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Cartilage Defect of Lunate Facet of Distal Radius After Fracture Treated With Osteochondral Autograft From Knee
Clinical Measurement of Patellar Tendon: Accuracy and Relationship to Surgical Tendon Dimensions
Open Repair of Retracted Latissimus Dorsi Tendon Avulsion
Patient Education Is Key in Sports Medicine
Practicing sports medicine in a large Southern city has a number of pros and cons on an everyday basis. One of the many upsides is the trusting respect that patients have for their caregivers, doctors included. As an orthopedic resident in a large Northern city, I was often amazed at the distrust and skepticism that many patients showed toward the same professionals. I still believe—14 years later—that many of the surgeons I trained with are among the finest in the country, and they continue to lead the orthopedic world in many ways.
The trust that seems inherent in the population that I interact with on a daily basis can easily be taken for granted and/or misplaced. One manifestation of this misplaced trust occurs when a physician fails to educate a patient about their condition and treatment plan, and the patient is left wondering if the doctor is truly acting in their best interest, or if there are better options. On a daily basis, many patients who have come from every walk of life and every level of education simply want to better understand their condition and what their options are, in order to make an informed decision about what is best for them.
It is customary at this point in sports medicine practice to advise active people who suffer a torn anterior cruciate ligament (ACL) to undergo surgical reconstruction. Although the timing of surgery, surgical technique, postoperative rehabilitation, and return-to-activity criteria may differ from one surgeon to the next, the plan of care would generally be the same. The sports medicine literature would certainly support that there is more than one path to successful outcomes in ACL surgery, and it would also support there are some paths which are less likely to lead to success in some patient populations.
When encountering a patient whose surgeon did not explain the reasoning behind their specific treatment plan, what I find the most striking is that they had no idea that there was more than one way to achieve a successful outcome; they appreciate the education that we provide to help them decide which path to choose. In the case of ACL treatment, I believe that the treating physician should be well-versed in the available literature and offer considerable education to the patient about his or her options, and why the surgeon chose to recommend a specific treatment plan. I do not believe that simply saying that surgery is required, with no further discussion of the process and the inherent variables within it, is sufficient. With accessibility of information via any number of online sites, the dogmatic one-path-fits-them-all ACL surgeon may find that patients increasingly seek other opinions. The single-technique ACL surgeon may find happiness through years of successful outcomes—by his or her standards—but may ultimately find that savvy patients become aware of their other options.
I have sat through many national meetings and listened to respected surgeons talk about their techniques and innovation, along with their outcomes. Too many times I have heard that one technique, or one device, is better than another. I have also heard surgeons say with absolute certainty that a specific device or technique cannot lead to success. There is more than one way to drill a femoral tunnel for ACL reconstruction, and the ACL surgeon should be able to accomplish the goal of proper tunnel placement regardless of the technique he or she chooses. More than one graft option may lead to successful outcomes, and ACL surgeons should be skilled in the use of the various graft options. ACL surgeons should be versatile, not dogmatic and one-dimensional, allowing for a better understanding of the spectrum of injury. In saying this, I am certain that there is more than one path to successful outcomes in many of the injuries we treat as sports medicine physicians, and that thoughtful and considerate education of the patient regarding the reasoning behind our recommendations is of paramount importance.
Perhaps the patients I encountered in my training were not trusting right off the bat. I learned to watch and listen to my mentors as they communicated their knowledge to their patients. I fully recognize that clinicians who are reading this editorial likely are the ones most interested in education of both themselves and their patients. However, patients are increasingly aware that there is often more than one path to success, and I find it interesting that the medically uninformed patients seem to be more willing to accept this fact than many of the medically knowledgeable physicians.
Dr. Dugas is Editorial Board Member of this journal; and Fellowship Director, American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama.
Author’s Disclosure Statement: The author reports no actual or potential conflict of interest in relation to this article.
Am J Orthop. 2013;42(6):261. Copyright Frontline Medical Communications Inc. 2013. All rights reserved.
Practicing sports medicine in a large Southern city has a number of pros and cons on an everyday basis. One of the many upsides is the trusting respect that patients have for their caregivers, doctors included. As an orthopedic resident in a large Northern city, I was often amazed at the distrust and skepticism that many patients showed toward the same professionals. I still believe—14 years later—that many of the surgeons I trained with are among the finest in the country, and they continue to lead the orthopedic world in many ways.
The trust that seems inherent in the population that I interact with on a daily basis can easily be taken for granted and/or misplaced. One manifestation of this misplaced trust occurs when a physician fails to educate a patient about their condition and treatment plan, and the patient is left wondering if the doctor is truly acting in their best interest, or if there are better options. On a daily basis, many patients who have come from every walk of life and every level of education simply want to better understand their condition and what their options are, in order to make an informed decision about what is best for them.
