Our objective was to examine the effect of current neck or shoulder pain on concussion outcomes. Variables included symptom resolution and return-to-sport time, symptom severity, amount of school missed, and sleep disturbances. Three hundred twelve patients (37% female; median age = 15.0 years; evaluated median = 9 days postinjury) reported experiencing current neck or shoulder pain at initial evaluation, and 268 did not (31% female; median age = 14.7 years; evaluated median = 8 days postinjury). Neck or shoulder pain was associated with longer symptom resolution time (β = 6.38, 95% confidence interval [CI] = 2.44, 10.31; P = .002), more severe symptoms (β = 7.06, 95% CI = 4.91, 9.21; P < .001), and greater odds of missing >5 days of school (adjusted odds ratio [aOR] = 1.89, 95% CI = 1.23, 2.93; P = .004), and postinjury sleep problems (aOR = 2.20, 95% CI = 1.51, 3.21; P < .001). Experiencing neck or shoulder pain during the initial postinjury clinical evaluation was associated with worsened clinical outcomes. Clinicians may consider referral to early rehabilitation following concussion among those who report neck or shoulder pain.
Keywords: cervical spine; mild traumatic brain injury; pain; sports; youth.