Semin Musculoskelet Radiol 2022; 26(01): 028-040
DOI: 10.1055/s-0041-1731420
Review Article

Imaging of Hockey-related Injuries of the Head, Neck, and Body

1   Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
,
John P. Walsh
2   Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
,
Yet Y. Yan
2   Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
,
2   Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
,
2   Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
,
Peter L. Munk
2   Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
,
2   Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
› Author Affiliations

Abstract

Hockey is a demanding contact sport with growing popularity around the world. This article is part of a review series in this issue of Seminars in Musculoskeletal Radiology that summarizes epidemiological research on the patterns of ice hockey injuries as well as provides pictorial examples for a radiologist's perspective. We focus on non-extremity pathologies which encompass many of the most devastating injuries of hockey, namely those involving the head, neck, face, spine, and body.



Publication History

Article published online:
09 February 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Statistics Canada. The Daily—Sports for fun and fitness. Accessed March 10, 2020 at: https://www150.statcan.gc.ca/n1/daily-quotidien/190521/dq190521c-eng.htm
  • 2 Ashare A, Ziejewski M. eds. Mechanism of Concussion in Sports. West Conshohocken, PA: ASTM International; 2014. https://doi.org/10.1520/STP1552-EB
  • 3 Sharp DJ, Jenkins PO. Concussion is confusing us all. Pract Neurol 2015; 15 (03) 172-186
  • 4 Cusimano MD, Cho N, Amin K. et al. Mechanisms of team-sport-related brain injuries in children 5 to 19 years old: opportunities for prevention. PLoS One 2013; 8 (03) e58868
  • 5 Honey CR. Brain injury in ice hockey. Clin J Sport Med 1998; 8 (01) 43-46
  • 6 Flik K, Lyman S, Marx RG. American collegiate men's ice hockey: an analysis of injuries. Am J Sports Med 2005; 33 (02) 183-187
  • 7 Guenette JP, Shenton ME, Koerte IK. Imaging of concussion in young athletes. Neuroimaging Clin N Am 2018; 28 (01) 43-53
  • 8 Mittl RL, Grossman RI, Hiehle JF. et al. Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings. AJNR Am J Neuroradiol 1994; 15 (08) 1583-1589
  • 9 Helmer KG, Pasternak O, Fredman E. et al. Hockey Concussion Education Project, Part 1. Susceptibility-weighted imaging study in male and female ice hockey players over a single season. J Neurosurg 2014; 120 (04) 864-872
  • 10 Park J-H, Park S-W, Kang S-H, Nam T-K, Min B-K, Hwang S-N. Detection of traumatic cerebral microbleeds by susceptibility-weighted image of MRI. J Korean Neurosurg Soc 2009; 46 (04) 365-369
  • 11 Benson RR, Gattu R, Sewick B. et al. Detection of hemorrhagic and axonal pathology in mild traumatic brain injury using advanced MRI: implications for neurorehabilitation. NeuroRehabilitation 2012; 31 (03) 261-279
  • 12 Yuh EL, Mukherjee P, Lingsma HF. et al; TRACK-TBI Investigators. Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury. Ann Neurol 2013; 73 (02) 224-235
  • 13 Vagnozzi R, Signoretti S, Tavazzi B. et al. Temporal window of metabolic brain vulnerability to concussion: a pilot 1H-magnetic resonance spectroscopic study in concussed athletes--part III. Neurosurgery 2008; 62 (06) 1286-1295
