Author: Torrance Laury, MD
Co Author #1: Torrance Laury, MD
Co Author #2: Brandon Mines, MD
Co Author #3: Neeru Jayanthi, MD
Editor: Margaret Gibson, MD
Senior Editor: Margaret Gibson, MD
Editor: Amy Leu, DO
Senior Editor: Margaret E Gibson, MD
A 22-year-old defensive back presented to team physician and athletic trainer on the sidelines spitting up blood. He denied any neck pain, chest pain, shortness of breath, or trauma. He was noted to have a superficial bleeding laceration on tongue. Bleeding resolved with pressure.
Two weeks later, presented to ED with progressive pain in the base of skull radiating to left ear. There was pain with neck flexion and a catching sensation when extending back to neutral. There was no associated weakness, numbness, tingling, headache, dizziness, or tinnitus. In the ED, he admitted for the first time to taking a traumatic hit to the neck and chest at the same game where he was noted to spit up blood. He attributes his current neck pain to that hit.
General: Alert and oriented with no acute distress
MSK: Decreased range of motion of cervical spine with flexion, extension, lateral rotation, and side bend
Cranial Nerves X-XII intact
Sensation to light touch intact in bilateral upper and lower extremities
5/5 strength in bilateral deltoids, biceps, triceps
5/5 strength with bilateral wrist flexion, wrist extension, and gripping
5/5 strength with bilateral hip flexion, knee extension, ankle dorsiflexion, and plantar flexion
2+ reflexes in bilateral biceps and brachioradialis
1+ reflexes in bilateral patellar tendons
Coordination intact with finger-to-nose testing
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