Albany Arthritis & Orthopaedic Center

Patient Education: Concussion

Concussion

Although Head injuries are common in all contacts sports, most are minor injury. Sports in which minor injuries are common are American football, boxing, gymnastics, horse riding and martial arts. Major Head injuries are commonly seen after motor vehicle accidents.

Concussion is one the most difficult problems faced by healthcare profession on the sideline. It is a high risk injury that is complicated by emotional responses and legal ramifications, but it is commonly treated based on guidelines built on opinion, experience and very little direct science.

It is a common term used to describe minor head injury. It is clinically defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. There are several common features of concussion: Rapid onset of short-lived impairment of neurological function that clears spontaneously, caused by direct blow to head, face, neck or elsewhere on body with “impulse” force transmitted to head, may result in neuropathological changes but acute clinical symptoms largely reflect functional disturbance and  not structural injury, typically associated with grossly normal structure neuroimaging studies .It is also a graded set of clinical syndromes that may or may not include LOC, resolution of clinical and cognitive symptoms typically follows sequential course.

Based on survey and surveillance data,there are 300,000 sports-related traumatic brain injury annually (majority are concussion). The incidence of concussion is 3-6% of total recorded injuries, football 64.4%, girls’ and boys’ soccer 11.9%, wrestling 10.5%. The incidence of concussion has found to be highest in high school (5.6%) and division III (5.5%).

The identification of a concussed player is often difficult. Although loss of consciousness is usually apparent, this often not present.In other cases, diagnosis can be made on reporting symptoms by the athlete or abnormal physical findings by medical staff. Some of the common features easily observed are slurred speech, stumbling, and vomiting. Other signs and symptoms are headaches, memory deficit or amnesia, fatigue , dazed, lack of concentration, changes in personality,depression, anxiety, irritability, clumsiness, decrease in playing agility, sensitivity to light, inappropriate emotional reactions( laughing or crying).

Historically, there are many different grading systems which include the American Academy of Neurology, Colorado Medical Society and Cantu System. These systems are based on opinions or “best guess” recommendations. A new classification scheme was proposed in the Prague in 2004 for management purpose that distinguished concussion as either simple or complex. Simple concussion is when the athletes suffers an injury that resolves with out complication over period of 7- 10 days and complex concussion is when the athlete suffers persistent symptoms , LOC > 1 min, convulsive concussion and prolong cognitive impairment after the injury.

The first step in managing concussion is to exclude serious head or spinal injury. If the athlete is unconscious, it is a serious head or spinal injury until proven otherwise. Some of the side line assessment tools include standardized assessment of concussion (SAC) and Sports Concussion assessment tools. Other Computer based neuropsychological testing (NPT) includes the Impact, Headminder and Cog Sport. These tests are use to identify and quantify cognitive impairment and return to play decision for athlete with concussion or prolonged post-concussive symptoms. CT or MRI maybe use to excludes structural abnormalities but they are usually normal. There are ongoing researches on the use of functional MRI to aid in the diagnosis of concussion.

If an athlete demonstrates any post-concussive signs and symptoms,the athlete is held from current game or practice, “When in doubt, hold them out”, monitor closely immediately post-injury for deterioration of mental status changes and follow up medical evaluation.

The return to play decision is based on complete rest, no physical and/or mental activity while symptomatic, light aerobic exercise, no resistance training, exercise bike, walking, sport-specific exercise with progressive addition of weight training, skating in hockey, running in soccer, noncontact training drills, and plus+/_ NPT. The athlete is allowed full-contact training (after med clearance). And finally, allow to full game play. At times, medicines are used briefly for symptoms such as Sleep, anxiety, headache and mood/emotional liability.

The most feared complication of concussion is the second Impact syndrome. It is a potential fatal cascade of cerebral hemorrhage and edema resulting from second concussion blow following incomplete resolution of the first concussive event. Another complication is post concussive syndrome. This is characterized by persistent headache, inability to concentrate, irritability, fatigue, vertigo, emotional liability, gait disturbance , sleep and vision.

Dr. Cherinor Sillah at Albany Arthritis & Orthopaedic Center has established a concussion program to manage athlete that sustained a minor head injury. This program also includes the Impact Testing. The program is currently available. For more information call AAOC at (229) 446-1990.

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