  • 14 Orr CA, Albaugh MD, Watts R. et al. Neuroimaging biomarkers of a history of concussion observed in asymptomatic young athletes. J Neurotrauma 2016; 33 (09) 803-810
  • 15 Wright AD, Jarrett M, Vavasour I. et al. Myelin water fraction is transiently reduced after a single mild traumatic brain injury—a prospective cohort study in collegiate hockey players. PLoS One 2016; 11 (02) e0150215
  • 16 McCrea M, Meier T, Huber D. et al. Role of advanced neuroimaging, fluid biomarkers and genetic testing in the assessment of sport-related concussion: a systematic review. Br J Sports Med 2017; 51 (12) 919-929
  • 17 Gaz D, Stuart MJ. Mayo Clinic Sports Medicine Center and USA Hockey Injury Registry. October 2020
  • 18 Tator CH, Provvidenza C, Cassidy JD. Update and overview of spinal injuries in Canadian ice hockey, 1943 to 2011: the continuing need for injury prevention and education. Clin J Sport Med 2016; 26 (03) 232-238
  • 19 Tator CH, Edmonds VE. National survey of spinal injuries in hockey players. Can Med Assoc J 1984; 130 (07) 875-880
  • 20 Biasca N, Wirth S, Tegner Y. The avoidability of head and neck injuries in ice hockey: an historical review. Br J Sports Med 2002; 36 (06) 410-427
  • 21 Tator CH, Carson JD, Edmonds VE. Spinal injuries in ice hockey. Clin Sports Med 1998; 17 (01) 183-194
  • 22 Nightingale RW, McElhaney JH, Richardson WJ, Myers BS. Dynamic responses of the head and cervical spine to axial impact loading. J Biomech 1996; 29 (03) 307-318
  • 23 Sim FH, Chao EY. Injury potential in modern ice hockey. Am J Sports Med 1978; 6 (06) 378-384
  • 24 Ivancic PC. Biomechanics of sports-induced axial-compression injuries of the neck. J Athl Train 2012; 47 (05) 489-497
  • 25 Swartz EE, Floyd RT, Cendoma M. Cervical spine functional anatomy and the biomechanics of injury due to compressive loading. J Athl Train 2005; 40 (03) 155-161
  • 26 Torg JS, Pavlov H, O'Neill MJ, Nichols Jr CE, Sennett B. The axial load teardrop fracture. A biomechanical, clinical and roentgenographic analysis. Am J Sports Med 1991; 19 (04) 355-364
  • 27 Yue JJ, Ivancic PC, Scott DL. Teardrop fracture following head-first impact in an ice hockey player: case report and analysis of injury mechanisms. Int J Spine Surg 2016;10(09):
  • 28 Kim KS, Chen HH, Russell EJ, Rogers LF. Flexion teardrop fracture of the cervical spine: radiographic characteristics. AJR Am J Roentgenol 1989; 152 (02) 319-326
  • 29 Rao SK, Wasyliw C, Nunez Jr DB. Spectrum of imaging findings in hyperextension injuries of the neck. Radiographics 2005; 25 (05) 1239-1254
  • 30 Tator CH, Carson JD, Edmonds VE. New spinal injuries in hockey. Clin J Sport Med 1997; 7 (01) 17-21
  • 31 Tator CH, Provvidenza C. Parachute Canada/ThinkFirst Hockey Spinal Injuries Registry update. Can J Neurol Sci 2015; 42 (S1): S19-S19
  • 32 Mölsä JJ, Tegner Y, Alaranta H, Myllynen P, Kujala UM. Spinal cord injuries in ice hockey in Finland and Sweden from 1980 to 1996. Int J Sports Med 1999; 20 (01) 64-67
  • 33 Beckmann NM, West OC, Nunez Jr D. et al; Expert Panel on Neurological Imaging and Musculoskeletal Imaging. ACR Appropriateness Criteria® Suspected Spine Trauma. J Am Coll Radiol 2019; 16 (5S): S264-S285
