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athletic injuries 2036 > Lecture 18: Neck Injuries and on-field assessment > Flashcards

Lecture 18: Neck Injuries and on-field assessment Flashcards

1
Q

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

A

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

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2
Q

what to do with a C-spine injury

A

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

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3
Q

primary survey

A
  • 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

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4
Q

what are the UABC

A

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

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5
Q

the athlete with a suspected neck injury

A

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?

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6
Q

the 8 subjective spinal questoins

A

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

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7
Q

stinger/burner (mechanism)

A

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)

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8
Q

sings and symptoms of stinger/burner

A
  • 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

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9
Q

Return to play following stinger/Burner

A

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

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10
Q

C-spine injuries: MOI

A

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

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11
Q

on field findings of C-spine injuries

A
  • 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
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12
Q

neck injuries to board or not to board

A

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

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13
Q

palpation of the injured athlete

A
  • 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
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14
Q

neurological testing: sensation dermatomes

A
  • cutaneous area receiving the greater part of its innervation from a single spinal nerve
  • pin prick for pain or cotton for pressure
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15
Q

Neurological testing sensation C1

A

Top of head

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16
Q

Neurological testing sensation C2

A

Side of head

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17
Q

Neurological testing sensation C3

A

Side of neck

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18
Q

Neurological testing sensation C4

A

above clavicle

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19
Q

Neurological testing sensation C5

A

Lateral arm over deltoid

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20
Q

Neurological testing sensation C6

A

radial side of arm and entire thumb

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21
Q

Neurological testing sensation C7

A

Middle finger

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22
Q

Neurological testing sensation C8

A

ulnar side of arm and last 2 fingers

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23
Q

Neurological testing sensation T1

A

medial elbow

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24
Q

Neurological testing sensation L1

A

iliac crest

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25
Q

Neurological testing sensation L2

A

anteromedial thigh

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26
Q

Neurological testing sensation L3

A

medial tibial

27
Q

Neurological testing sensation L4

A

Medial side of foot

28
Q

Neurological testing sensation L5

A

between 1st and second toe

29
Q

Neurological testing sensation S1

A

lateral foot

30
Q

Neurolgoical testing Myotomes

A

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

31
Q

Myotome patterns for cervical and lumbar spine C2

A

neck flexion

32
Q

Myotome patterns for cervical and lumbar spine C3

A

neck side flexion

33
Q

Myotome patterns for cervical and lumbar spine C4

A

shoulder shrug

34
Q

Myotome patterns for cervical and lumbar spine C5

A

shoulder abduction

35
Q

Myotome patterns for cervical and lumbar spine C6

A

elbow flexion

36
Q

Myotome patterns for cervical and lumbar spine C7

A

elbow extension

37
Q

Myotome patterns for cervical and lumbar spine C8

A

Thumb extension

38
Q

Myotome patterns for cervical and lumbar spine T1

A

spread fingers

39
Q

Myotome patterns for cervical and lumbar spine L1

A

hip flexion

40
Q

Myotome patterns for cervical and lumbar spine L2

A

hip flexion

41
Q

Myotome patterns for cervical and lumbar spine L3

A

knee extension

42
Q

Myotome patterns for cervical and lumbar spine L4

A

ankle dorsiflexion

43
Q

Myotome patterns for cervical and lumbar spine L5

A

1st toe extension

44
Q

Myotome patterns for cervical and lumbar spine S1

A

plantar flexion

45
Q

Myotome patterns for cervical and lumbar spine S2

A

knee flexion

46
Q

Myotome patterns for cervical and lumbar spine S3

A

intrinsics of foot

47
Q

stinger burner vs spinal cord/ cervical spine injury

A

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

48
Q

the log-roll set up

A

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

49
Q

log roll procedure

A

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

50
Q

Hockey and boarding

A

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

51
Q

football boarding

A

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

52
Q

Lacrosse boarding

A

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

53
Q

when do you remove the helmet of an injured athlete?

A

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

54
Q

you should remove the shoulder pads of an injured athlete when

A

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

55
Q

transport to spine board

A

1: vertical lift
2: log roll

always use vertical lift when you are able

56
Q

vertical life - transport to spine board

A
  • 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
57
Q

log roll - spinal board transfer

A
  • 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
58
Q

transport to the spine board (securing the athlete)

A
  • 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
59
Q

secondary ax goals (non-emergent or extremity)

A
  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
60
Q

know your sport!

A

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

61
Q

history (non-emergent or extremity)

A
  • 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?
62
Q

clearing the ABC’S and C-spine

A

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

63
Q

treatment and transportation

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

athletic injuries 2036 (20 decks)

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