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