  • 34 Torg JS, Pavlov H, Genuario SE. et al. Neurapraxia of the cervical spinal cord with transient quadriplegia. J Bone Joint Surg Am 1986; 68 (09) 1354-1370
  • 35 Penning L. Some aspects of plain radiography of the cervical spine in chronic myelopathy. Neurology 1962; 12: 513-519
  • 36 Boese CK, Lechler P. Spinal cord injury without radiologic abnormalities in adults: a systematic review. J Trauma Acute Care Surg 2013; 75 (02) 320-330
  • 37 Shah LM, Zollinger LV. Congenital craniocervical anomalies pose a vulnerability to spinal cord injury without radiographic abnormality (SCIWORA). Emerg Radiol 2011; 18 (04) 353-356
  • 38 Cantu RC. The cervical spinal stenosis controversy. Clin Sports Med 1998; 17 (01) 121-126
  • 39 Waicus KM, Smith BW. Back injuries in the pediatric athlete. Curr Sports Med Rep 2002; 1 (01) 52-58
  • 40 Zupon AB, Kerr ZY, Dalton SL, Dompier TP, Gardner EC. The epidemiology of back/neck/spine injuries in National Collegiate Athletic Association men's and women's ice hockey, 2009/2010 to 2014/2015. Res Sports Med 2018; 26 (01) 13-26
  • 41 Sallis RE, Jones K, Knopp W. Burners. Phys Sportsmed 1992; 20 (11) 47-55
  • 42 Shannon B, Klimkiewicz JJ. Cervical burners in the athlete. Clin Sports Med 2002; 21 (01) 29-35
  • 43 Greenberg J, Leung D, Kendall J. Predicting chronic stinger syndrome using the mean subaxial space available for the cord index. Sports Health 2011; 3 (03) 264-267
  • 44 Standaert CJ, Herring SA. Expert opinion and controversies in musculoskeletal and sports medicine: stingers. Arch Phys Med Rehabil 2009; 90 (03) 402-406
  • 45 Presciutti SM, DeLuca P, Marchetto P, Wilsey JT, Shaffrey C, Vaccaro AR. Mean subaxial space available for the cord index as a novel method of measuring cervical spine geometry to predict the chronic stinger syndrome in American football players. J Neurosurg Spine 2009; 11 (03) 264-271
  • 46 Jonasson P, Halldin K, Karlsson J. et al. Prevalence of joint-related pain in the extremities and spine in five groups of top athletes. Knee Surg Sports Traumatol Arthrosc 2011; 19 (09) 1540-1546
  • 47 Engebretsen L, Steffen K, Alonso JM. et al. Sports injuries and illnesses during the Winter Olympic Games 2010. Br J Sports Med 2010; 44 (11) 772-780
  • 48 Donaldson LD. Spondylolysis in elite junior-level ice hockey players. Sports Health 2014; 6 (04) 356-359
  • 49 Tator CH, Provvidenza C, Cassidy JD. Spinal injuries in Canadian ice hockey: an update to 2005. Clin J Sport Med 2009; 19 (06) 451-456
  • 50 Ball JR, Harris CB, Lee J, Vives MJ. Lumbar spine injuries in sports: review of the literature and current treatment recommendations. Sports Med Open 2019; 5 (01) 26
  • 51 Beutler WJ, Fredrickson BE, Murtland A, Sweeney CA, Grant WD, Baker D. The natural history of spondylolysis and spondylolisthesis: 45-year follow-up evaluation. Spine 2003; 28 (10) 1027-1035
  • 52 Sakai T, Sairyo K, Suzue N, Kosaka H, Yasui N. Incidence and etiology of lumbar spondylolysis: review of the literature. J Orthop Sci 2010; 15 (03) 281-288
  • 53 Sairyo K, Katoh S, Komatsubara S. et al. Spondylolysis fracture angle in children and adolescents on CT indicates the facture producing force vector: a biomechanical rationale. Int J Spine Surg 2004;01(02):n.p.
