Author: Craig Yarbrough, MD
Co Author #1: Craig M. Yarbrough M.D.
Co Author #2: Chris Miles M.D.
Editor: Siobhan Statuta, MD
A 20 year old Caucasian collegiate male football player was tackled during a football play. He was struck in the chest by a defender's helmet while catching a pass. He shouted out in immediate pain while lying in a face-up position on the field. The medical team hurried onto the field to evaluate the downed athlete. He denied any loss of consciousness or amnesia but complained of difficulty "getting his wind". Shortly thereafter, he noted midline neck pain along with numbness and inability to feel his feet. Examination confirmed pain on palpation of the cervical spine and was then spine-boarded and transported to the Emergency Department.
No significant past medical, social or family history of neck injury or neurologic disorders.
Specifically, no personal history of cervical neck injury, concussion, or neurologic disorder.
General: no acute distress
- Alert and oriented to person, place, time and situation
- Speech with normal rate, rhythm, and tone, appropriate for context
Neuro: Cranial nerves II-XII intact
- Sensation: intact to light touch bilaterally and symmetric in the upper and lower extremities except for bilateral feet. In both feet, he displayed decreased pinprick sensation and no proprioception. Perirectal sensation intact.
- Reflexes: 2+ bilateral patellar, 2+ biceps. No clonus, no Babinski's sign.
- Rectal tone: present
- Motor: Upper extremities: Bilateral weakness 3/5 of deltoid, biceps, triceps, wrist extension / flexion, grip strength.
Lower extremities: no movement against gravity of hip, knee, ankle, toes.
Musculoskeletal: Pain midline along the entire spine.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.