It is customary at this point in sports medicine practice to advise active people who suffer a torn anterior cruciate ligament (ACL) to undergo surgical reconstruction. Although the timing of surgery, surgical technique, postoperative rehabilitation, and return-to-activity criteria may differ from one surgeon to the next, the plan of care would generally be the same. The sports medicine literature would certainly support that there is more than one path to successful outcomes in ACL surgery, and it would also support there are some paths which are less likely to lead to success in some patient populations.
When encountering a patient whose surgeon did not explain the reasoning behind their specific treatment plan, what I find the most striking is that they had no idea that there was more than one way to achieve a successful outcome; they appreciate the education that we provide to help them decide which path to choose. In the case of ACL treatment, I believe that the treating physician should be well-versed in the available literature and offer considerable education to the patient about his or her options, and why the surgeon chose to recommend a specific treatment plan. I do not believe that simply saying that surgery is required, with no further discussion of the process and the inherent variables within it, is sufficient. With accessibility of information via any number of online sites, the dogmatic one-path-fits-them-all ACL surgeon may find that patients increasingly seek other opinions. The single-technique ACL surgeon may find happiness through years of successful outcomes—by his or her standards—but may ultimately find that savvy patients become aware of their other options.
I have sat through many national meetings and listened to respected surgeons talk about their techniques and innovation, along with their outcomes. Too many times I have heard that one technique, or one device, is better than another. I have also heard surgeons say with absolute certainty that a specific device or technique cannot lead to success. There is more than one way to drill a femoral tunnel for ACL reconstruction, and the ACL surgeon should be able to accomplish the goal of proper tunnel placement regardless of the technique he or she chooses. More than one graft option may lead to successful outcomes, and ACL surgeons should be skilled in the use of the various graft options. ACL surgeons should be versatile, not dogmatic and one-dimensional, allowing for a better understanding of the spectrum of injury. In saying this, I am certain that there is more than one path to successful outcomes in many of the injuries we treat as sports medicine physicians, and that thoughtful and considerate education of the patient regarding the reasoning behind our recommendations is of paramount importance.
Perhaps the patients I encountered in my training were not trusting right off the bat. I learned to watch and listen to my mentors as they communicated their knowledge to their patients. I fully recognize that clinicians who are reading this editorial likely are the ones most interested in education of both themselves and their patients. However, patients are increasingly aware that there is often more than one path to success, and I find it interesting that the medically uninformed patients seem to be more willing to accept this fact than many of the medically knowledgeable physicians.
Dr. Dugas is Editorial Board Member of this journal; and Fellowship Director, American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama.
Author’s Disclosure Statement: The author reports no actual or potential conflict of interest in relation to this article.
Am J Orthop. 2013;42(6):261. Copyright Frontline Medical Communications Inc. 2013. All rights reserved.
Practicing sports medicine in a large Southern city has a number of pros and cons on an everyday basis. One of the many upsides is the trusting respect that patients have for their caregivers, doctors included. As an orthopedic resident in a large Northern city, I was often amazed at the distrust and skepticism that many patients showed toward the same professionals. I still believe—14 years later—that many of the surgeons I trained with are among the finest in the country, and they continue to lead the orthopedic world in many ways.
The trust that seems inherent in the population that I interact with on a daily basis can easily be taken for granted and/or misplaced. One manifestation of this misplaced trust occurs when a physician fails to educate a patient about their condition and treatment plan, and the patient is left wondering if the doctor is truly acting in their best interest, or if there are better options. On a daily basis, many patients who have come from every walk of life and every level of education simply want to better understand their condition and what their options are, in order to make an informed decision about what is best for them.
It is customary at this point in sports medicine practice to advise active people who suffer a torn anterior cruciate ligament (ACL) to undergo surgical reconstruction. Although the timing of surgery, surgical technique, postoperative rehabilitation, and return-to-activity criteria may differ from one surgeon to the next, the plan of care would generally be the same. The sports medicine literature would certainly support that there is more than one path to successful outcomes in ACL surgery, and it would also support there are some paths which are less likely to lead to success in some patient populations.
When encountering a patient whose surgeon did not explain the reasoning behind their specific treatment plan, what I find the most striking is that they had no idea that there was more than one way to achieve a successful outcome; they appreciate the education that we provide to help them decide which path to choose. In the case of ACL treatment, I believe that the treating physician should be well-versed in the available literature and offer considerable education to the patient about his or her options, and why the surgeon chose to recommend a specific treatment plan. I do not believe that simply saying that surgery is required, with no further discussion of the process and the inherent variables within it, is sufficient. With accessibility of information via any number of online sites, the dogmatic one-path-fits-them-all ACL surgeon may find that patients increasingly seek other opinions. The single-technique ACL surgeon may find happiness through years of successful outcomes—by his or her standards—but may ultimately find that savvy patients become aware of their other options.
