Neck injuries are often overlooked and under diagnosed
Posted by Administrator (admin) on Apr 26 2007 at 10:41 PM
Spinal Cord Injury >>

(Created: Sunday, April 22, 2007 11:22 AM EDT)

Last week, this column covered some information about head injuries and, in particular, concussions. Because head and neck injuries often occur simultaneously, we associate any blow to the head with potential injury to the neck. When assessing any such victim, we must check the neck for spinal cord injury and determine whether the victim can be moved safely. Only if the neck evaluation is normal, can the victim be moved.

    Serious neck injuries may be significantly under diagnosed. When 108 freshmen recruits to the University of Iowa football team had x-ray assessment of the neck, 35 were found to have evidence of previous neck injury. These injuries included old compression fractures, posterior element fractures, and disk narrowing with instability.

    If a person has any injury to the head or neck, the exact time of the injury should be noted because management decisions are based on duration of symptoms. The victim should not be moved until a complete evaluation has occurred unless the victim and rescuers are in danger of further injury or death, such as in a fire or explosion. Even then, every reasonable precaution should be taken to protect the neck and spine from further injury.

    Although chronic neck pain is a real and serious potential problem with any neck injury, damage to the spinal cord can lead to life-altering, or even life-threatening complications. Any numbness, tingling, or loss of function suggests a nervous system injury, especially if the symptoms are on both sides.

    If there is pain in the neck or if the patient is unconscious or unreliable for any reason such as confusion or intoxication, the neck should be immobilized since it must be assumed the neck is unstable. Care must be taken to avoid manipulation of the neck. The patient should be prepared for transport to an emergency department.

    Whenever possible, the victim should remain at the site of the injury until the spine is fully immobilized. This is true whether the injury is due to an auto accident, a sports injury, or whatever else. Three or four trained persons are required to safely “log roll” the patient onto a backboard. This procedure may require leaving the patient at the site until emergency medical personnel arrive.

    We must protect the spinal cord from injury whenever instability is a consideration. A cervical collar alone never should be considered adequate protection for the spinal cord. Instead, full immobilization on a backboard is required to stabilize the neck.

    When the neck has been evaluated with negative x-rays, CT, and/or MRI, the neck problems may be just beginning for patients who suffer from “whiplash.” This is a nonmedical term used to describe neck pain following an injury to the soft tissues of your neck (specifically ligaments, tendons, and muscles). It is caused by an accidental motion or force applied to your neck that results in movement beyond the neck’s normal range of motion. Whiplash may happen in motor vehicle accidents, sporting activities, accidental falls and assault.

    Just like ankle sprains can be as troublesome as ankle fractures, whiplash injuries of the neck can create long-term problems for the victim. On the other hand, they may improve in just a few days. Physical therapy and other treatments may be necessary to return the whiplash sufferer to adequate function.

    In addition to whiplash injuries to the soft tissues of the neck, there can be temporary nervous system injuries. Severe, immediate, burning pain radiating from the neck to one arm characterizes “burners” (also called “stingers”), which are common among football players. The pain may be associated with weakness or numbness.

    Their brief duration, one-sided symptoms, and lack of associated pain or reduced range of motion at the neck separate burners from serious neck injuries. If you play football, you can get a burner when you tackle or block another player. In this case, one of three things happens:

    • Your shoulder is pushed down at the same time that your head is forced to the opposite side. This stretches nerves between your neck and shoulder.

    • Your head is quickly moved to one side. This pinches nerves on that side.

    • The area above your collarbone is hit directly. This bruises nerves.

Although athletes whose symptoms resolve completely within minutes can safely return to play, it is important that an experienced examiner such as a certified trainer or team physician evaluate the player beforehand. Some burners last a few minutes. Others take several days or weeks to heal.

    An important point for athletes or anyone else with a neck injury: Do not just assume that you have a burner. You might have a serious neck injury. If you have burning, stinging, numbness or tingling in your arms or legs, stop what you’re doing. Stay seated or slowly lie down on the ground and wait for a medic or trainer or doctor to examine you.