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Bronxville Injury Prevention Seminar January 14, 2013. The Sidelines: Evaluation, management and prevention of neck Injuries. Charles A. Popkin, MD Columbia Sports Medicine Center for the Developing Athlete. The Sidelines: Neck Injuries Goals of the Talk: The Hook.
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Bronxville Injury Prevention Seminar January 14, 2013 The Sidelines: Evaluation, management and prevention of neck Injuries Charles A. Popkin, MD Columbia Sports Medicine Center for the Developing Athlete
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
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 InjuryCase 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”
Evaluation and Return to Play Stinger • Brachial Plexopathy/nerve root injury • Radiates from shoulder down to arm • Three Keys: • Short duration • Unilateral arm • 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 stingers 2) 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
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 • USA football website www.usafootball.com
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
THANK YOU • Questions or comments • cp2654@columbia.edu