guidelines for return to sport after cervical trauma

RETURN TO ACTIVITY AFTER CERVICAL INJURY

Paul Licina

COLLISION • intentional contact • football, boxing CONTACT • frequent contact • basketball, soccer LIMITED CONTACT • infrequent/inadvertent contact • baseball, volleyball

NONCONTACT • no contact • golf, running

CLASSIFICATION

CERVICAL TRAUMA

• cervical sprain/strain

• burners or stingers

• cervical neuropraxia

• disc herniation

• fracture

• surgery

Morganti et al in questionnaire to

spinal surgeons about return to play

after cervical spine injury found

no consensus in opinion

• 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

• 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

• return to sport when

• resolution of neurological symptoms/signs

• full painless ROM

• investigate persistent symptoms or recurrences

BURNER OR STINGER

• 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

• 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


• due to compression of spinal cord

• occurs when canal dynamically narrowed

by neck movement

• usually forced hyperflexion or hyperextension

• commonly associated with canal stenosis


Stenosis

• two ways of assessment

• x-ray

• Pavlov/Torg ratio


Stenosis

• two ways of assessment

• MRI

• CSF reserve

• cord shape


Return to sport


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

• 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

• can return to play if have • spinous process or laminar fracture

• healed vertebral fracture without

instability or malalignment

• after minimum 8 weeks

FRACTURES

• 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

• guidelines exist

• have to be individualised

• severity of original injury

• risk of reinjury • desire of player to return to sport

SUMMARY

guidelines for return to sport after cervical trauma

Health & Medicine