Stingers

Volume 90, Issue 3, Pages 402-406 (March 2009)

Archives of Physical Medicine and Rehabilitation

Christopher J. Standaert, MD, Stanley A. Herring, MD

Stingers are a common injury in contact sports and are characterized by acute lancinating pain in 1 upper extremity with or without associated weakness and neck pain. Appropriate on-field evaluation is necessary to identify the extent of injury and rule out structural injuries to the head, spine, or shoulder girdle. Although athletes can often return to play after a single acute event that resolves rapidly, those who have recurrent events, persisting pain, or strength deficits require a thorough diagnostic evaluation before return-to-play decisions can be made. In some circumstances, players sustaining a single stinger or multiple recurrent stingers may be permanently removed from participation in collision or contact sports.

A Prospective Study of Postconcussive Outcomes After Return to Play in Australian Football.

Am J Sports Med. 2009 Feb 9.

Makdissi M, McCrory P, Ugoni A, Darby D, Brukner P.

University of Melbourne.

BACKGROUND: Decisions regarding safe return to play after concussion in sport remain difficult. OBJECTIVE: To determine whether a concussed player returned to play using an individual clinical management strategy is at risk of impaired performance or increased risk of injury or concussion. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: All elite Australian football players were followed for 4 seasons. Players were recruited into the study after sustaining a concussive injury. Outcome measures included performance statistics (disposals per hour match-time), injury rates, and recurrence of concussion on return to play. A subset of players had brief screening cognitive tests performed at baseline and after their concussion. Noninjured players matched for team, position, age, and size were chosen as controls. RESULTS: A total of 199 concussive injuries were observed in 158 players. Sixty-one concussive injuries were excluded from analysis because of incomplete data (45 players) or presence of concurrent injury (16 players). Of the 138 concussive injuries assessed, 127 players returned to play without missing a game (92%). The remainder of concussed players returned to play after missing a single game (8%). Overall, there was no significant decline in disposal rates in concussed players on return to competition. Furthermore, there were no significant differences in injury rates between concussed and team, position, and gamematched controls. In the subset of players who had completed screening cognitive tests, all had returned to their individual baseline performance before being returned to play.

CONCLUSION: Return to play decisions based on individual clinical assessment of recovery allows safe and appropriate return to sport following a concussive injury.

Return-to-Play Criteria After Athletic Concussion

Lester Mayers, MD

Arch Neurol. 2008;65(9):1158-1161.

Management of a sport-related concussion, especially involving return-to-play decisions, is one of the most important challenges confronting sports medicine professionals. Current guidelines result from thoughtful consensus recommendations by expert committees but are chiefly based on the resolution of symptoms and the results of neuropsychological testing, if available. Adherence to this paradigm results in most injured athletes resuming competition in 1 to 2 weeks.

Author Affiliation: Athletics Department, Goldstein Fitness Center, Pace University, Pleasantville, New York.

RELATED LETTERS

National Football League Experiences With Return to Play After Concussion
Ira R. Casson, Elliot J. Pellman, and David C. Viano
Arch Neurol. 2009;66(3):419-420.
EXTRACT | FULL TEXT

Convolutions of the Silent Sports Concussion: A Neuropsychologist’s Response to the Dark Ages of Rule-Based Return-to-Play Decisions
Ann B. Shuttleworth-Edwards
Arch Neurol. 2009;66(3):420-421.
EXTRACT | FULL TEXT

Convolutions of the Silent Sports Concussion: A Neuropsychologist’s Response to the Dark Ages of Rule-Based Return-to-Play Decisions—Reply
Lester Mayers
Arch Neurol. 2009;66(3):421.
EXTRACT | FULL TEXT

Alterations to locomotor navigation in a complex environment at 7 and 30 days following a concussion in an elite athlete.

Brain Inj. 2009 Mar 9:1-8

Alterations to locomotor navigation in a complex environment at 7 and 30 days following a concussion in an elite athlete.

Fait P, McFadyen BJ, Swaine B, Cantin JF.

Faculty of Medicine, Department of Rehabilitation, Laval University, Quebec, Canada.

Primary objective: To compare the locomotor capacity during (1) unobstructed walking and (2) the circumvention of fixed obstacles with and without a simultaneous visual task in an elite athlete before and after a sports-related concussion. Research design: Case report. Methods and procedures: Gait analysis and clinical neuropsychological measures were taken pre- and at 7 and 30 days post-injury in an 18 year old male junior hockey player. The task consisted of walking along an unobstructed or obstructed path with or without a visual interference task. Measurements included dual tasks costs, response errors, maximal gait speed and minimal clearance with the obstacle. Main outcome and results: Although the athlete was symptom-free and neuropsychological test results returned to baseline relatively quickly, he showed continued errors in the interference task, abnormally small obstacle clearance distances and decreased maximal gait speed up to 30 days after the concussion.

Conclusions: Concussion can result in persistent planning and attention deficits in ecologically valid, complex environments. This report suggests that functional assessment within an ecological context could be an innovative way to evaluate concussed athletes before sending them back to play, even in the absence of medically related symptoms or abnormal neuropsychological test results.