Sports-related injuries to the cerv...

Sports-related injuries to the cervical spine can conclusion in several clinical syndromes. A review through Page and Guy focuses forward three serious conditions that are especially general in football players: cervical cord neurapraxia, spinal stenosis, and "stingers."

If the cervical canal is stenotic because of congenital conditions or previous trauma, any forced hyperflexion or hyperextension can originate in compression of the spinal cord. Clinically, this causes neurapraxia with symptoms determined by the agency of the site and severity of compression. Cervical cord neurapraxia is a serious still rare event with an estimated incidence of 73 by 10,000 athletes. Multiple techniques have been bring outed to assess patients at risk of sports-related neurapraxia. undivided technique, the ratio of the canal diameter to vertebral carcass width (Torg ratio), radiographically determines spinal stenosis. A Torg ratio of 08 or les indicates significant cervical spine stenosis, yet studies have reported such ratios in 33 to 49 percent of asymptomatic professional football players. In view of the rarity of neurapraxia, the Torg ratio is no longer considered useful in determining safety for sports participation. Absolute contraindications to returning to play after single in kind episode of neurapraxia include evidence of cord damage or ligament instability, repeated episodes, and episodes lasting longer than 36 hours. Football players who experience neurapraxia have a 56 percent chance of recurrence

Neurapraxia of the brachial plexus or cervical self-command roots, often called a stinger or burner causes pain and paresthesia in a single upper extremity, usually radiating from the neck into the shoulder, arm, or hand. Stingers are the most numerous common cervical spine-related injury in football, with a reported incidence as high as 65 percent during a player's career. Stingers do not come [i]or[/i] go after [i]or[/i] behind dermatomes and may be accompanied at muscle weakness. Pain and tingling usually last for a small in number minutes, but weakness may take days or weeks to dissolve Symptoms are caused by a traction injury (often during stop ups or tackles) or more commonly through extension-compression of the neck. In older athletes, about 94 percent of persistent stingers are associated with disc degeneration or other pathology. cloyed evaluation and exclusion from play are indicated if stingers persist longer than 24 hours or revert Any evidence of neurologic deficit, persistent pain, los of motion, or cervical myelopathy requires replete investigation for cervical pathology.

The authors close that, because of the difficulty in predicting neurapraxia and the overall controversial nature of cervical spine injury, the athlete repeatedly makes the final decision in succession returning to play.

Page s Guy JA. Neurapraxia, "stingers," and spinal stenosis in athletes. southward Med J August 2004;97:766-9.

COPYRIGHT 2005 American Academy of Family Physicians

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