Abnormalities of transcranial magnetic stimulation in rugby players: A possible diagnostic tool for the identification of players at risk for symptomatic cervical myeloradiculopathy?

BACKGROUND: Rugby is a contact team sport with a high risk of injury to the cervical spine. Different radiological imaging studies have been proposed for the screening of players most at risk of neurological sequelae. It is not rare, though, that a severe radiological spinal cord compression is accompanied by mild symptoms while a mild compression is often accompanied by severe neurological symptoms, hence the need for more accurate diagnostic tools. METHODS: We performed a neurological evaluation and examined 29 rugby players with electromyography (EMG) and transcranial magnetic stimulation (TMS) studies. 28 healthy volunteers were studied as a control group. A magnetic resonance imaging (MRI) study was performed on players with abnormal findings at the TMS testing. RESULTS: No neurological anomalies were present in both groups. Significant slower central conduction times were recorded in the TMS studies of the left ulnar nerve, both right and left tibial nerves and, considering the F-wave evaluation, of the right ulnar nerve and the left tibial nerve of the rugby players (P<0.05). Some kind of alteration at TMS testing was present in a total of 16 players on 29 (55.2%). There were no abnormal result in the control group. EMG and MRI studies failed to identify frank signs of myelopathy or radiculopathy. CONCLUSIONS: This study showed that TMS could be a promising diagnostic tool for the identification of myelopathy and/or radiculopathy that may not be necessarily evident at clinical and radiological evaluations.