Neck Pain In A Discus Thrower

Abstract

HISTORY: A 20yo female collegiate discus thrower with acute onset of shooting pain in her left neck when she abruptly extends her neck and turns it to the left. She develops simultaneous numbness on her left tongue and face. She has difficulty speaking transiently. Episodes last 20 to 30 seconds. They are followed by a left-sided headache which lasts all day. It is a shooting sensation radiating up from the neck and "feels like getting hit in the funny bone." The athlete denies any weakness or sensation deficits in extremities, seizures, dizziness, or visual changes. Symptoms began in high school but have increased in severity since she joined the collegiate discus team. Family history is negative. Negative review of systems. PHYSICAL EXAMINATION: Full range of motion in neck, with significant hyperextension. No C-spine tenderness. Negative bilateral Spurling's. Cranial nerves intact. Speech within normal limits. Sensation intact to pinprick. Normal pupillary and funduscopic exams. Reflexes are 2+ and strength 5/5 in all extremities. Coordination intact. Normal gait. Negative Rhomberg's. No clonus. Negative bilateral Babinski. DIFFERENTIAL DIAGNOSIS: Vascular insufficiency/occlusion. Transient ischemia to isolated cranial nerves. Mass compressing cranial/ cervical nerves. Nerve compression from disc hernition or spinal stenosis. TEST AND RESULTS: Laboratory testing - Normal complete blood count, erythrocyte sedimentation rate, comprehensive metabolic panel, thyroid simulating hormone. Negative anti-nuclear antibody (<1:40) and rheumatoid factor (<17). C-spine X-rays - Mild reversal of the normal cervical lordosis. 2-3mm anterolistheses of all cervical bodies C2-C6 with neck flexion, which revert to mild retrolistheses with extension. No spinal stenosis or degenerative disease. There is mild instability throughout the cervical spine. C-spine MRI - No cervical mass, disc herniation, spinal stenosis, or neuroforaminal narrowing. Brain MRI with contrast - Negative. FINAL WORKING DIAGNOSIS: Neck-Tongue Syndrome TREATMENT AND OUTCOMES: 1. Neck strengthening and postural training to stabilize neck. 2. Patient declines acetaminophen and NSAIDs. 3. She stops discus throwing without specific plans to resume it. 4. Referred to a spine surgeon. 5, Continues to follow-up with her neurologist.