I have sat through many national meetings and listened to respected surgeons talk about their techniques and innovation, along with their outcomes. Too many times I have heard that one technique, or one device, is better than another. I have also heard surgeons say with absolute certainty that a specific device or technique cannot lead to success. There is more than one way to drill a femoral tunnel for ACL reconstruction, and the ACL surgeon should be able to accomplish the goal of proper tunnel placement regardless of the technique he or she chooses. More than one graft option may lead to successful outcomes, and ACL surgeons should be skilled in the use of the various graft options. ACL surgeons should be versatile, not dogmatic and one-dimensional, allowing for a better understanding of the spectrum of injury. In saying this, I am certain that there is more than one path to successful outcomes in many of the injuries we treat as sports medicine physicians, and that thoughtful and considerate education of the patient regarding the reasoning behind our recommendations is of paramount importance.
Perhaps the patients I encountered in my training were not trusting right off the bat. I learned to watch and listen to my mentors as they communicated their knowledge to their patients. I fully recognize that clinicians who are reading this editorial likely are the ones most interested in education of both themselves and their patients. However, patients are increasingly aware that there is often more than one path to success, and I find it interesting that the medically uninformed patients seem to be more willing to accept this fact than many of the medically knowledgeable physicians.
Dr. Dugas is Editorial Board Member of this journal; and Fellowship Director, American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama.
Author’s Disclosure Statement: The author reports no actual or potential conflict of interest in relation to this article.
Am J Orthop. 2013;42(6):261. Copyright Frontline Medical Communications Inc. 2013. All rights reserved.
Consider developmental issues when treating teen sports injuries
BUENA VISTA, FLA – The cups and ribbons that young athletes bring home sometimes come with a price – injuries that can sideline them for a few games or haunt them for the rest of their lives.
Teenagers are more likely than adults to sustain sports injuries, Dr. Ilene Claudius said at a meeting sponsored by the American College of Emergency Physicians and the American Academy of Pediatrics. Immature bones, strong tendons, and a general tendency to brush off aches and pains all conspire to increase the risk.
Open epiphyseal plates are always points of weakness on a growing bone, said Dr. Claudius of the University of Southern California, Los Angeles. "During periods of rapid growth, the epiphyses are incredibly weak, so boys in their early teens get a lot of sports injuries. They also have strong tendons that insert there and set those kids up for inflammation."
Most of these stress injuries occur in runners, jumpers, and dancers, she said – but they can be seen in those who play other sports. The risk is highest in two periods during a young athlete’s career – just as they delve enthusiastically into their sport and when they reach an elite level, during which time physical efforts grow even more demanding.
"Think about what that person has been doing that might predispose him to an injury: the couch potato who has been doing nothing for 12 years and then starts running every day, the elite athlete who excels in a sport and never deviates from that sport, or the athlete who has played a single sport for years and then takes up a new one, which uses an entirely different set of muscles and bones."
Muscles and bones grow rapidly to accommodate new activities, Dr. Claudius said. Muscles increase in mass and pull on bones, increasing bone mass. It takes a full 14 months for skeletal remodeling. But, in the meantime, when bone absorption outstrips bone repair, stress fractures can occur.
With some ice, rest, and NSAIDs, most of these injuries will heal within 8 weeks. Occasionally, stress fractures appear in more concerning places, like the navicular bone, femur, or femoral neck "These have a higher risk of complete fracture, so they need more aggressive treatment."
Gymnastics, football, and wrestling predispose athletes to hyperextension injuries. Symptoms include lower back pain that radiates to the buttocks and gets worse with exercise. Affected teens can present with paresthesia. These patients usually respond to a few months of activity modification and some physical therapy.
Repetitive hyperextension injuries can leave a lasting effect in the form of traction apophysitis, impingement of the spinous processes, or pseudoarthrosis of the transitional vertebrae.
Concussion is probably the most-feared sports injury. Every time an athlete sustains a concussion, the chances of getting another are increased and the time it takes to recover is extended.
Repeated head trauma can lead to a chronic traumatic encephalopathy. The latency period is 6-10 years, after which the athlete may begin to express emotional disorders, paranoia, memory problems, and even suicidal ideation. "Pathologically, it looks a lot like Alzheimer’s," Dr. Claudius said.
Concussion isn’t always easy to identify on the field or in the emergency department. Preseason neurocognitive testing can make diagnosis easier. "This gives you a baseline; if a concussion is present, the score typically decreases by 10% or more."
While adults typically return to normal in 4 or 5 days, research shows that young people have a much longer recovery time. For a teenager, up to 3 weeks or recovery is not unusual. Any kind of return to full play is absolutely contraindicated during recovery, and resting the brain is just as important as resting other parts of the body.
