Vascular injuries of the head and neck in martial Arts: A scoping review

Blunt cerebrovascular injury (BCVI) is one of the most feared complications of martial arts practice. Both striking and grappling disciplines place the cervical vasculature at risk either by way of direct blows or application of chokeholds, respectively. Research on BCVI in martial arts remains limited, primarily consisting of case reports. This study aimed to provide a scoping review of BCVI in martial arts.

Following the PRISMA guidelines, a systematic literature review was performed using PubMed and Ovid Embase databases from date of database inception to October 2024. Studies were selected based on predetermined inclusion and exclusion criteria.

31 papers from 1964 to 2024 by 31 authors reported BCVI in martial arts. Of these, 40 individual cases (39 male) were reported, with ages ranging from 7 to 66 years old (mean 35.18 ± 14.56). 30 papers were single case reports, and one was a case series of 10 patients. Three mechanisms of injury were identified: chokeholds (n = 19, 53 %), "whiplash" (n = 6, 17 %), and direct blunt trauma (n = 11, 31 %). Brazilian Jiu Jitsu (BJJ) was the most implicated (n = 18 cases). The most frequently injured vascular structure was the vertebral artery (n = 16), followed by the cervical segment of the internal carotid artery (ICA) (n = 12), most often injured at its distal segment.

This study aims to highlight BCVI in martial arts. While rare, the findings suggest the highest rates of injury in BJJ and kickboxing. The V3 segment of the vertebral artery and cervical segment of the ICA were at greatest risk.