Neck Injury ??? Football

Abstract

HISTORY A 26 year old semi-professional defensive tackle was seen in consultation for neck pain with radiating numbness down both arms and into hands. Initial symptoms occurred 3 weeks prior as he described using a spearing technique to tackle an opponent in practice after which he developed posterior neck pain and numbness and paresthesias of both arms to the fingertips lasting ten minutes. He completed practice. Two weeks later, during a game, he had two recurrences of similar neck pain and bilateral upper extremity symptoms after use of similar tackling technique and did not complete the game due to neck pain. He then presented to his physician for initial evaluation of neck pain and was referred to Sports Medicine. At the time of his consultative visit his pain had improved 50% and he had no upper extremity symptoms. He gave no prior history of neck injury. Past medical history was otherwise negative. PHYSICAL EXAMINATION He had no palpable cervical spine tenderness. Active range of motion was decreased in extension, flexion, left and right lateral bending, but bilateral rotation was full. Neck pain was exacerbated by left and right lateral bending. Spurling's was negative. Strength of neck flexion, extension, rotation and lateral bending was full. Bilateral upper extremity strength, sensation and reflexes were intact/symmetric/normal. DIFFERENTIAL DIAGNOSIS Cervical spinal cord neurapraxia Cervical disc herniation Cervical spinal stenosis Fracture or instability of the cervical spine TEST AND RESULTS Cervical spine AP and lateral radiographs: normal alignment without subluxation or fracture loss of normal cervical lordosis Cervical spine flexion and extension views: normal alignment without evidence of instability Cervical spine MRI: multi-level mild to moderate degenerative changes with central disc herniations at C2-3 and C3-4 causing mild central canal stenosis FINAL WORKING DIAGNOSIS Spear-tackler's spine TREATMENT AND OUTCOMES He was advised to remove himself from football due to risk of cord injury. Second opinion was offered with a spine surgeon. Recommendations were reviewed with his primary care physician. Consideration for possible rehabilitation in order to attempt to restore cervical alignment (normal neutral lordosis) was discussed without guarantee of a favorable outcome. He did not return to football for the remainder of the 2004 season and is undecided about future participation. He did not return to his primary care physician for follow up. Neck pain had fully resolved by 2 months after the initial injury, and he had no recurrence of upper extremity neurological symptoms.