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Down On The Field - Page #1
 

Author: Dainon Miles, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Mark Matusak, DO

Patient Presentation:
A 19-year-old healthy male football player was playing on special teams on a Saturday night. He attempted to tackle the opposing kick returner when he inadvertently struck his head on his teammate.

History:
Following the impact, he was initially down with his chest on top of his teammate's leg. After the teammate freed his leg, he remained on the field with his torso now facing upwards and legs crossed. He was immediately assessed by medical staff on the field and was found to be awake and oriented but had limited spontaneous movement noted in his bilateral upper and lower extremities. He also complained of neck pain and weakness from the chest down. On field management: Cervical spine precautions were initiated, and he was rolled into a supine position and his face mask was removed. He was placed on a spine board and transported to the Emergency Room by EMS. During transport, he reported improvement in his weakness and was noted to have more spontaneous movement of his extremities but still complained of altered sensation, numbness, and weakness to his arms and legs.

Physical Exam:
General: No overt external signs of trauma. Helmet removed with spinal precautions and C collar placed. HEENT: Pupils equal and reactive bilaterally.
Neck: + midline bony tenderness to palpation, no palpable step offs or deformities to cervical spine.
CV: Regular rate and rhythm, no murmur.
Neuro: GCS 15. Awake, alert, able to answer questions and follow commands appropriately. Decreased sensation to bilateral upper and lower extremities. Decreased strength with plantar flexion and dorsiflexion of right foot with decreased grip strength to right upper extremity. Unable to distinguish between sharp dull sensation to bilateral upper extremities. Able to move all 4 extremities.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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