"Tingling In The Scrum": Paresthesias And Neck Pain - Rugby

Abstract

HISTORY: A 19 year old female college student “new to club rugby” presented to the campus health clinic for evaluation of neck stiffness and extremity tingling following last week’s practice. She was unable to recall a specific injury. However, she reported later feeling neck stiffness with associated soreness. She also reported paresthesias involving both hands, left worse than right, and her left foot. Her symptoms were improving but she had not resumed practice. She reported being a multi-sport high school athlete with participation in varsity field hockey and lacrosse without prior concussion, head or neck pain, or extremity abnormalities. She had also been in an auto accident years prior without subsequent injury. History was notable for resolved low back pain, and a family history of back pain. PHYSICAL EXAMINATION: Spine exam demonstrated FROM with no C/T/L spinous process tenderness. Spurling maneuver was negative. Tightness was appreciated in left trapezius muscle compared to right. Shoulders demonstrated FROM with normal rotator cuff strength. Upper and lower extremities with equal sensation, reflexes, and pulses. Grip strength normal. Straight leg raise and slump tests were negative. DIFFERENTIAL DIAGNOSIS: 1. Cervical strain 2. Herniated cervical disc 3. Cervical spondylolysis 4. Vertebral fracture 5. Spinal stenosis 6. Spinal infection 7. Autoimmune disease TESTS AND RESULTS: 1. Cervical spine x-rays: straightening without bony pathology 2. MRI brain & cervical spine: - Mild disc narrowing at C5-6 - Chiari I malformation with pointed tonsils herniated 1.1 cm from foramen magnum - Syrinx spanning C5-T4 with max diameter 3 mm in upper thoracic cord FINAL WORKING DIAGNOSIS: Chiari I malformation with C5-T4 syringomyelia TREATMENT AND OUTCOMES: The athlete was initially restricted from rugby activities until follow-up evaluation. She noted interval improvement and wished to pursue strength training at season end. Her symptoms then recurred with overhead lifting, and later with chiropractic treatments. Upon return to campus, brain and cervical MRI were ordered as recommended by a neurologist. Due to the above MRI findings, she stopped recreational activity and was referred for urgent neurosurgical evaluation. She will undergo decompression surgery.