Musculoskeletal Assessment of the Injured Athlete Julio A. Martinez-Silvestrini, MD Sports Medicine Specialist Medical Director Baystate Physical Medicine and Rehabilitation
Nov 28, 2014
Musculoskeletal Assessment of the Injured Athlete
Julio A. Martinez-Silvestrini, MDSports Medicine Specialist
Medical DirectorBaystate Physical Medicine and Rehabilitation
ObjectivesDiscuss the musculoskeletal assessment
on the field or locker room of the injured athleteSpecial interest to concussion
assessmentSports modifications recommendationsRehabilitation recommendations
ConcussionIt is a TRAUMATIC BRAIN INJURYMost patients will not have loss of
consciousnessNo need for a head blow to develop a
concussion
HistorySymptoms:
Dizziness“Stunned”Confusion ForgetfulnessBehavior or mood
changes
HeadacheNauseaDouble visionSensitivity to light or
soundsSchool problems
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
Mental statusOrientation
Place, time, situationPeriod, score, opponent
ConcentrationMonths of the year in reverse orderName 3 objects
Mental statusMemory
Name of the teams in the last 3 gamesRecall 3 objects
Neurologic examCranial nervesReflexesBabinskiBalance Error Scoring System (BESS)
Check balance in 2 legs, tandem and 1 legFlat surface and high density foam
ImagingCT and MRI are rarely
neededConcussion are
mostly a brain chemical deregulation
If positive neurologic findings are present, imaging is needed.
Return to sportsNo symptoms at restNo symptoms during or after exerciseFull neck range of motionNormal balanceMedical Clearance
Sports modificationsIf asymptomatic
Gym exercises onlyNo padsPractice, no gamesNo restrictions
Sports modificationsIf symptomatic
Neck range of motionBalance trainingProgress to aerobic exercises when
symptomatic
RehabilitationNeck pain
Range of motionStretchingShoulder girdle strengtheningTraction (?)
Visual disturbancesOcular exercises
RehabilitationBalance
2 legs activities1 leg activitiesUneven surfacesJumping drills
MedicationsDepending on
patient symptoms complexMood problems
AntidepressantsMood stabilizers
Tension headacheMuscle relaxers
MigraineProphylaxis
agentsInsomnia
MelatoninMagnesiumZinc
For appointmentsPhone: (413) 794-1150
QUESTIONSTwitter: JulioMartinezMD