musculoskeletal assessment of the injured athlete
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Musculoskeletal Assessment of the Injured Athlete
Julio A. Martinez-Silvestrini, MDSports Medicine Specialist
Medical DirectorBaystate Physical Medicine and Rehabilitation
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ObjectivesDiscuss the musculoskeletal assessment
on the field or locker room of the injured athleteSpecial interest to concussion
assessmentSports modifications recommendationsRehabilitation recommendations
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ConcussionIt is a TRAUMATIC BRAIN INJURYMost patients will not have loss of
consciousnessNo need for a head blow to develop a
concussion
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HistorySymptoms:
Dizziness“Stunned”Confusion ForgetfulnessBehavior or mood
changes
HeadacheNauseaDouble visionSensitivity to light or
soundsSchool problems
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Physical examIf LOC occurs or
athlete lands on head or neck, CALL 911.
PalpationHead, neck and upper
shouldersNo need to do exertion
testing. If in doubt, sit out
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Mental statusOrientation
Place, time, situationPeriod, score, opponent
ConcentrationMonths of the year in reverse orderName 3 objects
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Mental statusMemory
Name of the teams in the last 3 gamesRecall 3 objects
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Neurologic examCranial nervesReflexesBabinskiBalance Error Scoring System (BESS)
Check balance in 2 legs, tandem and 1 legFlat surface and high density foam
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ImagingCT and MRI are rarely
neededConcussion are
mostly a brain chemical deregulation
If positive neurologic findings are present, imaging is needed.
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Return to sportsNo symptoms at restNo symptoms during or after exerciseFull neck range of motionNormal balanceMedical Clearance
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Sports modificationsIf asymptomatic
Gym exercises onlyNo padsPractice, no gamesNo restrictions
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Sports modificationsIf symptomatic
Neck range of motionBalance trainingProgress to aerobic exercises when
symptomatic
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RehabilitationNeck pain
Range of motionStretchingShoulder girdle strengtheningTraction (?)
Visual disturbancesOcular exercises
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RehabilitationBalance
2 legs activities1 leg activitiesUneven surfacesJumping drills
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MedicationsDepending on
patient symptoms complexMood problems
AntidepressantsMood stabilizers
Tension headacheMuscle relaxers
MigraineProphylaxis
agentsInsomnia
MelatoninMagnesiumZinc
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For appointmentsPhone: (413) 794-1150
QUESTIONSTwitter: JulioMartinezMD