Cognitive rest can be a difficult concept for the teen to grasp. Dr. Claudius said. "We always need to tailor our message to the audience, and in this case, our audience is an adolescent. A week of cognitive rest means more than just a few days off school. It means not staying up late; it means no texting or video games. It means no sex."
When symptoms recede to mild – for example, sustained attention for 30 minutes without the return of somatic symptoms- the teen can take on a limited amount of school work. It’s important to get up out of bed and start returning to regular activities, with the exception of sports.
"They should avoid aerobic activity until they’re completely asymptomatic," Dr. Claudius said. "Then there can be a careful program that includes light aerobic exercise."
This should be followed by sport-specific training, then noncontact training, followed by full contact practice and, finally, returning to the game.
"Athletes should stay at each level until are completely asymptomatic for 24 hours. If they become symptomatic, they need to drop back to the prior level and stay there until they are."
Dr. Claudius had no financial disclosures.
BUENA VISTA, FLA – The cups and ribbons that young athletes bring home sometimes come with a price – injuries that can sideline them for a few games or haunt them for the rest of their lives.
Teenagers are more likely than adults to sustain sports injuries, Dr. Ilene Claudius said at a meeting sponsored by the American College of Emergency Physicians and the American Academy of Pediatrics. Immature bones, strong tendons, and a general tendency to brush off aches and pains all conspire to increase the risk.
Open epiphyseal plates are always points of weakness on a growing bone, said Dr. Claudius of the University of Southern California, Los Angeles. "During periods of rapid growth, the epiphyses are incredibly weak, so boys in their early teens get a lot of sports injuries. They also have strong tendons that insert there and set those kids up for inflammation."
Most of these stress injuries occur in runners, jumpers, and dancers, she said – but they can be seen in those who play other sports. The risk is highest in two periods during a young athlete’s career – just as they delve enthusiastically into their sport and when they reach an elite level, during which time physical efforts grow even more demanding.
"Think about what that person has been doing that might predispose him to an injury: the couch potato who has been doing nothing for 12 years and then starts running every day, the elite athlete who excels in a sport and never deviates from that sport, or the athlete who has played a single sport for years and then takes up a new one, which uses an entirely different set of muscles and bones."
Muscles and bones grow rapidly to accommodate new activities, Dr. Claudius said. Muscles increase in mass and pull on bones, increasing bone mass. It takes a full 14 months for skeletal remodeling. But, in the meantime, when bone absorption outstrips bone repair, stress fractures can occur.
With some ice, rest, and NSAIDs, most of these injuries will heal within 8 weeks. Occasionally, stress fractures appear in more concerning places, like the navicular bone, femur, or femoral neck "These have a higher risk of complete fracture, so they need more aggressive treatment."
Gymnastics, football, and wrestling predispose athletes to hyperextension injuries. Symptoms include lower back pain that radiates to the buttocks and gets worse with exercise. Affected teens can present with paresthesia. These patients usually respond to a few months of activity modification and some physical therapy.
Repetitive hyperextension injuries can leave a lasting effect in the form of traction apophysitis, impingement of the spinous processes, or pseudoarthrosis of the transitional vertebrae.
Concussion is probably the most-feared sports injury. Every time an athlete sustains a concussion, the chances of getting another are increased and the time it takes to recover is extended.
Repeated head trauma can lead to a chronic traumatic encephalopathy. The latency period is 6-10 years, after which the athlete may begin to express emotional disorders, paranoia, memory problems, and even suicidal ideation. "Pathologically, it looks a lot like Alzheimer’s," Dr. Claudius said.
Concussion isn’t always easy to identify on the field or in the emergency department. Preseason neurocognitive testing can make diagnosis easier. "This gives you a baseline; if a concussion is present, the score typically decreases by 10% or more."
While adults typically return to normal in 4 or 5 days, research shows that young people have a much longer recovery time. For a teenager, up to 3 weeks or recovery is not unusual. Any kind of return to full play is absolutely contraindicated during recovery, and resting the brain is just as important as resting other parts of the body.
Cognitive rest can be a difficult concept for the teen to grasp. Dr. Claudius said. "We always need to tailor our message to the audience, and in this case, our audience is an adolescent. A week of cognitive rest means more than just a few days off school. It means not staying up late; it means no texting or video games. It means no sex."
When symptoms recede to mild – for example, sustained attention for 30 minutes without the return of somatic symptoms- the teen can take on a limited amount of school work. It’s important to get up out of bed and start returning to regular activities, with the exception of sports.
"They should avoid aerobic activity until they’re completely asymptomatic," Dr. Claudius said. "Then there can be a careful program that includes light aerobic exercise."
