Kinesiology 2236A/B Lecture 8: KIN 2236B - Athletic Injuries lecture 8
16 Jan 2019
School
Department
Course
Professor
KIN 2236B – Athletic Injuries
Cervical Spine Injuries
Emergency: “An unexpected serious occurrence that may cause injuries that require immediate medical attention”
Emergency Management:
- Knowledge of what to do
- Knowledge of how to do it
- Skills to accomplish it
o Minimize error
What should you be thinking while you are sprinting onto the field? Ask 3 questions.
- Is the athlete at risk?
o Life/limb (is their life at risk, any noticeable injuries/internal bleeding?)
- Is the area stable? (knee, neck, limb etc.)
o Can they continue w/o significant risk (safely & effectively)
- How do I get athlete off the field?
o Walk
o Assist
o Non-weight bearing
o Boarded/immobilized
On-Field Assessment: (fill in)
Injury: 1st thing you need to do is… STABILIZE C-SPINE
Once is stabilized… determine if CONSCIOUS or UNCONSCIOUS
Then do PRIMARY SURVEY
Primary Survey Goals
- Determine the existence of potentially life-threatening situations
o U responsiveness (alert, verbal, pain, or unresponsive)
o Airway
o Breathing
o Circulation
- Is there a spinal injury?? (suspected by mechanism or appearance, still stabilize neck)
o Spine (ensure ABC’s & stabilize)
o Prone (may need to reposition/roll to ensure ABC’s & stabilize airway)
- Also consider:
o Significant deformation/fracture (femur/pelvis require immediate emergency personnel)
o Profuse bleeding and shock
- If YES: activate EAP – “Load and Go “
- If NO: 2° assessment
Suspected Neck Injury: (should take about 1 min)
- Stabilize c-spine
- Assure athlete and tell them not to move (be firm & assertive)
- Get brief hx and subjective report (helps decide course of action)
- Begin palpation & assessment (looking for pain, decreased sensation, weakness or deformation - dermatomes/myotomes)
- What is our differential dx?
Subjective Report: Can use 8 Q’s
1. Can you tell me what happened (mechanism of injury = MOI)
Scenario…
Injuries usually happen in 4th quarter
Look, listen, feel.
o What part of body made contact?
o How was it hit? (head down/up?)
2. Do you have pain in your head?
3. Do you have pain in your neck?
o Central C-spine pain
4. Do you have pain in your back?
o Central L-spine pain
5. Do you have tingling or numbness in any of your arms or legs?
o Get specifics
o Single arm or leg, both arms, both legs
6. Do you have pain anywhere else?
7. Can you wiggle your toes?
o Check both sides
8. Can you wiggle your fingers?
o Check both sides
What is Our Differential Dx?
- What can it be?
o Best & worst case scenario
- How can I tell the difference?
- How can I know for sure?
Stinger/Burner
MOI:
- Nerve traction or compression injury, particularly involving C5 & C6 (brachial plexus)
1. Forced neck extension & rotation to injured side (pinches nerve)
2. Shoulder distracted down from head to neck (stretch injury to brachial plexus)
3. Blow to supraclavicular fossa (shot right to the brachial plexus)
Signs/Sx:
- Rarely neck pain (more in shoulder)
- Unilateral symptoms
- Can be transient
- Sensory changes C5 – C6 distribution
- Motor changes C5 – C6
o Shoulder abduction/external rotation
o Elbow flexion
- Heals quickly, often by the time they reach the sideline
Return to Play Following Stinger/Burner:
- Following 1°, same game return to play if…
o Quick resolution of all sx (seconds to minutes)
o Full ROM
o Full strength
o Ability to complete sport specific skills
o W/o sx
o Mentally ready
C-Spine Injuries:
- Usually occur d/t axial load
MOI: Usually 1 of 2 mechanisms…
- Axial load-vertical compression
- Burst fracture (C4 & C5)
o When you drop head, you straighten c-spine &
can’t dissipate load as well
- Compression-flexion injury
o Anterior portion compresses & posterior portion
elongates
o Of lower c-spine
On-Field Findings:
- True pain
- Pain on central palpation (spinous process)
- Bilateral neural findings
o Dermatomes & myotomes
- Upper & lower extremity findings
Palpation of the Injured Athlete:
- Need to palpate key structures of the upper back, neck, clavicle, and sternum
- Failure to do so could mean aggravated injury, paralysis, or death
- Know the order & complete the same way every time!!
Midline Pain over the Spinous Processes:
- This is what we are looking for**
- Do they have central pain on spinous processes??
Neurological Testing Sensation/Key Muscles: ** KNOW THEM ALL
- Dermatomes
o Cutaneous area receiving the greater part of its innervation from a single spinal nerve
o Pin prick for pain or cotton for pressure
- Myotomes
o A muscle receiving the greater part of its innervation from a spinal nerve
o No contraction w a complete s.c. transection
How can we tell if we need to send for an X-ray? The Canadian C-
Spine Rule.
- If in doubt, keep stabilized & get them checked out
- If they have c-spine pain/tenderness, send to x-ray
- No pain & can rotate neck = no X-ray
Neck Injuries: To board or not to board
By now we should have information to answer the 3 questions: At risk? Yes. Stable for transport? No. How do I get athlete to
sidelines? Board them.
The Log Roll
Set-up: (prior to roll)
- If prone, might need to roll to supine
- Make sure grip is firm & stable
- Make sure helmet
- Need to use cross arm technique so arms unwind as roll is performed
Procedure:
Document Summary
Emergency: an unexpected serious occurrence that may cause injuries that require immediate medical attention . Is the athlete at risk: life/limb (is their life at risk, any noticeable injuries/internal bleeding?) Is the area stable? (knee, neck, limb etc. : can they continue w/o significant risk (safely & effectively) How do i get athlete off the field: walk, assist, non-weight bearing, boarded/immobilized. Injury: 1st thing you need to do is stabilize c-spine. Once is stabilized determine if conscious or unconscious. Determine the existence of potentially life-threatening situations: u responsiveness (alert, verbal, pain, or unresponsive, airway, breathing, circulation. Is there a spinal injury?? (suspected by mechanism or appearance, still stabilize neck: spine (ensure abc"s & stabilize, prone (may need to reposition/roll to ensure abc"s & stabilize airway) Also consider: significant deformation/fracture (femur/pelvis require immediate emergency personnel, profuse bleeding and shock. If yes: activate eap load and go . Suspected neck injury: (should take about 1 min)
