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Correspondence to: MrDearing Department of Orthopaedic Surgery, Raigmore Hospital, Old Perth Road, Inverness, Scotland, UK; [email protected]
Rugby union is a sport that has a perceived association with neck injuries, both acutely and in the longer term.1 Commonly involved are front row players, classically injured at the time of scrum collapse. Previously undescribed, however, are the widely recognised soft tissue masses on the back of the neck of front row players, colloquially known as the “prop’s hump”. Known in France as a “bouffe”, it is regarded as a badge of honour among players, but its prevalence, aetiology, management, and sequelae have not been documented. This paper describes an index case, its operative management, and the subsequent involvement of the rugby union media to assist in an epidemiological survey of players throughout Britain.
CASE PRESENTATION
A 30 year old amateur loose head prop presented to a consultant general surgeon with a history of several years duration of a slowly enlarging soft tissue mass overlying the spinous process of the seventh cervical vertebra. The mass became inflamed after rugby matches through friction in the scrum and occasionally ulcerated. This was usually more common at the start of each new season and slowly settled as the season progressed. He sought attention because of the size of the mass, which was becoming increasingly unsightly.
On examination, a 7 cm by 5 cm smooth, uninflamed, non-tender, fluctuant mass was found at the base of the dorsum of the neck which was not attached to skin or deeper structures Clinically this appeared to be a lipoma, and the patient was listed for surgical excision. At operation, however, the mass was found to consist of dense fibrous tissue which extended to the vertebra. Excision would have involved extensive skin grafting to close the subsequent defect and precluded any continuation of the patient’s rugby career; consequently the procedure was abandoned.
The misdiagnosis of the mass raised understandable questions. A Medline search revealed no references to such neck masses. With the patient’s consent, clinical pictures (figs 1 and 2) were printed in the Rugby World magazine (May 2005) along with a brief clinical synopsis. A request was made to readers to contact the author with details of players with...