This should be followed by sport-specific training, then noncontact training, followed by full contact practice and, finally, returning to the game.
"Athletes should stay at each level until are completely asymptomatic for 24 hours. If they become symptomatic, they need to drop back to the prior level and stay there until they are."
Dr. Claudius had no financial disclosures.
BUENA VISTA, FLA – The cups and ribbons that young athletes bring home sometimes come with a price – injuries that can sideline them for a few games or haunt them for the rest of their lives.
Teenagers are more likely than adults to sustain sports injuries, Dr. Ilene Claudius said at a meeting sponsored by the American College of Emergency Physicians and the American Academy of Pediatrics. Immature bones, strong tendons, and a general tendency to brush off aches and pains all conspire to increase the risk.
Open epiphyseal plates are always points of weakness on a growing bone, said Dr. Claudius of the University of Southern California, Los Angeles. "During periods of rapid growth, the epiphyses are incredibly weak, so boys in their early teens get a lot of sports injuries. They also have strong tendons that insert there and set those kids up for inflammation."
Most of these stress injuries occur in runners, jumpers, and dancers, she said – but they can be seen in those who play other sports. The risk is highest in two periods during a young athlete’s career – just as they delve enthusiastically into their sport and when they reach an elite level, during which time physical efforts grow even more demanding.
"Think about what that person has been doing that might predispose him to an injury: the couch potato who has been doing nothing for 12 years and then starts running every day, the elite athlete who excels in a sport and never deviates from that sport, or the athlete who has played a single sport for years and then takes up a new one, which uses an entirely different set of muscles and bones."
Muscles and bones grow rapidly to accommodate new activities, Dr. Claudius said. Muscles increase in mass and pull on bones, increasing bone mass. It takes a full 14 months for skeletal remodeling. But, in the meantime, when bone absorption outstrips bone repair, stress fractures can occur.
With some ice, rest, and NSAIDs, most of these injuries will heal within 8 weeks. Occasionally, stress fractures appear in more concerning places, like the navicular bone, femur, or femoral neck "These have a higher risk of complete fracture, so they need more aggressive treatment."
Gymnastics, football, and wrestling predispose athletes to hyperextension injuries. Symptoms include lower back pain that radiates to the buttocks and gets worse with exercise. Affected teens can present with paresthesia. These patients usually respond to a few months of activity modification and some physical therapy.
Repetitive hyperextension injuries can leave a lasting effect in the form of traction apophysitis, impingement of the spinous processes, or pseudoarthrosis of the transitional vertebrae.
Concussion is probably the most-feared sports injury. Every time an athlete sustains a concussion, the chances of getting another are increased and the time it takes to recover is extended.
Repeated head trauma can lead to a chronic traumatic encephalopathy. The latency period is 6-10 years, after which the athlete may begin to express emotional disorders, paranoia, memory problems, and even suicidal ideation. "Pathologically, it looks a lot like Alzheimer’s," Dr. Claudius said.
Concussion isn’t always easy to identify on the field or in the emergency department. Preseason neurocognitive testing can make diagnosis easier. "This gives you a baseline; if a concussion is present, the score typically decreases by 10% or more."
While adults typically return to normal in 4 or 5 days, research shows that young people have a much longer recovery time. For a teenager, up to 3 weeks or recovery is not unusual. Any kind of return to full play is absolutely contraindicated during recovery, and resting the brain is just as important as resting other parts of the body.
Cognitive rest can be a difficult concept for the teen to grasp. Dr. Claudius said. "We always need to tailor our message to the audience, and in this case, our audience is an adolescent. A week of cognitive rest means more than just a few days off school. It means not staying up late; it means no texting or video games. It means no sex."
When symptoms recede to mild – for example, sustained attention for 30 minutes without the return of somatic symptoms- the teen can take on a limited amount of school work. It’s important to get up out of bed and start returning to regular activities, with the exception of sports.
"They should avoid aerobic activity until they’re completely asymptomatic," Dr. Claudius said. "Then there can be a careful program that includes light aerobic exercise."
This should be followed by sport-specific training, then noncontact training, followed by full contact practice and, finally, returning to the game.
"Athletes should stay at each level until are completely asymptomatic for 24 hours. If they become symptomatic, they need to drop back to the prior level and stay there until they are."
Dr. Claudius had no financial disclosures.
EXPERT ANALYSIS AT THE ADVANCED PEDIATRIC EMERGENCY MEDICINE ASSEMBLY
In the Hips, Increasing Pain and Decreasing Range of Motion
Arthroscopic Acetabular Recession With Chondrolabral Preservation
To read the full study, click here.
To read the full study, click here.
To read the full study, click here.
