After years of intense breakdancing, a performer faced a unique scalp injury from headspins. Surgery successfully removed the painful mass, shedding light on an underreported risk in the dance community.
Study: ‘Headspin hole’: an overuse injury among breakdancers. Image Credit: Owlie Productions / Shutterstock.com
A recent case report published in BMJ Case Reports discusses the headspin hole injury among breakdancers that results from repetitive headspins.
The physical toll of breakdancing
Breakdancing is a physically demanding activity that can result in injuries to numerous areas of the body. Breakdancers frequently sustain finger, wrist, shoulder, knee, elbow, neck, lower back, foot, and ankle injuries, with other common ailments including strains, sprains, and tendinitis.
Prolonged breakdancing can cause tenosynovitis, carpal tunnel syndrome (CTS), and impingement syndrome. Repetitive head motions can cause persistent head bumps, scalp discomfort, and hair loss.
The headspin hole is a unique type of scalp overuse injury that manifests as a fibrous mass on the scalp with hair loss and related distress. To date, there remains a lack of studies investigating the pathophysiology of headspring hole injury among breakdancers.
About the patient
The male patient in the current case report was a breakdancer in his early 30s who complained of a bump on the scalp associated with hair loss. Over the last five years, the patient noticed an increase in the size of the mass and the onset of tenderness, accompanied by discomfort and aesthetic displeasure.
The breakdancer engaged in several headspin maneuvers in the previous 19 years. The weekly training regimen comprised five sessions, each lasting about 90 minutes. In every session, breakdancing moves were applied directly to the vertex, the highest point on the skull, for two to seven minutes.
A primary care physician referred the patient to the neurosurgical department to evaluate the mass on his scalp. During the clinical examination, neurosurgeons observed a longitudinally inclined midline protuberance at the skull vertex, whereas other cranial structures appeared well-proportioned.
On palpation, the mass was tender, and the skin overlying the mass was mobile. These clinical features suggested a subgaleal tumor. Differential diagnoses included a benign tumor, kerion, atheroma, epidermoid cyst, lipoma, and cancer.
The patient underwent magnetic resonance imaging (MRI) to determine the specific diagnosis. The MRI showed subgaleal fibrosis with thickened subcutaneous tissue and overlying skin. The mass measured 33 cm by 0.60 cm by 2.90 cm in the midline.
Contrast enhancement and vascular structures resembled the galea with no focal tumor volume. A slightly thickened skull was observed below the mass as compared to adjacent areas. MRI features were consistent with the cone-head sign.
Based on the chief complaint, history, and clinical and radiological findings, the team advised surgical tumor removal. Under general anesthesia, neurosurgeons made a curved-shaped incision along the coronal suture to dissect the mass from the skull and galea, in addition to drilling down the underlying thickening up to surrounding bone levels. The patient did not develop complications during or after the surgery.
Pathologists examined the surgically removed scalp tissue under the microscope for a definitive diagnosis. Histological examination revealed extensive fibrosis in the scalp mass without any signs of malignancy. The surgery significantly reduced the size of the tumor mass, relieved symptoms, and improved aesthetics, highly satisfying the patient.
Discussion
Searching for similar case reports, the researchers identified one additional report describing a male between 30 and 40 years of age who engaged in breakdancing and ultimately developed a growth on the vertex resembling a cone. The patient experienced dizziness and persistent nosebleeds for many years.
After six months of an inconclusive MRI, the dizziness and nose bleeds stopped, but the causes remain unclear. Tumor status at follow-up is unreported.
Histological analysis revealed enlarged epicranial aponeurosis and subcutaneous fibrotic adipose tissues. The tumor location, radiological features, and histological features are similar to those of the present case.
Conclusions
The headspin hole injury presents as a chronic and benign fibrotic growth on the scalp of breakdancers that surgery can effectively remove. The injury is known to the breakdancing community; however, few documented cases have been published.
Increased reporting of the injury could help determine its prevalence, clinical presentations, radiological and histological features, treatment options, and prognosis. Increased scientific evidence on management protocols could also enable neurosurgeons to determine the most suitable treatment option and improve the standard of care.
Journal reference:
- Skotting, M. B., & Søndergaard, C. B. (2024). ‘Headspin hole’: an overuse injury among breakdancers. BMJ Case Reports 17. doi:10.1136/bcr-2024-261854