Abstract
Introduction: Traumatic atlanto-axial rotational subluxations (AARS) represent a serious condition that is associated with neurological complications, and should be considered among jūdō sports injuries involving the neck. Case presentation: A 6-year-old Caucasian girl with approximately 1 year of recreational jūdō experience presented with neck and shoulder pain while holding her head in a “Cock-robin” sideways tilted position. During a children’s jūdō class while seated on “all fours” she had been subjected to an improperly executed turnover performed by a boy of similar age, body mass and experience. Because of increasing torticollis symptoms after class she was taken by her parents to a local hospital’s emergency department where X-rays showed a mid-clavicular fracture. It was not until 7 weeks post-accident that a CT scan was ordered and a type-III traumatic acute AARS causing her clinical symptoms was recognized. Differential diagnosis: Congenital cervical spine anomalies, Grisel’s syndrome, Juvenile rheumatoid arthritis, Odontoid fracture without atlanto-axial dislocation. Treatment: A halo crown traction brace connected to a cervical traction pulley with gradual increased weight (+0.5 kg every half day to a maximum of 6.5 kg) was used for reduction over a 17-day period, followed by 6 weeks of ambulant immobilization with a halo vest, and 8 weeks of wearing a stiff neck brace. The girl fully recovered but was advised not to return to practicing contact sports. Uniqueness of the study: AARS has not previously been described in association with jūdō practice in children. Conclusion: Traumatic AARS should be considered as a potential diagnosis in jūdōka, especially those of very young age and of female gender, when presenting with torticollis following mechanical impact or severe pressure on the head if blocked in a tilted position. Prompt diagnosis is crucial, preferably by open-mouth X-rays and CT scan, to ensure proper management and prevent neurological complications.
Highlights
It has been suggested that several fatalities due severe head and neck injuries have occurred in jūdō [1,2,3]
Scarce studies, such as the one by Green, et al [11], found that neck injuries associated with participation in jūdō contests occurred at a rate of 1.03 per 1000 Athlete Exposures, with one Athlete Exposure representing the susceptibility to injury, expressed as one athlete participating in one match or practice session in which he or she is exposed to the possibility or injury
Expanding the number of more commonly known cervical spinal problems associated with jūdō practice, the present paper introduces and discusses a recent case of a juvenile jūdōka presenting with torticollis and traumatic Axial Rotary Subluxation (AARS)
Summary
Traumatic AARS should be considered as a potential diagnosis in jūdōka, especially those of very young age and of female gender, when presenting with torticollis following mechanical impact or severe pressure on the head if blocked in a tilted position. Atlanto-axial, Cervical vertebrae, Children, Judo, Martial arts, Neck injuries, Sports injuries, Sprains and strains
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