What is the recommended course of action for a 12-year-old boy with numbness and tingling on the dorsum of his left hand, without pain, and full range of motion, following a soccer-related injury for a week?

Evaluation and Management of Hand Numbness Following Soccer Injury

This 12-year-old boy should be immediately evaluated by a healthcare professional, ideally a physician with experience in pediatric sports injuries, to rule out nerve injury (likely superficial radial nerve neuropraxia) and determine appropriate management before any return to soccer activities. 1

Initial Assessment Priority

While the provided evidence focuses heavily on concussion management, this presentation of isolated numbness and tingling on the dorsum of the hand without pain, with preserved range of motion, suggests a peripheral nerve injury rather than a concussion. The dorsum of the hand is innervated by the superficial radial nerve, making this the most likely structure involved. 1

Key Clinical Features to Evaluate

• Sensory distribution: Map the exact area of numbness to confirm superficial radial nerve involvement (dorsal first web space and radial aspect of dorsum) 1
• Motor function: Test wrist extension, finger extension, and thumb extension to rule out deeper radial nerve involvement 1
• Mechanism of injury: Determine if there was direct trauma to the radial wrist/forearm area, compression, or traction injury 1
• Progression: Assess whether symptoms are improving, stable, or worsening over the past week 1

Recommended Management Approach

Immediate Actions

• Remove from soccer participation until fully evaluated by a physician, as any sports-related injury with persistent neurological symptoms requires medical clearance before return to play 1
• Avoid activities that may exacerbate the nerve injury, including repetitive wrist movements or direct pressure on the affected area 1

Specialist Referral Indications

Referral to a pediatric orthopedic surgeon is indicated for this patient given the persistent neurological symptoms (one week duration) following a sports injury. 1 According to the American Academy of Pediatrics guidelines, children and adolescents with sports injuries should be referred to specialists when symptoms persist or when there is concern for structural injury. 1

Expected Clinical Course

• Most peripheral nerve neuropraxias (stretch injuries without nerve disruption) in pediatric patients resolve spontaneously within 6-12 weeks 1
• Physical rest from soccer is essential during the acute recovery phase to prevent worsening of the nerve injury 1
• Progressive return to activity should only begin after complete symptom resolution and medical clearance 1

Return to Play Protocol

Once symptoms have completely resolved and medical clearance is obtained:

1. Light activity: Non-contact drills without risk of hand/wrist trauma 1
2. Sport-specific training: Soccer-specific skills with protective equipment if recommended 1
3. Full practice: Complete participation only after demonstrating no symptom recurrence 1
4. Game participation: Return to competitive play with continued monitoring 1

Critical Pitfalls to Avoid

• Never allow return to soccer while any numbness or tingling persists, as this indicates incomplete nerve recovery and risks permanent injury 1
• Do not assume this is a minor injury that will resolve without evaluation—persistent neurological symptoms warrant specialist assessment 1
• Avoid NSAIDs initially if there is any concern for associated trauma, though this is more relevant for head injuries 1

Monitoring and Follow-up

• Re-evaluate at 2-4 weeks if symptoms persist despite conservative management 1
• Consider electrodiagnostic studies (nerve conduction studies/EMG) if symptoms persist beyond 4-6 weeks to assess nerve injury severity 1
• Document progression carefully, as worsening symptoms or development of motor weakness requires urgent specialist evaluation 1