Musculoskeletal Assessment Of The Injured Athlete

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Musculoskeletal Assessment Of The Injured Athlete

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

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