Friday Night Palsy, Saturday Morning Mystery - Page #1

Author: Jorge Sucar-Marquez, MD
Co Author #1: Peter Rippey, MD University of South Alabama Sports Medicine Program Director
Co Author #2: Sarah McMullin, MD University of South Alabama Sports Medicine Associate Program Director
Senior Editor: Kevin Gray, MD
Editor: Mark Matusak, DO

Patient Presentation:
16-year-old male football player collapsed on the sideline minutes after playing on the punt return team.

Prior to being found down, the patient was involved in a punt return play and walked off the field apparently unscathed. A few minutes after the play, the sports medicine staff was alerted that a player had collapsed on the sideline. The player was found face down, confused, and he indicated significant pain in his head and neck region. Spinal stabilization protocol was performed by the sports medicine staff. Patient was noted to have altered mental status and hemiplegia of his right arm and leg. He had no recollection of the mechanism of his injury. Patient was transferred to the nearest trauma center where seizure activity was noted.

Physical Exam:
Exam on the field showed:
General: In moderate distress due to pain.
Head: Normocephalic and atraumatic.
Eyes: Pupils equal, round, and reactive to light. Extraocular movements intact.
Cardiovascular: Radial and dorsalis pedis pulses 2+ bilaterally and equal.
Respiratory: No signs of respiratory distress, speaking without difficulty.
Neurologic: Alert and oriented x 3, following commands. Cranial nerves II-XII grossly normal. Right upper extremity strength: elbow flexion and shoulder abduction 1/5, unable to grip. Right lower extremity: hip flexion and abduction 1/5, ankle plantar and dorsiflexion 1/5. Strength in left upper and lower extremities was 5/5. Sensation intact bilaterally.
Musculoskeletal: No visible deformities. Neck with midline tenderness along C3-C5.

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.

© The American Medical Society for Sports Medicine
4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415

Website created by the computer geek