What is the most appropriate management for a 20-year-old college football player with bilateral numbness, tingling, and pain radiating to his fingertips after being struck by another athlete?

Management of Suspected Cervical Spine Injury in a Football Player

Keeping his helmet and pads in place, log-rolling him onto a stretcher, and transporting him to the ED via EMS is the most appropriate management for this athlete with suspected cervical spine injury.

Initial Assessment and Stabilization

When faced with an athlete who has sustained a potential cervical spine injury, the primary concern is to prevent secondary injury through proper immobilization and transport. The presentation of bilateral numbness, tingling, and pain radiating to the fingertips after trauma strongly suggests cervical spine involvement that requires immediate attention.

Key Management Steps:

1. Do not remove the helmet or shoulder pads in the field

   • Helmets and shoulder pads work together to maintain neutral alignment of the cervical spine
   • Removing one without the other can cause hyperextension or hyperflexion, potentially worsening a cervical spine injury 1

2. Maintain manual in-line stabilization

   • Immediately stabilize the head and neck in the position found
   • Avoid any movement of the cervical spine

3. Perform log-roll technique onto a spine board

   • Requires coordinated effort from multiple providers
   • Maintain strict spinal alignment throughout the transfer

4. Transport via EMS to emergency department

   • Continuous spinal immobilization during transport
   • Communicate findings to receiving facility

Why This Approach Is Correct

The athlete's symptoms of bilateral upper extremity paresthesia and pain strongly suggest cervical nerve root or spinal cord involvement. While he is alert and doesn't show weakness, these neurological symptoms require comprehensive evaluation that cannot be performed adequately on the field.

Research supports keeping the helmet and shoulder pads in place during transport for suspected cervical spine injuries in football players. Removing the helmet alone can cause hyperextension of the cervical spine, potentially worsening any existing injury 1.

Why Other Options Are Incorrect

1. Immediate examination and return to play if unremarkable:

   • Dangerous approach that risks worsening a potential cervical spine injury
   • Neurological symptoms require comprehensive imaging that cannot be performed on the field

2. Return to play if symptoms resolve within 15 minutes:

   • Transient resolution of symptoms does not rule out serious cervical spine injury
   • Concussion guidelines recommend removal from play for the remainder of the day when neurological symptoms occur 2

3. Serial neurologic examinations with sideline observation:

   • Inadequate for potential cervical spine injury with bilateral neurological symptoms
   • Fails to provide proper immobilization and diagnostic imaging

4. Removing helmet but leaving shoulder pads:

   • Creates cervical hyperextension, potentially worsening injury
   • Contradicts established protocols for suspected cervical spine injuries 1

Common Pitfalls to Avoid

• Rushing assessment: Take time to properly assess and immobilize before transport
• Helmet removal on the field: Only remove if absolutely necessary for airway management
• Moving the athlete without proper coordination: Ensure adequate personnel for log-roll technique
• Allowing the athlete to self-transport: Always use EMS for suspected cervical spine injuries
• Dismissing transient symptoms: Even if symptoms improve, complete evaluation is necessary

By following proper immobilization and transport protocols, you maximize the chances of a good outcome while minimizing the risk of secondary injury to the cervical spine.