Differential Diagnosis for Cervical Spine Injury

The patient's presentation of severe neck pain, weakness in extremities, and specific patterns of sensory and motor deficits following a collision suggests a cervical spine injury. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Central Cord Syndrome: This condition is characterized by greater weakness in the upper limbs compared to the lower limbs, with a particular emphasis on weakness in the hands. It often results from a hyperextension injury in the cervical spine, which can occur in the context of a collision, especially in a football player. The patient's symptoms, including 2/5 strength in both upper extremities with a marked decrease in hand strength and relatively preserved lower extremity strength (4/5), align closely with central cord syndrome.

• Other Likely Diagnoses

  • Hyperextension Dislocation Injury: This type of injury can lead to various patterns of neurological deficit, depending on the structures damaged. Given the patient's mechanism of injury and symptoms, a hyperextension dislocation could be a possible cause, especially if it resulted in central cord syndrome.
  • Unilateral Facet Dislocation: Although less likely given the bilateral nature of the patient's symptoms, a unilateral facet dislocation could potentially cause significant neurological deficits, including weakness and sensory changes, depending on the nerve roots and spinal cord affected.

• Do Not Miss Diagnoses

  • Spinal Cord Injury with Potential for Further Deterioration: Any injury that compromises the spinal cord, such as a fracture-dislocation or a herniated disc, could lead to worsening neurological deficits if not promptly addressed. Conditions like spinal epidural hematoma or abscess, though less common, are critical not to miss due to their potential for severe and irreversible neurological damage if not treated emergently.
  • Atlanto-axial Subluxation or Fracture: Injuries involving the atlanto-axial joint can be particularly dangerous due to the risk of spinal cord compression and the potential for significant neurological deficits or even death.

• Rare Diagnoses

  • Clay-Shoveler Fracture: This is a fracture of the spinous process, typically of the lower cervical or upper thoracic vertebrae. While it could result from a traumatic injury, it is less likely to cause the significant neurological deficits described in this patient.
  • Flexion Teardrop Fracture: A severe injury that involves a fracture of the anterior portion of a cervical vertebra, often with posterior displacement of the posterior fragment into the spinal canal. This injury can cause significant spinal cord damage but might present with more profound neurological deficits than those described, including possible complete spinal cord injury patterns.