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Musculoskeletal Assessment Of The Injured Athlete
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Musculoskeletal Assessment Of The Injured Athlete

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  • 1. Musculoskeletal Assessment of the Injured Athlete Julio A. Martinez-Silvestrini, MD Sports Medicine Specialist Medical Director Baystate Physical Medicine and Rehabilitation
  • 2. Objectives
    • Discuss the musculoskeletal assessment on the field or locker room of the injured athlete
      • Special interest to concussion assessment
    • Sports modifications recommendations
    • Rehabilitation recommendations
  • 3. Concussion
    • It is a TRAUMATIC BRAIN INJURY
    • Most patients will not have loss of consciousness
    • No need for a head blow to develop a concussion
  • 4. History
    • Symptoms:
      • Dizziness
      • “ Stunned”
      • Confusion
      • Forgetfulness
      • Behavior or mood changes
    • Headache
    • Nausea
    • Double vision
    • Sensitivity to light or sounds
    • School problems
  • 5. Physical exam
    • If LOC occurs or athlete lands on head or neck, CALL 911.
    • Palpation
      • Head, neck and upper shoulders
      • No need to do exertion testing.
        • If in doubt, sit out
  • 6. Mental status
    • Orientation
      • Place, time, situation
        • Period, score, opponent
      • Concentration
        • Months of the year in reverse order
        • Name 3 objects
  • 7. Mental status
    • Memory
      • Name of the teams in the last 3 games
      • Recall 3 objects
  • 8. Neurologic exam
    • Cranial nerves
    • Reflexes
    • Babinski
    • Balance Error Scoring System (BESS)
      • Check balance in 2 legs, tandem and 1 leg
        • Flat surface and high density foam
  • 9. Imaging
    • CT and MRI are rarely needed
      • Concussion are mostly a brain chemical deregulation
      • If positive neurologic findings are present, imaging is needed.
  • 10. Return to sports
    • No symptoms at rest
    • No symptoms during or after exercise
    • Full neck range of motion
    • Normal balance
    • Medical Clearance
  • 11. Sports modifications
    • If asymptomatic
      • Gym exercises only
      • No pads
      • Practice, no games
      • No restrictions
  • 12. Sports modifications
    • If symptomatic
      • Neck range of motion
      • Balance training
      • Progress to aerobic exercises when symptomatic
  • 13. Rehabilitation
    • Neck pain
      • Range of motion
      • Stretching
      • Shoulder girdle strengthening
      • Traction (?)
    • Visual disturbances
      • Ocular exercises
  • 14. Rehabilitation
    • Balance
      • 2 legs activities
      • 1 leg activities
      • Uneven surfaces
      • Jumping drills
  • 15. Medications
    • Depending on patient symptoms complex
      • Mood problems
        • Antidepressants
        • Mood stabilizers
      • Tension headache
        • Muscle relaxers
      • Migraine
        • Prophylaxis agents
      • Insomnia
        • Melatonin
        • Magnesium
        • Zinc
  • 16.  
  • 17. For appointments Phone: (413) 794-1150 QUESTIONS Twitter: JulioMartinezMD

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