guidelines for return to sport after cervical trauma
TRANSCRIPT
![Page 1: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/1.jpg)
RETURN TO ACTIVITY AFTER CERVICAL INJURY
Paul Licina
![Page 2: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/2.jpg)
COLLISION • intentional contact • football, boxing CONTACT • frequent contact • basketball, soccer LIMITED CONTACT • infrequent/inadvertent contact • baseball, volleyball
NONCONTACT • no contact • golf, running
CLASSIFICATION
![Page 3: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/3.jpg)
COLLISION • intentional contact • football, boxing CONTACT • frequent contact • basketball, soccer LIMITED CONTACT • infrequent/inadvertent contact • baseball, volleyball
NONCONTACT • no contact • golf, running
CLASSIFICATION
![Page 4: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/4.jpg)
CERVICAL TRAUMA
![Page 5: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/5.jpg)
• cervical sprain/strain
• burners or stingers
• cervical neuropraxia
• disc herniation
• fracture
• surgery
![Page 6: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/6.jpg)
Morganti et al in questionnaire to
spinal surgeons about return to play
after cervical spine injury found
no consensus in opinion
![Page 7: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/7.jpg)
• 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
![Page 8: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/8.jpg)
• 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
![Page 9: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/9.jpg)
• return to sport when
• resolution of neurological symptoms/signs
• full painless ROM
• investigate persistent symptoms or recurrences
BURNER OR STINGER
![Page 10: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/10.jpg)
• 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
![Page 11: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/11.jpg)
• 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
![Page 12: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/12.jpg)
• 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
![Page 13: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/13.jpg)
Stenosis
• two ways of assessment
• x-ray
• Pavlov/Torg ratio
CERVICAL NEUROPRAXIA
![Page 14: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/14.jpg)
Stenosis
• two ways of assessment
• x-ray
• Pavlov/Torg ratio
CERVICAL NEUROPRAXIA
![Page 15: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/15.jpg)
Stenosis
• two ways of assessment
• MRI
• CSF reserve
• cord shape
CERVICAL NEUROPRAXIA
![Page 16: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/16.jpg)
CERVICAL NEUROPRAXIA
![Page 17: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/17.jpg)
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
![Page 18: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/18.jpg)
• 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
![Page 19: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/19.jpg)
• can return to play if have • spinous process or laminar fracture
• healed vertebral fracture without
instability or malalignment
• after minimum 8 weeks
FRACTURES
![Page 20: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/20.jpg)
• 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
![Page 21: Guidelines for return to sport after cervical trauma](https://reader031.vdocuments.net/reader031/viewer/2022021921/58f21ad21a28ab1e328b45bd/html5/thumbnails/21.jpg)
• guidelines exist
• have to be individualised
• severity of original injury
• risk of reinjury • desire of player to return to sport
SUMMARY