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