Neck Pain In A High School Football Player

HISTORY: A 17-year-old high school football linebacker with type 1 diabetes mellitus sustained a helmet-to-helmet collision with the ball carrier during kickoff return. His head was forced into hyperextension and he fell but did not lose consciousness. He attempted to stand but fell. He was incoherent and complained of neck pain and numbness of his mouth, hands, and upper thighs. He was tender over C5-7. He was spine boarded and taken to the emergency department (ED). On arrival, he had no neck pain. His cervical spine was cleared and no images were obtained. He is a known type 1 diabetic and removes his insulin pump prior to games. In the ED, his glucose was 759 but bicarbonate was normal with no anion gap. His insulin pump was restarted and he received 2 L of IV normal saline. He was discharged with resolution of his paresthesias and a repeat glucose of 324. He presented to the athletic training room (ATR) the next day with midline neck pain, headache, photophobia, phonophobia, and difficulty concentrating. PHYSICAL EXAM: Upon exam in the ATR, patient was alert and oriented. He was tender to palpation over C5-C7. Neck had decreased ROM in lateral bending and rotation. Spurling’s maneuver reproduced neck pain but no radiating symptoms. Motor and sensation intact in all 4 extremities. Otherwise normal physical and cognitive exam. DIFFERENTIAL DIAGNOSIS: Fracture of cervical spineCervical paraspinal muscle strainConcussionAltered mental status and parasthesias due to hyperglycemia TEST AND RESULTS: X-ray of cervical spine: No fracture. Trace anterior listhesis of C3 on C4, C4 on C5, and C5 on C6 MRI of cervical spine obtained due to abnormal x-rays: Bone marrow edema in the anterior superior endplate of C7 could reflect a contusion or tiny fracture. Mildly desiccated C4-5 disc space with a small right foraminal protrusion resulting in mild foraminal stenosis. FINAL/WORKING DIAGNOSIS: 1. C7 cervical spine fracture 2. C4-5 disk protrusion TREATMENT AND OUTCOME: Case discussed with spine surgeon and patient was placed in a cervical collar for 6 weeks. His concussion symptoms resolved within 1 week. He started light aerobic activity while in his brace. Once cervical collar was discontinued, physical therapy was ordered which focused on neck range of motion and stretching. He returned to weightlifting by 8 weeks and will run track in the spring.