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Injury of peripheral nerves of neck — Clinical Guidelines

Overview

Injury to peripheral nerves of the neck can result from trauma sustained during sports activities, leading to significant functional impairment and potential long-term disability if not managed appropriately. 2

Diagnosis

Clinical Assessment: Initial evaluation includes assessing neurological function, pain levels, and range of motion. 2

Imaging: Lateral soft-tissue radiographs can help measure prevertebral soft-tissue thickness for identifying abnormalities, particularly useful in pediatric and adult populations. Mean thickness varies: retropharyngeal region (6.2-3.7 mm) and retrotracheal region (9.2-12.1 mm). 4

Neurological Testing: Electromyography (EMG) and nerve conduction studies may be necessary for detailed assessment of nerve function. 2

Management

Immediate Care: Ensure cervical spine immobilization, airway management, and stabilization to prevent further injury. 2

Education and Training: Coaches and medical staff should receive comprehensive training in recognition and initial management of neck injuries, including the Mayday Safety Procedure (MSP). 1 3

Supportive Measures: Pain management with analgesics (e.g., NSAIDs) and physical therapy for rehabilitation post-injury. Specific drug doses not detailed in abstracts. 2

Facility Preparedness: Schools and sports facilities should equip first aid kits with neck collars and stretchers to facilitate safe transport and initial care. 3

Special Populations

Pediatrics: Prevertebral soft-tissue thickness varies significantly, requiring careful monitoring and tailored imaging standards. 4

Coaches and Educators: Significant knowledge gaps identified; targeted educational programs are crucial for improving prevention and management practices. 3

Key Recommendations

Implement comprehensive training programs for coaches and medical staff in recognizing and managing acute neck injuries, emphasizing the Mayday Safety Procedure (MSP). (Evidence: Expert opinion 1)

Ensure that all sports facilities, particularly schools, are equipped with necessary first aid supplies including neck collars and stretchers for immediate care. (Evidence: Moderate 3)

Utilize lateral soft-tissue radiographs with standardized measurement criteria for prevertebral soft-tissue thickness to aid in diagnosing abnormalities in neck injuries across different age groups. (Evidence: Moderate 4)

References

1 Donaldson A, Poulos RG. Planning the diffusion of a neck-injury prevention programme among community rugby union coaches. British journal of sports medicine 2014. link 2 Cooper L. Acute disposition of neck injuries. Current sports medicine reports 2005. link 3 Cooney M, Coleman F, Flynn A. A study of the knowledge that school rugby coaches have in the management and prevention of serious neck injury. Irish medical journal 2000. link 4 Haug RH, Wible RT, Lieberman J. Measurement standards for the prevertebral region in the lateral soft-tissue radiograph of the neck. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 1991. link90405-b)

Injury of peripheral nerves of neck