New concussion guidelines stress individualized approach
Any athlete with a possible concussion should be immediately removed from play pending an evaluation by a licensed health care provider trained in assessing concussions and traumatic brain injury, according to a new guideline from the American Academy of Neurology.
The guideline for evaluating and managing athletes with concussion was published online in the journal Neurology on March 18 (doi:10.1212/WNL.0b013e31828d57dd) in conjunction with the annual meeting of the AAN. The guideline replaces the Academy’s 1997 recommendations, which stressed using a grading system to try to predict concussion outcomes.
The new guideline takes a more individualized and conservative approach, especially for younger athletes. The new approach comes as many states have enacted legislation regulating when young athletes can return to play following a concussion.
"If in doubt, sit it out," Dr. Jeffrey S. Kutcher, coauthor of the guideline and a neurologist at the University of Michigan in Ann Arbor, said in a statement. "Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor. You only get one brain; treat it well."
The new guideline calls for athletes to stay off the field until they are asymptomatic off medication. High school athletes and younger players with a concussion should be managed more conservatively since they take longer to recover than older athletes, according to the AAN.
But there is not enough evidence to support complete rest after a concussion. Activities that do not worsen symptoms and don’t pose a risk of another concussion can be part of the management of the injury, according to the guideline.
"We’re moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually," Dr. Christopher C. Giza, the co–lead guideline author and a neurologist at Mattel Children’s Hospital at the University of California, Los Angeles, said in a statement. "There is no set timeline for safe return to play."
The AAN expert panel recommends that sideline providers use symptom checklists such as the Standardized Assessment of Concussion to help identify suspected concussion and that the scores be shared with the physicians involved in the athletes’ care off the field. But these checklists should not be the only tool used in making a diagnosis, according to the guidelines. Also, the checklist scores may be more useful if they are compared against preinjury individual scores, especially in younger athletes and those with prior concussions.
CT imaging should not be used to diagnose a suspected sport-related concussion, according to the guideline. But imaging might be used to rule out more serious traumatic brain injuries, such as intracranial hemorrhage in athletes with a suspected concussion who also have a loss of consciousness, posttraumatic amnesia, persistently altered mental status, focal neurologic deficit, evidence of skull fracture, or signs of clinical deterioration.
Athletes are at greater risk of concussion if they have a history of concussion. The first 10 days after a concussion pose the greatest risk for a repeat injury.
The AAN advises physicians to be on the lookout for ongoing symptoms that are linked to a longer recovery, such as continued headache or fogginess. Athletes with a history of concussions and younger players also tend to have a longer recovery.
The guideline also include level C recommendations stating that health care providers "might" develop individualized graded plans for returning to physical and cognitive activity. They might also provide cognitive restructuring counseling in an effort to shorten the duration of symptoms and the likelihood of developing chronic post-concussion syndrome, according to the guideline.
The guideline also included a number of recommendations on areas for future research, including studies of pre–high school age athletes to determine the natural history of concussion and recovery time for this age group, as well as the best assessment tools. The expert panel also called for clinical trials of different postconcussion management strategies and return-to-play protocols.
The guidelines were developed by a multidisciplinary expert committee that included representatives from neurology, athletic training, neuropsychology, epidemiology and biostatistics, neurosurgery, physical medicine and rehabilitation, and sports medicine. Many of the authors reported serving as consultants for professional sports associations, receiving honoraria and funding for travel for lectures on sports concussion, receiving research support from various foundations and organizations, and providing expert testimony in legal cases involving traumatic brain injury or concussion.
One of the most important statements in the new guideline
is that providers should not rely on a single diagnostic test when evaluating
an athlete, said Dr. Barry Jordan, the assistant medical director and attending
neurologist at the Burke Rehabilitation Hospital in White Plains, N.Y. Dr.
Jordan, who is an expert on sports concussions, said he’s seen too many
providers using a single computerized screening tool to assess whether an
athlete is well enough to return to play.
The new
guideline calls on providers to combine screening checklists with clinical
findings when making the determination about whether an athlete is well enough
to return to the field. Dr. Jordan
said this comprehensive approach is the way to go. And physicians who are
knowledgeable about concussions must be involved with that evaluation, he said.
|
| Dr. Barry Jordan |
The new guideline is an important update reflecting
the movement away from grading concussions to a more individualized approach. "You can't grade the severity until the concussion is over," he said.
Dr. Jordan
said the AAN guideline is "clear and easy to follow" and will results in better
care if followed.
Dr.
Barry Jordan is the director of the Brain Injury Program at Burke
Rehabilitation Hospital in White Plains, N.Y. He works with several sports
organizations including the New York State Athletic Commission, U.S.A. Boxing, and the National
Football League Players Association. He also writes a bimonthly column for
Clinical Neurology News called “On the Sidelines.”
