1. The Sidelines: Evaluation, management and prevention of neck Injuries Charles A. Popkin, MD Columbia Sports Medicine Center for the Developing Athlete Bronxville Injury Prevention Seminar January 14, 2013

2. The Sidelines: Neck Injuries Goals 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

3. 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

4. Case Example

5. What do you do? Player’s down……

6. 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

7. Always be Prepared Necessary equipment includes spine board, tools necessary to remove face masks from helmets and to perform cardiopulmonary resuscitation

8. Evaluating On Field Neck Injury Review your procedure- game plan annually Start with the ABC’s Airway Breathing Circulation

9. 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?

10. On Field Evaluation If they are unconscious or you suspect a neck injury DO NOT REMOVE THE HELMET Protect the Airway Spine Precautions

11. The Player who comes off on his own Sit player Full neck and neuro exam Significant neck pain or limited motion assume neck injury

12. Evaluation, Management and Prevention of Neck Injury Case 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”

13. What is a Stinger?

14. Evaluation and Return to Play Stinger Brachial Plexopathy/nerve root injury Radiates from shoulder down to arm Three Keys: 1) Short duration 2) Unilateral arm 3) Pain-free neck motion

15. 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”

16. Evaluation and Return to Play Athlete may return to play if: –Burning symptoms resolve –Neuro exam is normal with return of motor strength

17. Evaluation and Return to Play Chronic 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

18. Prevention What can my collision athlete wear to minimize stingers? Start with appropriate fitting shoulder pads There are a couple options

19. There are many types

20. Compared three commonly used Neck collars

21. 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!!!

22. See what You Hit

23. USA football website www.usafootball.com

24. Hockey Eliminate Checking from Behind

25. 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

26. Questions or comments cp2654@columbia.edu