The neck is not designed to be a weight- bearing part of the body.

IT IS IN THE SPORT

MOBILITY Facet Joint (Controls mov’t.)

Spinous Process Facet Joint Vert. Body Disc

LATERAL C7 T1 Craniocervical Ligaments Spinous Process

MUSCLES Trapezius Scalenes Sterno- mastoid

TYPES OF NECK INJURIES Strains Sprains Fractures/ Disloc. Nerve

MECHANISMS OF CERVICAL INJURY

AXIAL LOADING

FLEXION FLEXION AND ROTATION (Most fractures)

EXTENSION

IN

BURNER OR STINGER

MECHANISM OF INJURY Head tilted away. Head rotated away. Shoulder depressed.

Posture of the arm after a burner. Pain is burning and it radiates down to the arm. Tenderness on Brachial Plexus

BRACHIAL PLEXUS

PINCHED NERVE Mechanism of Injury (M.O.I.) …. Axial loading to the extended, side-flexed neck.

LO AD STRETCH PINCH

ASSESSMENT OF THE HEAD-NECK INJURED ATHLETE ON THE PLAYING SURFACE

NEUROLOGICAL SIGNS Disruption of nerve function Weakness Reduced Sensation Reduced Reflexes Muscle Atrophy

PAIN IS NOT A NEUROLOGICAL SIGN!!!!!

Nerve Cover Touching Nerve

FIELD APPROACH TO THE INJURED ATHLETE

B LOCK THE HEAD

No Helmet Removal

C.P.R. Look Listen Feel

ANY UNCONSCIOUS ATHLETE MUST BE TREATED AS A POTENTIAL SPINAL CORD INJURY!!!

Athlete unconscious. Athlete conscious with loss of movement or sensation. Complains of central neck pain.

FIELD MONITORING Re-check vitals. Reassure athlete. Observe for Shock. Be prepared to treat for shock.

SHOCK Collapse of the c.v. system, or failure of the system to provide an adequate blood supply to all body tissues.

CAUSES OF SHOCK Blood vessels dilated so widely that there is a poor venous return. There is loss of blood. Heart fails to circulate the blood properly.

TYPES AND CAUSE OF SHOCK Hemorrhagic – Internal and/or External Bleeding Respiratory – reduce O 2 in blood. (sucking wound, airway obstruction, spinal cord injury).

Neurogenic – loss of control by the nervous system. Psychogenic – reaction of nervous system to fear, bad news etc. Cardiogenic – inadequate function of the heart

Septic – severe infection resulting in vasodilation. Metabolic – loss of fluids through diarrhea, or urination. Anaphylactic – caused by allergic reactions. Extreme emergency.

SIGNS AND SYMPTOMS Eyes dull, lackluster Pupils dilated Face pale Shallow, irregular respirations Pulse rapid and weak 2

… 2 Skin cool and clammy May have nausea, fainting, anxiety, thirst Blood pressure is low

TREATMENT FOR SHOCK Control bleeding. Elevate lower extremities if no chest or head injury. Prevent loss of body heat. Lie athlete down. N.P.O.

Primary Survey Initial scan done by the ‘at head’ person. Feeling for deformity etc. Secondary Survey Someone else holds head and you check lower ext.

Initial Questions What happen? Pain? Present or after accident. Feelings: burning/tingling Head pain/ache?

Orientation to time and place. Observations of pupils. Observe for any CSF or blood coming from nose or ears. Look for bruising.

Test motor and sensory of upper extremity. Do gross motor of feet. Test grip strength of the upper extremity. Continue to ask about headache and nausea.

Removal from Field Supine lying. Sitting. Four Point Kneeling. Three Point Kneeling. Standing (with support). Slowly walk to sideling. Sideline Testing.

SIDE LINE TESTING Subjective Question about their feelings (headache, tingling, nausea) Objective Motor skills, verbal skills

HEEL TO SHIN 1 2

EYE MOVEMENTS (Nystagmus)

BALANCE TANDEM WALK

DECREASED STATUS

GUIDELINES FOR CONTINUED MONITORING

Grade II should be sent to the hospital. Grade I monitored at home. We give instructions. No A.S.A. One drink!

MINOR NECK TRAUMA SIDELINE MANAGEMENT

Minor Neck Trauma is an injury that has no arm pain, no loss of neck motion and no central pain during movement. The following should be tested……

General test of the myotomes (specific nerves that innervate specific muscles) to determine if there is gross weakness. If weakness; no return.

SIDE LIGHT… ‘Motion Talk’..ors – muscles doing the movement...ion – direction of mov’t...ed – end position.

SHOULDER ELEVATION C 3,4 “Lift your shoulders up, hold and do not let me push them down”.

“ Don’t let me push your arms down”. SHOULDER ABDUCTORS C5C5

ELBOW FLEXION C6C6 “Bend your elbow”

ELBOW EXTENSION C7C7 “Straighten your elbow.”

THUMB EXTENSORS C8C8 “ Do not let me pull your thumb down”.

FINGER ABD/ADDUCTORS T1T1 “Do not let me push your fingers together”.

If the neck motion is good, there is no neck/arm pain and the strength in the extremities is good, it is decision time!

If in doubt, don’t! If the tests are good and you tested long and often enough, then do! RETURN