A 38-year-old man came to the emergency department at Jefferson Stratford Hospital in Camden County, complaining of neck pain, plus discomfort while swallowing and even breathing.

He explained that he had been play-wrestling with his 15-year-old son when he heard a pop. His son had him in a choke hold from behind. Choke holds are fairly common in mixed martial arts, which are becoming more popular, not to mention friendly horseplay. The man thought he had broken his neck.

We checked to see if he had any wheezing or sounds to suggest that his airways were obstructed, and they weren't. We saw no bruising, swelling, or other signs of trauma to his neck, although he said he felt some tenderness.

It certainly would have been unlikely to see a major injury from horseplay. While various structures in the neck and spine can be damaged during high-impact sports, car accidents, or other instances where a large force hits the neck, we wouldn't normally expect major damage from a friendly wrestling match.

What was causing our patient's symptoms? 


A CT scan of the neck area revealed a small fracture in the cartilage surrounding the patient's thyroid. So in one sense he was right about his neck being broken. Luckily, it was his Adam's apple rather than his spine that sustained the damage.

While it was still an unusual injury for horseplay, we had seen other examples of physicians reporting Adam's apple fractures from something as benign as a sneeze, to a blow to the back of the head. In all of these cases, we think the break happened as a result of compressing the thyroid cartilage while bringing the chin to the chest. The typical response when placed in a choke hold is to bring your chin down and protect your neck and carotid artery. That's likely when the fracture occurred.

Because it's a relatively rare fracture, it's also one that may be easy to miss. However, there's the potential for long-term damage to the vocal cords that can lead to speech difficulties. Some physicians have said the injury can be deadly.

Our patient required only an overnight stay for observation and was discharged the following day without need for further intervention.

Alan Lucerna, assistant director for the emergency department, and James Espinosa, attending physician in the emergency department at Jefferson Stratford Hospital.