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Guidelines for return to sport after cervical trauma
- 1. RETURN TO ACTIVITY AFTER CERVICAL INJURY Paul Licina
- 2. COLLISION • intentional contact • football, boxing CONTACT • frequent contact • basketball, soccer LIMITED CONTACT • infrequent/inadvertent contact • baseball, volleyball NONCONTACT • no contact • golf, running CLASSIFICATION
- 3. COLLISION • intentional contact • football, boxing CONTACT • frequent contact • basketball, soccer LIMITED CONTACT • infrequent/inadvertent contact • baseball, volleyball NONCONTACT • no contact • golf, running CLASSIFICATION
- 5. • cervical sprain/strain • burners or stingers • cervical neuropraxia • disc herniation • fracture • surgery
- 6. Morganti et al in questionnaire to spinal surgeons about return to play after cervical spine injury found no consensus in opinion
- 7. • no neurological symptoms or signs • no abnormalities on imaging • can return to play when • no neck pain • full pain-free ROM • note risk of unrecognised ligamentous injury CERVICAL SPRAIN/STRAIN
- 8. • transient sensory and/or motor loss in one arm • tingling, burning, numbness • weakness esp. deltoid and biceps • due to • brachial plexus traction • nerve root foraminal compression • direct blow at Erb’s point (above clavicle) • full pain-free ROM BURNER OR STINGER
- 9. • return to sport when • resolution of neurological symptoms/signs • full painless ROM • investigate persistent symptoms or recurrences BURNER OR STINGER
- 10. • syn transient quadriplegia • after loading of neck • sensory changes • numbness, tingling, burning • with or without motor changes • weakness, paralysis • involves BOTH arms and/or BOTH legs CERVICAL NEUROPRAXIA
- 11. • complete return of • motor function • full pain-free cervical motion • transient - resolves quickly • usually within 15 minutes • may be residual symptoms up to 48 hrs • no bony or ligamentous injury on imaging CERVICAL NEUROPRAXIA
- 12. • due to compression of spinal cord • occurs when canal dynamically narrowed by neck movement • usually forced hyperflexion or hyperextension • commonly associated with canal stenosis CERVICAL NEUROPRAXIA
- 13. Stenosis • two ways of assessment • x-ray • Pavlov/Torg ratio CERVICAL NEUROPRAXIA
- 14. Stenosis • two ways of assessment • x-ray • Pavlov/Torg ratio CERVICAL NEUROPRAXIA
- 15. Stenosis • two ways of assessment • MRI • CSF reserve • cord shape CERVICAL NEUROPRAXIA
- 17. Return to sport CERVICAL NEUROPRAXIA Cord Stenosis Previous Normal No No YES Normal No Once MAYBE Normal Mild No MAYBE Normal Mild Once NO Normal Severe NO* Normal Mild Once NO Normal More NO Abnormal NO
- 18. • common • acute disc herniation • absolute contraindication • can return to play when • no symptoms • no neurological deficit • full pain-free ROM • ?minimum six weeks from injury • incidental finding on imaging • as above DISC HERNIATION
- 19. • can return to play if have • spinous process or laminar fracture • healed vertebral fracture without instability or malalignment • after minimum 8 weeks FRACTURES
- 20. • can return to play if have • foraminotomy • one-level anterior fusion • may be able to return to play if have • one-level laminectomy • one-level posterior fusion • two-level anterior fusion • cannot return to play if have • three-level anterior fusion • C1-2 fusion • multi level laminectomy SURGERY
- 21. • guidelines exist • have to be individualised • severity of original injury • risk of reinjury • desire of player to return to sport SUMMARY