Headspinning Into Trouble - An Analysis Of A Neck Injury In A Teenage Breakdancer

HISTORY: A 13-year old breakdancer attended a breakdance competition. Without warming up, he went into battle and started headspinning – a breakdance move consisted of spinning on the top of the head. He felt sudden pain and fell. Sports medicine physician examined him at the competition venue and noticed left paravertebral soft swelling and redness of the skin and a lateral torticolis to the right. They referred him to the hospital. PHYSICAL EXAM: The patient denied collapsing, vomiting, nausea, loss of conscience or urinating. The patient was conscious, oriented, contactable, neurological status normal, GCS 15. The neck was immobilized in a Philadelphia neck collar, flexed laterally to the right. The parents sought help and treatment from a physiotherapist who diagnosed a strain of m. rectus capitis posterior major. Ten days after the injury occurred, a follow-up physician examination was performed (no imaging diagnostics), with conclusion of torn paraspinal muscles. It was advised to continue wearing Philadelphia neck collar, 3 weeks rest, warm compresses and neck massages. DIFFERENTIAL DIAGNOSIS: 1. Strain of cervical paraspinal muscles 2. Fracture of cervical spine 3. Cervical sprain, 4. Low-grade rupture of deep neck muscles TEST AND RESULTS: Cervical spine anterior-posterior and lateral RTG: adequate height of the cervical vertebrae, without signs of fresh bone trauma. The small joints were congruent.An MR of cervical spine was recommended by the sports physician to visualize the soft tissues and nerves. On ultrasound examination of the upper posterior cervical spine (1 month later): no signs of muscle rupture or muscle contusion, no intramuscular or perifascial fluid collections. Subcutaneous tissue normal. No signs of capsular bulging and effusion in facet joints. FINAL/WORKING DIAGNOSIS: Strain of cervical paraspinal muscles, m. rectus capitis posterior major. TREATMAN AND OUTCOMES: 1. First 2 weeks: Philadelphia neck collar, rest, analgetics2. week 2-6 - Philadelphia neck collar, warm compresses, massages with physiotherapist, gradually introducing neck and back exercises (with physiotherapist supervision)3. after 6 weeks – continued neck exercises, return to sport up to 50%, only toprock 4. after 6 months – complete return to sport except elements on head/neck, return to competition Supported by: The study was funded by University of Zagreb Funding, Title of the project: Development of health screening and physical fitness assessment protocols for breakdancers, grant no. 10106-22-3045; Croatia, EU