Neurological Injury in Sports Concussion,Stingers, and Cervical Cord Neuropraxia

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Amanda Gilmore
5 years ago
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1 Richard Roberts M.D. Department of Neurosurgery Cook Children s Hospital Concussion Remains one of the most common injuries in sports The most common neurological injury Often goes unrecognized or ignored Potentially very dangerous 1

2 The new preferred term is Mild Traumatic Brain Injury or MTBI The term underscores the significance of the injury This is injury without radiographic evidence No CT, MRI findings seen Be concerned for MTBI after any head impact 2

3 Signs -seen by you Appears dazed or stunned Is confused about assignment position Forgets sports plays Is unsure of game, score, or opponent Moves clumsily Answers questions slowly Loses consciousness (even briefly) Shows behavior or personality changes Confusion Can t recall events prior to hit or fall Can t recall events after hit or fall Symptoms- felt by athlete Headache or pressure in head Nausea or vomiting Balance problems or dizziness Double or blurry vision Sensitivity to light Sensitivity to noise Feeling sluggish, hazy, foggy, or groggy Concentration or memory problems Confusion Does not feel right 3

4 What to do Take the player out of play This would include practice or any activity If the player soon returns to normal(5 min) then continue to observe(this assumes there is no other signs of neurological injury: pupils, N\V, etc ) If not better then seek immediate medical evaluation The player needs full evaluation and clearance prior to return to play Loss of consciousness or seizure seek immediate attention Time out from activity Symptoms from MTBI can last commonly 6-8 weeks Players should not return to activity if they have any issues Rarely Second impact syndrome can occur which can be serious or fatal Uncertain diagnosis but again underscores the seriousness of head injury 4

5 Cumulative effects Most studies feel that the risk of long term cognitive effects increases dramatically after 3 episodes of MTBI Reports indicate a 3-9x increase in the findings of long term depression or cognitive decline This may include dementia Out at 2 I do not allow athletes to participate in impact or combat sports after 2 MTBI If the injuries occurred in the same sport, even if it is not considered a combat/impact then I do not release them Their 3rd MTBI is reserved for their regular life Most people will have a MTBI in the course of their lives 5

6 Stingers Also called Burners A nerve injury of the upper extremities It can effect any part of the arm or shoulder Stingers are caused by a injury to the nerves of the Brachial plexus These are the nerves made of C5-C6-C7-C8-T1 The nerves begin as they leave the spinal cord Nerve injury can be anywhere outside the spinal cord 6

The specific mechanism of this injury is unknown Theories include Head turned toward the side of the injury Nerves compressed at the bone as they leave the

7 The specific mechanism of this injury is unknown Theories include Head turned toward the side of the injury Nerves compressed at the bone as they leave the spinal canal Head turned away from the side of the injury Stretch of the nerves Downward movement of the affected side Traction and exposure of the nerves 7

8 Stingers by definition are transient injuries Most patients recover without incident Numbness and/or burning may be in any part of the hand, forearm, arm, or shoulder 8

9 Stingers that do not recover or are accompanied by weakness may be a more serious injury These brachial plexus injuries must be evaluated by a physician and may result in permanent deficits Prognosis Most stingers will recover without issue However repeated stingers or a injury before recovery may result in a type of double crush injury which could have lasting effects 9

10 One consideration Athletes who suffer these injuries may have unfavorable anatomy The spinal canal and the foramen or holes where the nerves exit may be congenitally small This would predispose the athlete to further injury Cervical cord neuropraxia or CCN Injury where the athlete has whole body numbness or transient weakness/paralysis This is a much more serious injury than a stinger Reflects a injury to the spinal cord 10

11 Mechanism of injury Extreme hyperflexion of the neck During hyperflexion the spinal cord thickens The cervical discs compress toward the spinal cord Extended discs may bulge up to 1.16 mm or 11% of the canal diameter The ligamentum flavum thickens in extension May bulge up to 2.7mm or 20-30% of the canal 11

12 Mechanism cont. The combination of the narrowing of the canal and transient interruption of blood flow causes a spinal cord injury Athletes with congenitally smaller canals are at much greater risk for these injuries 12

13 Out at 1 An athlete who suffers this injury should not participate in combat/impact sports or any activity where there is a risk of neck hyperextension The anatomy which causes this predisposition does not change and the risk of further injury is increased 13

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Coliseum SC Concussion Protocol Signs and Symptoms

Coliseum SC Concussion Protocol Signs and Symptoms Athletes who experience one or more of the signs or symptoms listed below after a bump, blow, or jolt to the head or body may have a concussion. SIGNS