavicle

Question 19

Neurological testing sensation C5

Answer 19

Lateral arm over deltoid

Question 20

Neurological testing sensation C6

Answer 20

radial side of arm and entire thumb

Question 21

Neurological testing sensation C7

Answer 21

Middle finger

Question 22

Neurological testing sensation C8

Answer 22

ulnar side of arm and last 2 fingers

Question 23

Neurological testing sensation T1

Answer 23

medial elbow

Question 24

Neurological testing sensation L1

Answer 24

iliac crest

Question 25

Neurological testing sensation L2

Answer 25

anteromedial thigh

Question 26

Neurological testing sensation L3

Answer 26

medial tibial

Question 27

Neurological testing sensation L4

Answer 27

Medial side of foot

Question 28

Neurological testing sensation L5

Answer 28

between 1st and second toe

Question 29

Neurological testing sensation S1

Answer 29

lateral foot

Question 30

Neurolgoical testing Myotomes

Answer 30

a muscle receiving the greater part of its innervation from a single spinal nerve

Question 31

Myotome patterns for cervical and lumbar spine C2

Answer 31

neck flexion

Question 32

Myotome patterns for cervical and lumbar spine C3

Answer 32

neck side flexion

Question 33

Myotome patterns for cervical and lumbar spine C4

Answer 33

shoulder shrug

Question 34

Myotome patterns for cervical and lumbar spine C5

Answer 34

shoulder abduction

Question 35

Myotome patterns for cervical and lumbar spine C6

Answer 35

elbow flexion

Question 36

Myotome patterns for cervical and lumbar spine C7

Answer 36

elbow extension

Question 37

Myotome patterns for cervical and lumbar spine C8

Answer 37

Thumb extension

Question 38

Myotome patterns for cervical and lumbar spine T1

Answer 38

spread fingers

Question 39

Myotome patterns for cervical and lumbar spine L1

Answer 39

hip flexion

Question 40

Myotome patterns for cervical and lumbar spine L2

Answer 40

hip flexion

Question 41

Myotome patterns for cervical and lumbar spine L3

Answer 41

knee extension

Question 42

Myotome patterns for cervical and lumbar spine L4

Answer 42

ankle dorsiflexion

Question 43

Myotome patterns for cervical and lumbar spine L5

Answer 43

1st toe extension

Question 44

Myotome patterns for cervical and lumbar spine S1

Answer 44

plantar flexion

Question 45

Myotome patterns for cervical and lumbar spine S2

Answer 45

knee flexion

Question 46

Myotome patterns for cervical and lumbar spine S3

Answer 46

intrinsics of foot

Question 47

stinger burner vs spinal cord/ cervical spine injury

Answer 47

stinger/burner - unilateral - rarely involve the lower extremities (because it is not central, it is in your brachial plexes) - transient - sensory (C5 C6 dermatome) - weakness spinal cord/cervical spine injury - bilateral - upper and lower extremity involvement - transient or prolonged/permanent - sensory with possible total loss of sensation - weakness/paralysis

Question 48

the log-roll set up

Answer 48

prior to the roll - make sure grip is firm and stable - make sure helmet is stable - need to use cross arm technique, so arms unwind as roll is performed

Question 49

log roll procedure

Answer 49

leader will instruct the assistants as to when to roll and when to stop rolling the athlete - leader will use these commands "prepare to roll" and "roll" it is important that the assistants follow the leader's command and roll the athletes as one unit - this would be the charge person in the EAP

Question 50

Hockey and boarding

Answer 50

stable ice hockey helmet's should not be removed from injured players, with rare exceptions, because doing so results in unnecessary motion of the cervical spine

Question 51

football boarding

Answer 51

you either have to take both the helmet and shoulder pads off or keep them both on

Question 52

Lacrosse boarding

Answer 52

would most likely take all the equipment off because the helmets are a strange shape

Question 53

when do you remove the helmet of an injured athlete?

Answer 53

1: when you cannot get face mask off 2: when you an not get a clear airway 3: when there is a weird shape of the helmet (i.e. lacrosse) so you cannot fully stabilize them 4: if the helmet prevents immobilization for transport in an appropriate position 5: always if the shoulder pads are removed

Question 54

you should remove the shoulder pads of an injured athlete when

Answer 54

1: multiple injuries requiring full access to the shoulder area 2: ill-fitting shoulder pads resulting in the inability to maintain spinal immobilization 3: cardiopulmonary resuscitation requiring access to the thorax that is inhibited by shoulder pads 4: always if the helmet is removed

Question 55

transport to spine board

Answer 55

1: vertical lift 2: log roll always use vertical lift when you are able

Question 56

vertical life - transport to spine board

Answer 56

- 8 people necessary - leader (charge person) immobilizes head and neck as a unit - 1 person to move board - 3 people on each side at shoulders, hips, and knees

Question 57

log roll - spinal board transfer

Answer 57

- in-line immobilization of the head - gentle traction - use at least 3 people - always roll towards - leader/charge always coordinates (head) - place board against back at 45 degree angle - may require "Z" reposition

Question 58

transport to the spine board (securing the athlete)

Answer 58

- once on the board, the leader must continue to stabilize the head and neck - the assistants can now secure the athlete to the board - important: begin with thorax, then head, then lower body

Question 59

secondary ax goals (non-emergent or extremity)

Answer 59

1. what is wrong? 2: if the sport allows: do they need a more detailed assessment? 3: determine if the athlete can play or if it is safe to remove from field 4: how to transport from the field

Question 60

know your sport!

Answer 60

there are different rules about taking an athlete out of the game for different sports

Question 61

history (non-emergent or extremity)

Answer 61

- evaluation of injury sustained by athlete - unique - you often see the MOI - ask what happened? where does it hurt? did you hear or feel any pops/grinding? have you injured this or the other side of your body before?

Question 62

clearing the ABC'S and C-spine

Answer 62

1: clear above or below 2: palpate 3: special tests for stability of bones and joints (just a few not all)

Question 63

treatment and transportation

Answer 63

- severity of the injury dictates medial management - take your time and complete your side-line assessment