Head and Neck Injuriesin Football Players
Joel Gonzales, M. D.
Today’s Topics
• Concussions
• Burner Syndrome
• Transient Quadriparesis
• Permanent Spinal Cord Injuries
Concussions
• Player’s initial state of condition does NOT reliably indicate severity of injury
Concussions
• Evaluate:– Facial expression
– Orientation to time, person, place
– Amnesia?
– Gait
Grade 1 Concussion
• Player dazed / confused
• May have unsteady gait
• Mildest form
• No loss of consciousness
Grade 1 Concussion
• No Amnesia
• Symptoms last only 10-15 minutes– Player lucid
– Gait steady
– Eyes clear
Grade 1 Concussion
• TREATMENT: allow return to play under close supervision
• No return to play if dizzy, have headache, or overly emotional
Grade 2 Concussions
• Same symptoms as Grade 1
• Post-traumatic amnesia
(cannot recall events since injury)
Grade 2 Concussions
• NO RETURN to play on day of injury
• Must see neurosurgeon
• No return to play until headache, irritability, and inability to concentrate resolve
Grade 3 Concussion
• Have Retrograde Amnesia
(cannot recall events PRIOR to injury)
• No return to play
• Need hospital observation
Grade 4 Concussion
• Loss of consciousness for seconds to minutes
• Emerge confused
• Have post-traumatic and retrograde amnesia
Grade 4 Concussion
• Place player on stretcher
• Protect cervical spine
• Hospital for observation
• Never allow player with l.o.c. to return to play that day
Grade 5 Concussion
• Loss of consciousness
• Cardiorespiratory arrest
• CPR and transport to hospital immediately
Summary on Concussions
• Grade 1 - No amnesia - return to play
• Grade 2 - Post-injury amnesia - see neurosurgeon
• Grade 3 - Retrograde amnesia - hospital
• Grade 4,5 - loss of consciousness - hospital
Burner Syndrome
• Common injury - 50% of NCAA players over 4 yr career
• Player makes contact with head and shoulder while tackling
• Intense burning pain about shoulder
Burner Syndrome
• Complain of burning numbness
• Pain may radiate into arm or hand
• “Dead arm” or numbness / tingling
• Recovery time = usually minutes
Burner Syndrome
• 5-10% of injuries more serious
• Neurologic deficit may last several hours
• Weakness in deltoids / biceps
Burner Syndrome
• Athletes may return to play only if:– complete recovery of biceps / deltoid strength
– complete resolution of symptoms• Watch player closely• Equip with more cushioned pads / custom rubber
neck roll
Burner Syndrome
• Some players more susceptible to repeat injury
• Equip with more cushioned pads and custom rubber neck roll
• Neck strengthening regimen
Transient Quadriparesis
• Numbness and weakness from neck down
• Persistent numbness or weakness in arms, legs, trunk
• Need immediate spine x-rays / MRI
Transient Quadriparesis
• No return to play
• Referral to neurosurgeon
• Must rule out cervical fracture or disc problem
Permanent Spinal Cord Injuries
• 99 permanent spinal cord injuries in H.S. and college football 1971-1975
• 1976 - “NO SPEARING RULE”
• 1977-1987 = 105 permanent cord inj.
• 50% reduction rate after rule started
Permanent Spinal Cord Injuries
• 86 H.S. player / 14college / 5 semi-pro
• Most occur during games
• Defensive backs most vulnerable
Prevention of Spinal Cord Injury
• Teach proper tackling (no spearing)
• Proper conditioning / neck strengthening
• Enforce “no spearing” rule during practice
Prevention of Spinal Cord Injury
• Make certain equipment fits properly
• Physician should be at all games