What is the most appropriate management for a football player with suspected spinal cord injury, presenting with bilateral numbness, tingling, and pain radiating to fingertips, but no weakness or confusion?

Management of Suspected Cervical Spine Injury in a Football Player

Keeping the helmet and pads in place, log-rolling the athlete 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

• The athlete's presentation with bilateral numbness, tingling, and pain radiating to fingertips following trauma indicates a potential cervical spine injury that requires immediate and careful management 1
• Athletes who have experienced trauma and report neurologic symptoms should be treated with the assumption of a possible cervical spine injury 1, 2
• Apprehension of cervical range of motion is a significant clinical finding that further supports suspicion for cervical spine injury 2, 3

Evidence-Based Management Protocol

Equipment Handling

• When managing a football player with suspected cervical spine injury, both helmet and shoulder pads should remain in place during stabilization and transport 4, 5
• The "all or none" principle for equipment removal is strongly supported by evidence - either leave both helmet and shoulder pads in place or remove both together as a unit 4, 6
• Removing only the helmet or only the shoulder pads violates the principle of maintaining neutral cervical spine alignment and may cause further injury 4, 6

Proper Transport Technique

• The athlete should be log-rolled onto a stretcher while maintaining in-line stabilization of the head and neck with the equipment in place 1
• Emergency medical services (EMS) transport is required for proper evaluation and management of suspected cervical spine injuries 1
• Field medical teams should resist demands to move the athlete unless the location presents immediate safety concerns 1

Rationale for Keeping Equipment in Place

• Studies demonstrate that removing only the helmet while leaving shoulder pads in place significantly increases cervical lordosis (mean increase of 13.6 degrees), potentially worsening any existing injury 4
• In destabilized cervical spine specimens, helmet removal alone resulted in significant increases in forward angulation (16.5 degrees), posterior disk space height (3.8 mm), and dorsal element distraction (8.3 mm) 4
• Research shows that improper handling during attempted equipment removal can cause iatrogenic neurologic deterioration 5

Why Other Management Options Are Inappropriate

• Immediate return to play is absolutely contraindicated with any neurologic symptoms, regardless of how quickly they resolve 2
• Serial neurologic examinations without transport is insufficient management for an athlete with bilateral neurologic symptoms 1, 2
• Removing only the helmet while leaving shoulder pads in place creates dangerous cervical alignment changes and is strongly contraindicated 4, 6

Special Considerations

• Airway access may be a concern with equipment in place, but specialized techniques exist for managing airways in helmeted athletes without removing the helmet 7
• If equipment must be removed for life-saving interventions, both helmet and shoulder pads should be removed together using techniques that minimize cervical motion 7, 8
• Field medical teams should be trained in proper spine stabilization techniques specific to athletes wearing protective equipment 1

Common Pitfalls to Avoid

• Assuming neurologic symptoms that resolve quickly are not serious - even transient symptoms require full evaluation 2
• Removing only the helmet or only the shoulder pads, which disrupts neutral spine alignment 4, 6
• Moving the athlete unnecessarily or without proper stabilization techniques 1
• Failing to maintain cervical spine precautions throughout the entire management process 1