Thursday, January 25, 2018

Rinella's Sign (Cervical Fracture Self-Splinting)

The dashing yet pigmently challenged
Captain Halleman demonstrating Rinella's sign.

A couple few years ago I ran on a typical geriatric sick person call. The patient was experiencing general weakness which caused him mobility difficulties, and had suffered several ground level falls in the prior week without seeking treatment. Upon exam the pt had a mildly sore neck; jaundiced skin;  and a large, distended belly. He was unaware of being diagnosed with any liver issues. He did not have any numbness or paralysis in his extremities.

We helped the patient onto the stretcher and I kicked the call down to the BLS level. As the EMTs wheeled the patient out to the ambulance on his bumpy, unimproved driveway I noticed the patient gripping his neck with both of his hands as if to brace his head upright. I recalled a friend of mine from medic school miming one of his patients with a broken neck doing this, and so I threw a c-collar on the patient before leaving, just in case.

I later received a follow up that the patient was diagnosed with a neck fracture, and cancer which had presumably weakened his bones (in addition to causing liver failure). After pulling this case for review I began speaking with other people who have observed this similar phenomenon, including Dr. Jamie Karambay who once diagnosed a neck fracture after observing a patient holding up her own forehead while drinking from a water fountain. 

Sometimes people with broken necks, who don't yet know they have broken necks, self splint their fracture by creating an anatomical c-collar with cupped hands on either side of their neck. After scouring the internet I have been unable to find reference to this behavior, and so I now unashamedly dub this Rinella's Sign. The combination of neck pain, decreased neck mobility, and Rinella's Sign creates a syndrome now called Rinella's Triad

I am not aware of anyone having eponymously named this medical sign prior to me, but if you do see it mentioned somewhere in the literature please let me know. Also, if you are reading this and believe yours to be the rightful name of this sign, then I see no other way to resolve this...... I  must challenge you to a duel,  and God will decide.

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