One of the most important statements in the new guideline
is that providers should not rely on a single diagnostic test when evaluating
an athlete, said Dr. Barry Jordan, the assistant medical director and attending
neurologist at the Burke Rehabilitation Hospital in White Plains, N.Y. Dr.
Jordan, who is an expert on sports concussions, said he’s seen too many
providers using a single computerized screening tool to assess whether an
athlete is well enough to return to play.
The new
guideline calls on providers to combine screening checklists with clinical
findings when making the determination about whether an athlete is well enough
to return to the field. Dr. Jordan
said this comprehensive approach is the way to go. And physicians who are
knowledgeable about concussions must be involved with that evaluation, he said.
|
|
| Dr. Barry Jordan |
The new guideline is an important update reflecting
the movement away from grading concussions to a more individualized approach. "You can't grade the severity until the concussion is over," he said.
Dr. Jordan
said the AAN guideline is "clear and easy to follow" and will results in better
care if followed.
Dr.
Barry Jordan is the director of the Brain Injury Program at Burke
Rehabilitation Hospital in White Plains, N.Y. He works with several sports
organizations including the New York State Athletic Commission, U.S.A. Boxing, and the National
Football League Players Association. He also writes a bimonthly column for
Clinical Neurology News called “On the Sidelines.”
One of the most important statements in the new guideline
is that providers should not rely on a single diagnostic test when evaluating
an athlete, said Dr. Barry Jordan, the assistant medical director and attending
neurologist at the Burke Rehabilitation Hospital in White Plains, N.Y. Dr.
Jordan, who is an expert on sports concussions, said he’s seen too many
providers using a single computerized screening tool to assess whether an
athlete is well enough to return to play.
The new
guideline calls on providers to combine screening checklists with clinical
findings when making the determination about whether an athlete is well enough
to return to the field. Dr. Jordan
said this comprehensive approach is the way to go. And physicians who are
knowledgeable about concussions must be involved with that evaluation, he said.
|
|
| Dr. Barry Jordan |
The new guideline is an important update reflecting
the movement away from grading concussions to a more individualized approach. "You can't grade the severity until the concussion is over," he said.
Dr. Jordan
said the AAN guideline is "clear and easy to follow" and will results in better
care if followed.
Dr.
Barry Jordan is the director of the Brain Injury Program at Burke
Rehabilitation Hospital in White Plains, N.Y. He works with several sports
organizations including the New York State Athletic Commission, U.S.A. Boxing, and the National
Football League Players Association. He also writes a bimonthly column for
Clinical Neurology News called “On the Sidelines.”
Any athlete with a possible concussion should be immediately removed from play pending an evaluation by a licensed health care provider trained in assessing concussions and traumatic brain injury, according to a new guideline from the American Academy of Neurology.
The guideline for evaluating and managing athletes with concussion was published online in the journal Neurology on March 18 (doi:10.1212/WNL.0b013e31828d57dd) in conjunction with the annual meeting of the AAN. The guideline replaces the Academy’s 1997 recommendations, which stressed using a grading system to try to predict concussion outcomes.
The new guideline takes a more individualized and conservative approach, especially for younger athletes. The new approach comes as many states have enacted legislation regulating when young athletes can return to play following a concussion.
"If in doubt, sit it out," Dr. Jeffrey S. Kutcher, coauthor of the guideline and a neurologist at the University of Michigan in Ann Arbor, said in a statement. "Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor. You only get one brain; treat it well."
The new guideline calls for athletes to stay off the field until they are asymptomatic off medication. High school athletes and younger players with a concussion should be managed more conservatively since they take longer to recover than older athletes, according to the AAN.
But there is not enough evidence to support complete rest after a concussion. Activities that do not worsen symptoms and don’t pose a risk of another concussion can be part of the management of the injury, according to the guideline.
"We’re moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually," Dr. Christopher C. Giza, the co–lead guideline author and a neurologist at Mattel Children’s Hospital at the University of California, Los Angeles, said in a statement. "There is no set timeline for safe return to play."
The AAN expert panel recommends that sideline providers use symptom checklists such as the Standardized Assessment of Concussion to help identify suspected concussion and that the scores be shared with the physicians involved in the athletes’ care off the field. But these checklists should not be the only tool used in making a diagnosis, according to the guidelines. Also, the checklist scores may be more useful if they are compared against preinjury individual scores, especially in younger athletes and those with prior concussions.
CT imaging should not be used to diagnose a suspected sport-related concussion, according to the guideline. But imaging might be used to rule out more serious traumatic brain injuries, such as intracranial hemorrhage in athletes with a suspected concussion who also have a loss of consciousness, posttraumatic amnesia, persistently altered mental status, focal neurologic deficit, evidence of skull fracture, or signs of clinical deterioration.
