Paper 61: NCAA Football Players are at Higher Risk of Upper Extremity Injury After Concussion
Authors: Castonguay Justin , Thompson Ashley , Bolia Ioanna , Petrigliano Frank , Liu Joseph , Gamradt Seth , Weber Alexander , Gardner Carson 
Published: August 2023

Objectives: Sport related concussion has been repeatedly demonstrated to increase the risk of subsequent lower extremity injury in athletes. The current literature suggests that, for multiple years after a concussion, athletes are at increased risk of lower extremity injury. However, we are unaware of any studies that have demonstrated an increase in risk for upper extremity injuries after sport related concussion. The purpose of this study was to investigate a change in the risk of upper extremity injuries for NCAA football players after return to play from a sport related concussion. Methods: The Sports Injury Research Archive (SIRA) of a single NCAA athletic conference was queried for de-identified injury data on concussions and upper extremity injuries. All football players diagnosed with a concussion and recorded in the database were identified between 2017-2021. Athletes were excluded if their concussion was not sport related, if they had multiple concussions, or if they did not return to previous activity level in their respective sport. Each concussed athlete was then retrospectively followed for the year prior to their concussion as well as for one year after their concussion, beginning at 3 months after the date of their concussion. If the athlete was known to have not returned to play within 3 months they were excluded from the study. All upper extremity injuries were identified in the year prior to concussion and for the previously described year after the concussion. The mean number of concussions per athlete were identified in the pre-concussion and post-concussion groups. The odds ratio, 95% confidence interval, and statistical significance between groups were calculated using Microsoft Excel. Results: After exclusions, 230 de-identified football players from a single conference were identified with concussions from the 2017 through 2021 NCAA football seasons. In these athletes there were a total of 60 upper extremity injuries in the year preceding concussion and a total of 111 in the year they were followed after concussion. The mean number of upper extremity injuries per athlete in the year prior to concussion was 0.26, and in the post-concussion athletes was 0.48. The odds of upper extremity injury in the post-concussion year were 1.85 times higher than in the pre-concussion year (OR = 1.85, 95% CI 1.29 – 2.66, p < 0.001). Conclusions: The data collected in this study demonstrates that collegiate football players are at higher risk of upper extremity injury after concussion. Multiple studies have shown an increased risk of lower extremity injury in athletes after sport related concussion. This study is the first to demonstrate an increased risk of injury specifically in the upper extremities after concussion. The explanation for why these athletes’ injury risk changes after concussion is still not fully understood. Prior research has shown that athletes have alterations in their balance, gait, and landing biomechanics after concussion, which could possibly be causative in upper extremity injuries. Various studies have investigated changes in the coupling between perception and reaction amongst athletes after head injury and have theorized these changes as potential causes of the increase in injury risk. Another consideration is simply that athletes may change the way they approach their sport after sustaining a concussion. Further research on the topic should aim at characterizing the types of injuries that portend the largest increase in risk, exploring different sports, and investigating the magnitude of the risk at longer post-concussion time points. Delineating a clear explanation for why athletes have increased risk of injury after concussion is worthy of future research.