Cervical Injury Assessments for Concussion Evaluation: A Review

Background: A concussion is a complex pathophysiologic process that is induced by biomechanical forces and affects the brain. Cervical injuries and concussion can share similar mechanisms and nearly identical symptoms or causes. Therefore, symptoms or causes alone may be insufficient to differentiate between patients with a concussion and patients with cervical injuries. Objective: To demonstrate the homogeneous causes and symptoms observed in patients with a concussion and patients with cervical injury and to provide information on clinical tests that can differentiate cervical injury from pathologic conditions of vestibular or central origin. Summary: Given that concussion and cervical injury share similar causes and symptoms, this information alone may be insufficient to diagnose a concussion. Clinical assessments, such as the cervical joint-reposition error test, smooth-pursuit neck-torsion test, head-neck differentiation test, cervical flexion-rotation test, and physical examination of the cervical spine, can be performed after a head and neck pathomechanical event to identify the presence of cervical injury. Differentiating between a concussion and cervical injury is clinically vital for timely and appropriate evidence-based treatment. Conclusions: Specific clinical tests should be used after a head and neck pathomechanical event to differentiate between symptoms due to a concussion and cervical injury. Continued research on the clinical utility of the 5 identified cervicogenic tests is also recommended.