The end of the patrol day is coming to a close and you’re in the shack awaiting the beginning of sweeps. A young woman named Sarah walks in and requests your help. She is a well-known local snowboarder on the freeride team, and she’s your friend as well. She reports that earlier in the day she was sessioning the big jump line in the advanced park. On her third trip through the park she was feeling confident and hit the second jump too fast. She says that she went deep and landed flat, landing on her back and hitting her head on the snow. The reason that she came in to see you is that a few minutes after the fall while she was getting up she started to feel some tingling in her shoulders and upper arms which is new for her.
She did take several more runs after the fall but now she feels tired and she’s worried about the possibility of falling as the light has gone flat. She says that her boyfriend is waiting in the parking lot to give her a ride down, and she requests a courtesy ride to the base in a toboggan or on a snowmobile.
Sarah agrees to let you evaluate her. You take a more thorough history of Sarah’s symptoms; she has no headache or vision changes. She denies neck pain. She continues to feel tightness at the base of her neck and tingling on the tops of her arms on both sides extending to the elbow, and she hasn’t ever had tingling like that before. She denies any weakness in her arms or legs, though she does feel tired. She doesn’t have any pain in her arms, legs, back, chest, or abdomen. She has been able to walk without difficulty. She hasn’t lost control of her bowel or bladder. She takes no medications.
Your head-to-toe exam reveals no other injuries. She has no point tenderness on her cervical spine and she turns her head without discomfort while you are speaking with her. She has spasm of the bilateral trapezius muscles (base of the neck, shrug muscles). She has subjectively decreased sensation to light touch across her shoulders and upper arms but has no weakness that you appreciate.
Sarah gets somewhat worried as you examine her. She’s running late to meet her boyfriend, but you’re also making her worried about the numbness. She asks if she can get a ride down and go to the urgent care.
Sarah is placed in a cervical collar and is transported to the base clinic. You have informed your dispatch, and they have requested an ambulance for transport to hospital. On arrival to the base clinic, she says that she would like to have her boyfriend transport her to the hospital and asks that she be allowed to keep the cervical collar on. She affirms that she will go directly to the hospital.