Whiplash


110
Whiplash


Eren O. Kuris MD and Alan H. Daniels MD


Department of Orthopaedic Surgery, Brown University, Providence, RI, USA


Clinical scenario



  • A 21‐year‐old college football players sustains a helmet‐to‐helmet collision and has immediate onset of neck pain.
  • The patient previously had one episode of transient weakness in his right upper extremity after a football collision in high school, but he has never had symptoms like this.
  • Initial evaluation reveals tenderness to palpation about the cervical spine, limited neck range of motion (ROM), and no neurological deficits.
  • He is concerned about his ability to return to play this season and the effects of this injury on his long‐term career prospects.

Top three questions



  1. In athletes with whiplash and/or cervical spine injuries, what are the return‐to‐play criteria, and what injuries/conditions are contraindications to return to play?
  2. In athletes who sustain a cervical disc herniation, do those who undergo surgery have higher return‐to‐play rates than individuals treated nonoperatively?
  3. In athletes who sustain a burner/stinger injury, do preexisting factors contribute to an increased risk of this condition, and how do these factors impact resolution of symptoms and return to play?

Question 1: In athletes with whiplash and/or cervical spine injuries, what are the return‐to‐play criteria, and what injuries/conditions are contraindications to return to play?


Rationale


Sports‐related cervical spine injuries are common and can range from minor cervical strains to catastrophic fractures/dislocations resulting in permanent neurological impairments and even death. Although severe neurological injuries are rare, many competitive athletes are quite motivated to return to sport. Therefore, the treatment for these injuries and criteria for return to play are important considerations for physicians.1


Clinical comment


Due to the risk of catastrophic spinal cord injury and persistent neurological dysfunction, certain criteria are absolute contraindications to return to play in intense athletic activity.


Available literature and quality of the evidence


There is a paucity of high‐quality studies that guide return to play criteria, likely due to the relative rarity of these injuries. In addition, some athletes with certain spine injuries cannot justify returning to play due to the potential for catastrophic spinal cord injury. The majority of guidelines that guide treatment decisions are based on retrospective evaluations and expert opinion.2


Table 110.1 Guidelines for return to collision/contact sports in patients with a cervical spine condition or injury. Asymptomatic patients are defined as athletes with no neurological deficits, neck pain, pain with ROM, or evidence of pseudarthrosis.4


































































Condition Return to Play
Patients with healed, stable nondisplaced fractures without spinal malalignment No Contraindication
Successful nonsurgical treatment of asymptomatic disc herniations No Contraindication
Asymptomatic patients after a previous one‐level cervical fusion No Contraindication
Certain congenital conditions, such as Klippel‐Feil type 2 anomoly No Contraindication

No Contraindication
Prior fracture of the upper cervical spine with evidence of union [nondisplaced Jefferson fracture, a dens fracture (type 1 or 2)] Relative Contraindication (If Patient Asymptomatic)
A healed vertebral compression fracture without significant displacement or malalignment Relative Contraindication (If Patient Asymptomatic)
A stable and healed fracture that involves the posterior elements (not including spinous process fractures) Relative Contraindication (If Patient Asymptomatic)
Two‐level cervical fusion Relative Contraindication (If Patient Asymptomatic)
Odontoid abnormalities Absolute Contraindication
Occipital‐cervical arthrodesis Absolute Contraindication
Atlantoaxial instability Absolute Contraindication
Klippel‐Feil typ 1 abnormalities Absolute Contraindication
Spear Tackler’s Spine Absolute Contraindication
Subaxial cervical spine instability Absolute Contraindication
Acute fracture of the body or posterior elements (both with and without instability) Absolute Contraindication
United subaxial vertebral body fractures with persistent saggital malalignment Absolute Contraindication
Retropulsed bone fragments Absolute Contraindication
Continued pain, limited motion, or neurological deficits after a healed fracture Absolute Contraindication
Acute or chronic disc herniation with associated pain, limited motion, or neurological deficts Absolute Contraindication

Findings

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May 14, 2023 | Posted by in Uncategorized | Comments Off on Whiplash

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