Concussion May Be Hidden Neck Injury

Is it a concussion or a neck Injury? John J. Leddy, M.D., clinical professor of orthopedics at the University of Buffalo, has found that it is difficult to distinguish between concussion injuries and neck injuries based on symptoms alone.

“I think a lot of practitioners listen to the symptoms and just chalk it up to concussion, but if they also examine the neck in these patients, they might discover that a neck injury is involved—and that’s a treatable problem, ” he said. Leddy, who is the senior author of a study on concussion, says that determining which condition a patient has experienced is critical because courses of treatment are very different.

He told a reporter for the School of Medicine and Biomedical Sciences, “Based on our research, we concluded that some patients who have been told they’ve suffered a concussion—and whose symptoms persisted for several months—may actually have suffered a neck injury rather than, or in addition to, a concussion.”

“I’d seen enough patients in our clinic, some previously diagnosed with post-concussion syndrome, who continued to experience symptoms even after passing our treadmill test, which indicates full recovery from concussion. The symptoms for both conditions are so nonspecific that it’s really hard to make a diagnosis based on them so we had to find another way to discriminate between them.”

Leddy based his study on symptoms experienced by 128 patients treated at the University at Buffalo’s Concussion Management Clinic, a joint effort between the Department of Orthopaedics and the Department of Psychiatry.

To determine which patients had sustained a concussion and which were more likely to have had a neck injury, Leddy and co-author Barry S. Willer, Ph.D, professor psychiatry, evaluated them on a graded treadmill test developed by Leddy and Willer. They then correlated their patients’ treadmill test results to their responses on a detailed questionnaire about symptoms.

“We did some sophisticated statistical analysis, ” said Leddy. “Even when we looked at the data in multiple ways, there was really no way to separate out the two groups based on their symptom patterns alone.”

Because a concussion is a brain injury, the researchers thought that cognitive symptoms would be more likely associated with concussions. To their surprise that did not turn out to be the case. “People who have had neck injuries can also have problems with concentration and with memory. They feel like they’re in a fog, which is exactly what people report after concussion, ” Leddy said. Both groups reported experiencing headache, dizziness, blurred vision, poor concentration and memory deficits.

Leddy says patients who think they’ve had a concussion—and whose symptoms have not diminished after several months—should be examined for neck and vestibular injury by a sports medicine physician, neurologist or a rehabilitation medicine specialist.