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ABSTRACT: Mild traumatic brain injury, or concussion, is a common consequence of collisions, falls and other forms of contact in sports. Concussion may be defined as an acute trauma-induced alteration of mental function lasting fewer than 24 hours, with or without preceding loss of consciousness. The physician's responsibilities in assessing an athlete with concussion include determining the need for emergency intervention and offering guidance about the athlete's ability to return to play. Concussion may be complicated by cerebral edema related to the second impact syndrome, cumulative neuropsychologic deficits, intracranial bleeding or the postconcussion syndrome. The risk of complications is increased in athletes who prematurely return to play and in those with prolonged loss of consciousness or post-traumatic amnesia. An athlete with prolonged loss of consciousness or signs and symptoms that worsen or persist after a concussion should be evaluated in the emergency department. An athlete should not be allowed to resume sports participation until all symptoms of a concussion have resolved.
ABSTRACT: Injuries to the head and neck are common in sports. Sideline physicians must be attentive and prepared with an organized approach to detect and manage these injuries. Because head and neck injuries often occur simultaneously, the sideline physician can combine the head and neck evaluations. When assessing a conscious athlete, the physician initially evaluates the neck for spinal cord injury and determines whether the athlete can be moved safely to the sideline for further evaluation. This decision is made using an on-field assessment of the athlete's peripheral sensation and strength, as well as neck tenderness and range of motion. If these evaluations are normal, axial loading and Spurling testing can be performed. Once the neck has been determined to be normal, the athlete can be assisted to the sideline for assessment of concussion symptoms and severity. This assessment should include evaluations of the athlete's reported symptoms, recently acquired memory, and postural stability. Injured athletes should be monitored with serial examinations, and those with severe, prolonged, or progressive findings require transport to an emergency department for further evaluation.
ABSTRACT: The most common head injury in sports is concussion. Athletes who sustain a prolonged loss of consciousness should be transported immediately to a hospital for further evaluation. Assessment of less severe injuries should include a thorough neurologic examination. The duration of symptoms and the presence or absence of post-traumatic amnesia and loss of consciousness should be noted. To avoid premature return to play, a good understanding of the possible hazards is important. Potential hazards of premature return to play include the possibility of death from second-impact syndrome, permanent neurologic impairment from cumulative trauma, and the postconcussion syndrome.
Concussion in Sports - Editorials
Concussion in Sports - Editorials
ABSTRACT: Concussion is a disturbance in brain function caused by direct or indirect force to the head. It is a functional rather than structural injury that results from shear stress to brain tissue caused by rotational or angular forces—direct impact to the head is not required. Initial evaluation involves eliminating cervical spine injury and serious traumatic brain injury. Headache is the most common symptom of concussion, although a variety of clinical domains (e.g., somatic, cognitive, affective) can be affected. Signs and symptoms are nonspecific; therefore, a temporal relationship between an appropriate mechanism of injury and symptoms must be determined. There are numerous assessment tools to aid diagnosis, including symptom checklists, neuropsychological tests, postural stability tests, and sideline assessment tools. These tools are also used to monitor recovery. Cognitive and physical rest are the cornerstones of initial management. There are no specific treatments for concussion; therefore, focus is on managing symptoms and return to play. Because concussion recovery is variable, rigid classification systems have mostly been abandoned in favor of an individualized approach. A graded return-to-play protocol can be implemented once a patient has recovered in all affected domains. Children, adolescents, and those with a history of concussions may require a longer recovery period. There is limited research on the management of concussions in children and adolescents, but concern for potential consequences of injury to the developing brain suggests that a more conservative approach to management is appropriate in these patients.
Cognitive Rest in Concussion Management - Editorials
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Evaluation and Management of Concussion in Athletes: Recommendations from the AAN - Practice Guidelines