Experts torn on Penguins captain Crosby's injury
By Rob Rossi
Published: Thursday, February 2, 2012
Concussion and spine experts said Wednesday they did not know what to make of Penguins center Sidney Crosby's "soft tissue" neck injury.
"It is not typical for a prolonged post-concussion syndrome case to have a neck injury as the cause," said Dr. Julian Bailes, chair of the NorthShore University HealthSystem department of neurology in Chicago. "That just doesn't make sense."
Bailes described the soft-tissue diagnosis as a "loose, vague term."
Crosby was diagnosed with a concussion Jan. 6, 2011. His brief return to NHL action Nov. 21 lasted eight games, and he has not played since Dec. 5. A Philadelphia-based orthopedic surgeon, Dr. Alexander Vaccaro, diagnosed Crosby with a soft-tissue neck injury Monday.
"Think of the term 'soft tissue' as a generic reference to the squishy parts," said Dr. John Heller, an orthopedic surgeon at Emory Spine Center in Atlanta. "In the world of orthopedics, we would use that term for muscles, ligaments and joints.
"One common way for somebody to injure their neck is to hit their head, so it's very common for those injuries to coexist. Sometimes it takes awhile to let one thing settle down so you can notice the real issue."
Crosby recently has complained of persistent headaches and balance issues, though he said Tuesday the latter has improved.
Los Angeles-based spinal surgeon Dr. Robert Bray administered Crosby an injection last week to alleviate swelling near his C1 and C2 vertebrae. Bray will oversee Crosby's treatment, which does not require surgery.
Recovery time from a soft-tissue injury to any part of the spine could "vary all over the map," Heller said.
There is no way to diagnose when a soft-tissue neck injury may have occurred, Bailes said.
Neither Crosby nor Penguins general manager Ray Shero identified the medication Crosby had been administered. Crosby said that "hopefully" he would not need another shot.
Cortisone or Novocain are the most common shots used to reduce swelling or pain, Bailes said. However, any injection for a soft-tissue injury is rare, said Dr. Scott Kreiner, a Phoenix-based physiatrist at Ahwatukee Sport and Spine.
"On occasion people can have a vestibular type of pain associated with trigger points, but that is usually associated with other underlying problems in the spine — disc problems, joint injuries in the spine, etc.," Kreiner said.
"Problems up at the C1-C2 area — that level is high, and generally there isn't much soft tissue up there," Kreiner said. "You could have a headache from problems in that area, but you don't get a lot of the same things that go along with concussion, typically."
Crosby said Tuesday a potential conclusive finding that his neck, and not his brain, is at the root of his problems would rate as "great news."
That is not out of the question, Heller said.
"Symptoms could range from nothing to fairly severe headaches and neck pain to spinal-cord dysfunction," Heller said, identifying other symptoms of C1-C2 soft-tissue damage as awkward gait, spasms or numb or clumsy hands.
"In a normal human, half of our ability to turn our heads from left to right comes from the C1 and C2 vertebrae. That first half of that turn is all C1 and C2."
Kreiner said typical treatments for soft-tissue injuries include rest, ice, compression, anti-inflammatory medications, physical therapy with electrical stimulation and, finally, a return to regular exercise.
Crosby resumed on-ice workouts Jan. 13. He resumed skating with fellow injured Penguins before practices Monday.
Shero conceded that "a lot of this stuff is trial and error with these concussions and the symptoms that accompany them."
"You want to rule out everything," he said. "When you start to rule out some things, maybe this (neck injury) will not be an issue that's causing him some of the symptoms."
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