  • 54 Hollenberg GM, Beattie PF, Meyers SP, Weinberg EP, Adams MJ. Stress reactions of the lumbar pars interarticularis: the development of a new MRI classification system. Spine 2002; 27 (02) 181-186
  • 55 Cheung KK, Dhawan RT, Wilson LF, Peirce NS, Rajeswaran G. Pars interarticularis injury in elite athletes—the role of imaging in diagnosis and management. Eur J Radiol 2018; 108: 28-42
  • 56 Selhorst M, Fischer A, Graft K. et al. Long-Term clinical outcomes and factors that predict poor prognosis in athletes after a diagnosis of acute spondylolysis: a retrospective review with telephone follow-up. J Orthop Sports Phys Ther 2016; 46 (12) 1029-1036
  • 57 Micheli LJ, Wood R. Back pain in young athletes. Significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med 1995; 149 (01) 15-18
  • 58 Baranto A, Hellström M, Cederlund C-G, Nyman R, Swärd L. Back pain and MRI changes in the thoraco-lumbar spine of top athletes in four different sports: a 15-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2009; 17 (09) 1125-1134
  • 59 Wu X, Ma W, Du H, Gurung K. A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation. Eur Spine J 2013; 22 (03) 475-488
  • 60 Ono T, Sakamoto A, Jono O, Shimizu A. Osteoid osteoma can occur at the pars interarticularis of the lumbar spine, leading to misdiagnosis of lumbar spondylolysis. Am J Case Rep 2018; 19: 207-213
  • 61 Lawrence LA, Svider PF, Raza SN, Zuliani G, Carron MA, Folbe AJ. Hockey-related facial injuries: a population-based analysis. Laryngoscope 2015; 125 (03) 589-593
  • 62 Deits J, Yard EE, Collins CL, Fields SK, Comstock RD. Patients with ice hockey injuries presenting to US emergency departments, 1990-2006. J Athl Train 2010; 45 (05) 467-474
  • 63 Voaklander DC, Saunders LD, Quinney HA, Macnab RB. Epidemiology of recreational and old-timer ice hockey injuries. Clin J Sport Med 1996; 6 (01) 15-21
  • 64 Caputo P, Mattson DJ. Recreational ice hockey injuries in adult non-checking leagues: a United States perspective. J Sports Sci Med 2005; 4 (01) 58-65
  • 65 Pettersson M, Lorentzon R. Ice hockey injuries: a 4-year prospective study of a Swedish élite ice hockey team. Br J Sports Med 1993; 27 (04) 251-254
  • 66 Scheffler P, Wolter NE, Namavarian A, Propst EJ, Chan Y. Contact sport related head and neck injuries in pediatric athletes. Int J Pediatr Otorhinolaryngol 2019; 121: 6-9
  • 67 Keshen S, Easterbrook M, Micieli JA. Ocular and facial injuries sustained by goaltenders in the National Hockey League: a preventable problem. Can J Ophthalmol 2020; 55 (01) 68-70
  • 68 Micieli JA, Zurakowski D, Ahmed IIK. Impact of visors on eye and orbital injuries in the National Hockey League. Can J Ophthalmol 2014; 49 (03) 243-248
  • 69 Pashby TJ. Ocular injuries in hockey. Int Ophthalmol Clin 1988; 28 (03) 228-231
  • 70 Vinger PF. Ocular injuries in hockey. Arch Ophthalmol 1976; 94 (01) 74-76
  • 71 Neussl A. Mouthguards in the American Hockey League [AHL]. J Dent Hyg 2008; 82 (05) 44
  • 72 Lahti H, Sane J, Ylipaavalniemi P. Dental injuries in ice hockey games and training. Med Sci Sports Exerc 2002; 34 (03) 400-402
  • 73 Rattai J, Levin L. Oral injuries related to ice hockey in the province of Alberta, Canada: trends over the last 15 years. Dent Traumatol 2018; 34 (02) 107-113
  • 74 Fernandes LM, Neto JCL, Lima TFR. et al. The use of mouthguards and prevalence of dento-alveolar trauma among athletes: a systematic review and meta-analysis. Dent Traumatol 2019; 35 (01) 54-72
