Chronic Neck Stiffness - Football

HISTORY:

18-year-old high school senior wide receiver presented with chronic neck stiffness all the time. He stated this had been present for many years but did not affect his daily function. He denied any history of injury, pain, stingers/burners, weakness or known family history of neck problems. ROS was negative for constitutional symptoms, fever, chills, recent illness, rashes, headaches, and other musculoskeletal symptoms.

PHYSICAL EXAM:

Alert and oriented WD white male, seated with his head slightly tilted to the left and a web neck. Palpation of the neck reveals no tenderness or palpable abnormalities. Range of motion testing reveals 20° extension, 45° side bending bilaterally, 45° rotation to right and 60° to left, and flexion to three fingerbreadths from chin to chest. Strength testing was normal in all planes at the neck and upper extremities. Spurling's maneuver was negative for pain or radicular symptoms bilaterally. Further examination of the upper extremities reveals a mildly misshapen and smaller left hand when compared to the right.

Neurovascular status of the extremities was normal.

DIFFERENTIAL DIAGNOSIS:

1. Mechanical neck pain

2. Congenital anomaly/syndrome

3. Discogenic neck pain

4. Segmental dysfunction

TESTS AND RESULTS:

1. C-spine AP and lateral radiographs - ill defined changes at the skull base, anterior fusion of C1 and C2 with grade one anterolisthesis at C1-C2.Additional flexion extension views revealed questionable instability at C2-3 and C3-4.

2. MRI-refused secondary to metal implants in his ear. Further history from the patient's mother revealed that he was adopted and had ear abnormalities at birth, including fusion of the inner ear bones, which required surgery.

3. CT-changes indicative of congenital abnormalities at C1 and C2 with essentially an absence of C1 and fusion of C2 to the occiput.

DIAGNOSIS:

Congenital syndrome involving the cervical spine, neck, ear, and left hand

MANAGEMENT:

1. No contact sports

2. Neurosurgical consult pending to determine allowable sports

3. Genetic studies recommended