Bilateral Upper Extremity Weakness in a Wrestler

Abstract

HISTORY: A19-year-old male college Wrestler with a history of right labral repair presented with 4-month insidious 10/10 neck pain and band-like pain over his shoulders. In the last month he developed bilateral dorsal hand paresthesias with shoulder fatigue while wrestling. After a month off, symptoms would emerge after 2.5 minutes of wrestling and progressively longer. No illness, increase in activity, color changes, temperature differences, loss of dexterity. PHYSICAL EXAMINATION: General: Well-developed male Skin: No rashes or lesions Vascular: Normal pulse and capillary refill Neuromuscular: Normal muscle bulk and tone. Normal range of motion, strength, deep tendon reflexes, and sensation to light touch and pinprick in the bilateral upper extremities. Positive Tromner reflex bilaterally, otherwise negative special testing of the cervical spine, shoulder, scapula, and neurovascular bundle. DIFFERENTIAL DIAGNOSIS: 1. Cervical Radiculopathy 2. Transient quadriplegia 3. Suprascapular or Axillary Mononeuropathy 4. Brachial Plexopathy 5. Thoracic Outlet Syndrome 6. Myopathy 7. Quadrilateral Space Syndrome 8. Spinal cord injury 9. Cervical facet pathology TEST AND RESULTS: Cervical MRI identified absent right C5 pedicle with no spinal cord signal abnormality. C5 and C6 spinal nerve roots were separate with no dural extension Cervical CT showed no fracture of the right C5 pedicle; likely congenital absence. Anterior and posterior columns were normal Cervical radiographs revealed no dynamic instability Bilateral upper extremity electrodiagnostics were normal with no axillary or suprascapular mononeuropathy, upper trunk plexopathy, or radiculopathy. FINAL WORKING DIAGNOSIS: Congenital absent right C5 pedicle with C6 subluxation TREATMENT AND OUTCOMES: 1. Neurosurgical consultation which confirmed spinal stability with no restriction on sporting activities 2. Progressed from limited sporting activities including aerobic activities without upper body utilization and non-Olympic lower body weight lifting without barbell utilization, to stabilization exercises aimed at cervical musculature, trapezius, deltoids, and rhomboids. 3. Return to sport in process, focusing on Folk style wrestling given less submission and upper extremity rapid force transmission.