On-Field Neck Pain With Transient Bilateral Arm Symptoms
A 17-year-old football player is tackled helmet-to-helmet and immediately reports neck pain and “both hands going numb.” He is conscious, breathing normally, and has no loss of consciousness. On-field examination, the numbness and weakness in both hands resolve within 5 minutes. He now has midline cervical tenderness but no focal motor deficit, and he is frightened. His helmet and shoulder pads are still on. The athletic trainer asks whether to remove the helmet on the field, whether he can walk to the sideline, and whether he can return in the second half if a sideline examination is normal.
1. Describe your immediate on-field management, including the equipment-removal decision.
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Treat this as a potential cervical spine injury until proven otherwise. Do not let him walk. Stabilize the head in a neutral position, log-roll him with coordinated team movement, and place him on a backboard for transport.
Leave the helmet and shoulder pads on if the airway is patent and the equipment does not prevent immobilization. Removing only the helmet can extend the neck because the shoulder pads remain; if the helmet must be removed, the shoulder pads should also be removed by trained personnel while maintaining inline stabilization. Remove the facemask first only if airway access or suction is needed.
He had bilateral transient symptoms and midline tenderness, so he should be transported for evaluation. Do not perform a sideline “clearance” examination and do not allow same-day return.
2. What imaging and return-to-play criteria do you use?
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Obtain CT of the cervical spine because he has midline tenderness and a mechanism concerning for fracture. If CT is normal but symptoms persist or there is concern for cord injury, obtain MRI to evaluate the spinal cord, ligaments, and discs.
Return to play is not considered until:
- imaging shows no fracture, instability, or cord signal change;
- he is asymptomatic with full pain-free cervical range of motion;
- strength and sensation are normal;
- a physician has reviewed the risk of recurrence and any stenosis.
If imaging shows congenital stenosis, cord contusion, or ligamentous instability, restrict from collision sports and refer to spine surgery. A normal CT alone does not automatically permit return if he had true bilateral cord symptoms.
3. How do you distinguish a stinger from cervical cord neurology?
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A stinger (brachial plexus injury) is usually unilateral, involves one arm, follows a dermatomal or peripheral nerve pattern, and resolves quickly. It often causes burning dysesthesia in the hand or arm and weakness in the deltoid or biceps, with neck pain that is less prominent.
Cervical cord neurology is suggested by bilateral symptoms, sensory changes in both arms or legs, transient quadriparesis, gait disturbance, or loss of bowel/bladder function. This patient had bilateral hand numbness and weakness, which is a red flag for cord involvement rather than a simple stinger. Midline tenderness also points toward a structural injury.
He should be evaluated urgently and should not return to play that day, even if his examination normalizes on the sideline.