Athletes are at greater risk of concussion if they have a history of concussion. The first 10 days after a concussion pose the greatest risk for a repeat injury.
The AAN advises physicians to be on the lookout for ongoing symptoms that are linked to a longer recovery, such as continued headache or fogginess. Athletes with a history of concussions and younger players also tend to have a longer recovery.
The guideline also include level C recommendations stating that health care providers "might" develop individualized graded plans for returning to physical and cognitive activity. They might also provide cognitive restructuring counseling in an effort to shorten the duration of symptoms and the likelihood of developing chronic post-concussion syndrome, according to the guideline.
The guideline also included a number of recommendations on areas for future research, including studies of pre–high school age athletes to determine the natural history of concussion and recovery time for this age group, as well as the best assessment tools. The expert panel also called for clinical trials of different postconcussion management strategies and return-to-play protocols.
The guidelines were developed by a multidisciplinary expert committee that included representatives from neurology, athletic training, neuropsychology, epidemiology and biostatistics, neurosurgery, physical medicine and rehabilitation, and sports medicine. Many of the authors reported serving as consultants for professional sports associations, receiving honoraria and funding for travel for lectures on sports concussion, receiving research support from various foundations and organizations, and providing expert testimony in legal cases involving traumatic brain injury or concussion.
Any athlete with a possible concussion should be immediately removed from play pending an evaluation by a licensed health care provider trained in assessing concussions and traumatic brain injury, according to a new guideline from the American Academy of Neurology.
The guideline for evaluating and managing athletes with concussion was published online in the journal Neurology on March 18 (doi:10.1212/WNL.0b013e31828d57dd) in conjunction with the annual meeting of the AAN. The guideline replaces the Academy’s 1997 recommendations, which stressed using a grading system to try to predict concussion outcomes.
The new guideline takes a more individualized and conservative approach, especially for younger athletes. The new approach comes as many states have enacted legislation regulating when young athletes can return to play following a concussion.
"If in doubt, sit it out," Dr. Jeffrey S. Kutcher, coauthor of the guideline and a neurologist at the University of Michigan in Ann Arbor, said in a statement. "Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor. You only get one brain; treat it well."
The new guideline calls for athletes to stay off the field until they are asymptomatic off medication. High school athletes and younger players with a concussion should be managed more conservatively since they take longer to recover than older athletes, according to the AAN.
But there is not enough evidence to support complete rest after a concussion. Activities that do not worsen symptoms and don’t pose a risk of another concussion can be part of the management of the injury, according to the guideline.
"We’re moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually," Dr. Christopher C. Giza, the co–lead guideline author and a neurologist at Mattel Children’s Hospital at the University of California, Los Angeles, said in a statement. "There is no set timeline for safe return to play."
The AAN expert panel recommends that sideline providers use symptom checklists such as the Standardized Assessment of Concussion to help identify suspected concussion and that the scores be shared with the physicians involved in the athletes’ care off the field. But these checklists should not be the only tool used in making a diagnosis, according to the guidelines. Also, the checklist scores may be more useful if they are compared against preinjury individual scores, especially in younger athletes and those with prior concussions.
CT imaging should not be used to diagnose a suspected sport-related concussion, according to the guideline. But imaging might be used to rule out more serious traumatic brain injuries, such as intracranial hemorrhage in athletes with a suspected concussion who also have a loss of consciousness, posttraumatic amnesia, persistently altered mental status, focal neurologic deficit, evidence of skull fracture, or signs of clinical deterioration.
Athletes are at greater risk of concussion if they have a history of concussion. The first 10 days after a concussion pose the greatest risk for a repeat injury.
The AAN advises physicians to be on the lookout for ongoing symptoms that are linked to a longer recovery, such as continued headache or fogginess. Athletes with a history of concussions and younger players also tend to have a longer recovery.
The guideline also include level C recommendations stating that health care providers "might" develop individualized graded plans for returning to physical and cognitive activity. They might also provide cognitive restructuring counseling in an effort to shorten the duration of symptoms and the likelihood of developing chronic post-concussion syndrome, according to the guideline.
The guideline also included a number of recommendations on areas for future research, including studies of pre–high school age athletes to determine the natural history of concussion and recovery time for this age group, as well as the best assessment tools. The expert panel also called for clinical trials of different postconcussion management strategies and return-to-play protocols.
The guidelines were developed by a multidisciplinary expert committee that included representatives from neurology, athletic training, neuropsychology, epidemiology and biostatistics, neurosurgery, physical medicine and rehabilitation, and sports medicine. Many of the authors reported serving as consultants for professional sports associations, receiving honoraria and funding for travel for lectures on sports concussion, receiving research support from various foundations and organizations, and providing expert testimony in legal cases involving traumatic brain injury or concussion.
FROM NEUROLOGY