  • 75 Lieger O, von Arx T. Orofacial/cerebral injuries and the use of mouthguards by professional athletes in Switzerland. Dent Traumatol 2006; 22 (01) 1-6
  • 76 Pinto M, Kuhn JE, Greenfield ML, Hawkins RJ. Prospective analysis of ice hockey injuries at the Junior A level over the course of one season. Clin J Sport Med 1999; 9 (02) 70-74
  • 77 Delaney JS, Al-Kashmiri A. Neck injuries presenting to emergency departments in the United States from 1990 to 1999 for ice hockey, soccer, and American football. Br J Sports Med 2005; 39 (04) e21
  • 78 Stuart MJ, Link AA, Smith AM, Krause DA, Sorenson MC, Larson DR. Skate blade neck lacerations: a survey and case follow-up. Clin J Sport Med 2009; 19 (06) 494-497
  • 79 Vergis A, Räsänen T, Hernefalk L. Neck injuries from skate blades in ice hockey: a report of three cases. Scand J Med Sci Sports 1996; 6 (06) 352-354
  • 80 Mendis D, Anderson JA. Blunt laryngeal trauma secondary to sporting injuries. J Laryngol Otol 2017; 131 (08) 728-735
  • 81 Peralta R, Hurford WE. Airway trauma. Int Anesthesiol Clin 2000; 38 (03) 111-127
  • 82 Liberman M, Mulder DS. Airway injuries in the professional ice hockey player. Clin J Sport Med 2007; 17 (01) 61-67
  • 83 Sproule JR. Hockey injuries. Can Fam Physician 1988; 34: 125-129
  • 84 Johnson BK, Comstock RD. Epidemiology of chest, rib, thoracic spine, and abdomen injuries among United States high school athletes, 2005/06 to 2013/14. Clin J Sport Med 2017; 27 (04) 388-393
  • 85 Subhas N, Kline MJ, Moskal MJ, White LM, Recht MP. MRI evaluation of costal cartilage injuries. AJR Am J Roentgenol 2008; 191 (01) 129-132
  • 86 Culp B, Hurbanek JG, Novak J, McCamey KL, Flanigan DC. Acute traumatic sternum fracture in a female college hockey player. Orthopedics 2010; 33 (09) 683
  • 87 Kennedy J, Green RS, Henteleff H. Penetrating chest trauma secondary to a composite hockey stick injury. CJEM 2006; 8 (06) 437-440
  • 88 Nummela MT, Bensch FV, Pyhältö TT, Koskinen SK. Incidence and imaging findings of costal cartilage fractures in patients with blunt chest trauma: a retrospective review of 1461 consecutive whole-body CT examinations for trauma. Radiology 2018; 286 (02) 696-704
  • 89 Hayashi D, Roemer FW, Kohler R, Guermazi A, Gebers C, De Villiers R. Thoracic injuries in professional rugby players: mechanisms of injury and imaging characteristics. Br J Sports Med 2014; 48 (14) 1097-1101
  • 90 Ziebell C, Kravitz L. Hemorrhagic pulmonary contusion secondary to blunt force trauma in a professional hockey player. Family Medicine and Care 2018; 1 (02) 1-3
  • 91 Pearce PZ. Commotio cordis: sudden death in a young hockey player. Curr Sports Med Rep 2005; 4 (03) 157-159
  • 92 Jonsson J, Jonsson M, Tegner Y. The epidemiology of overuse injuries in ice hockey: an analysis from 29 seasons in the Swedish Elite League. Orthopedics and Sports Medicine Open Access Journal 2019;2(04):
  • 93 Kucera KL, Currie DW, Wasserman EB. et al. Incidence of sport-related internal organ injuries due to direct-contact mechanisms among high school and collegiate athletes across 3 national surveillance systems. J Athl Train 2019; 54 (02) 152-164
  • 94 Wan J, Corvino TF, Greenfield SP, DiScala C. The incidence of recreational genitourinary and abdominal injuries in the Western New York pediatric population. J Urol 2003;170(4 Pt 2):1525–1527; discussion 1527
  • 95 Gerstenbluth RE, Spirnak JP, Elder JS. Sports participation and high grade renal injuries in children. J Urol 2002; 168 (06) 2575-2578