This book provides a modern and up to date overview of the evaluation and management of sports-related neuro trauma. The primary target audience is the “sports neurosurgeon,” who can be found on the sidelines of collision sports at all levels of play from high school to professional, or who may care for these athletes in the acute setting in hospital or the outpatient clinics. The reach of this book, however, will also extend to professionals in other fields of medicine due to some topics that extend outside the typical neurosurgical specialty, ranging from chiropractic care in the evaluation and treatment of elite athletes to alternative medical therapies for concussion. The importance of the emerging “sports neurosurgeon” subspecialty is exemplified by the adoption of a policy by the National Football League to require an Unaffiliated Neurotrauma Consultant on-field for player safety. This policy also speaks to the recent public awareness of the importance of recognizing and treating sports-related neuro trauma. This text aims to capitalize on this trend and become a multi-specialty reference to anyone interested in the field.
Neurosurgical Care of Athletes serves as a comprehensive resource for physicians and researchers involved in sports-related neuro trauma. All chapters are prepared by experts in their fields and include the most up to date scientific and clinical information.
Author(s): Mark E. Oppenlander
Publisher: Springer
Year: 2022
Language: English
Pages: 279
City: Cham
Introduction
Contents
Contributors
Chapter 1: Pre-Participation Screening for the Sports Neurosurgeon
Role of the Neurosurgeon in Sports
Epidemiology of Sport-Related Concussion and Catastrophic Neurologic Injuries
Pre-Participation Screening
What Sports Require Screening?
Neurological History
Baseline Testing
Screening for Specific Cranial and Spinal Conditions
Cranial Conditions
Arachnoid Cyst
Brain Tumor
Chiari Malformation
Previous Craniotomy
Seizure
Shunt
Vascular Lesions
Spinal Conditions
Cervical Stenosis
Cervical Surgery
Down’s Syndrome and Atlantoaxial Instability
Os Odontoideum
Stingers
Lumbar Spine
Conclusions
References
Chapter 2: On Field Assessment of the Athlete
Introduction
Identification of Injured Athletes
Assessment on the Field of Play
Sideline Assessment of Ambulatory Patient
Locker Room Assessment of Injured Player
Post-Competition and Game End Repeat Examination
References
Chapter 3: Spinal Injury in Athletes: Prevalence and Classification
Introduction
Cervical Spine Injuries
Incidence
Classification
Management
Thoracolumbar Spinal Injuries
Incidence
Injury Classification
Management Guidelines
-Spinal Cord Injury
Incidence
Injury Classification
Management Guidelines
Conclusion
References
Chapter 4: Neurosurgical Management of Spinal Cord Injuries in Athletes
Epidemiology
Pathophysiology
Initial Evaluation and Management of Sports-Related Spinal Cord Injuries
Classification of Spinal Cord Injuries
Complete Spinal Cord Injury (AIS A)
Incomplete Spinal Cord Injury (AIS B-D)
Early Medical Evaluation and Treatment
Imaging
Indication for Closed Reduction with Traction
Surgical Considerations for Acute SCI
Considerations for Long-Term Hospitalization
Secondary Complications Following Spinal Cord Injury
Acute and Long-Term Neurologic Outcomes
Conclusion
Works Cited
Chapter 5: Evaluation and Management of Cervical Radiculopathy in Athletes
Introduction
Diagnosis
Clinical History
Physical Examination
Imaging Studies
Ancillary Testing
Differential Diagnosis
Management
Nonsurgical
Surgical
Effectiveness
Anterior Cervical Discectomy and Fusion
Posterior Cervical Foraminotomy
Cervical Disc Replacement
Complications
Index-Level Reoperation
Adjacent-Level Reoperation
Return to Play
Conclusion
References
Chapter 6: Return to Play After Spinal Injury
Cervical Spine and Brachial Plexus Injuries
Cervical Stingers
Cervical Nerve Root Injuries
Congenital Cervical Stenosis
Cervical Cord Neurapraxia
Cervical Disc Herniation
Return-to-Play Recommendations Following Cervical Spine Surgery
Lumbar Injuries
Lumbar Disc Herniation
Lumbar Isthmic Spondylolisthesis
Conclusion
References
Chapter 7: Chiropractic: An Integrative Approach to the Evaluation and Treatment of Elite Athletes Utilizing Spinal Manipulation
Introduction
Indications for Spinal Manipulation
Contraindications for Spinal Manipulation
What Is an Adjustment?
The Effects of Spinal Misalignments (See Fig. 7.1)
Commonly Utilized Chiropractic Techniques
Conclusion
References
Chapter 8: Diagnosis of Sports-Related Peripheral Nerve Injury
Introduction
Overview
Epidemiology
Pathophysiology
Recovery and Prognosis
Diagnosis of Sports-Related Nerve Injuries
Upper Extremity Nerve Injuries
Brachial Plexus
Suprascapular Nerve
Axillary Nerve
Radial Nerve
Median Nerve
Ulnar Nerve
Lower Extremity Nerve Injuries
Lateral Femoral Cutaneous Nerve
Femoral Nerve
Sciatic Nerve
Common Peroneal Nerve
Pudendal Nerve
Conclusion
References
Chapter 9: Nonoperative and Operative Management of Sports-Related Peripheral Nerve Injury
Introduction
Foundational Principles
The Rule of 3’s Plus 1
Nonoperative Management Strategies
Management of Acute Nerve Injuries
Clean Open Injuries
Acute Compression
Fractures/Dislocations
Vascular Causes
Acute Compartment Syndrome
Management of Subacute Nerve Injuries
Management of Chronic Nerve Injuries
Closed Nerve Injuries
Overuse Injuries
Post-traumatic Inflammatory Neuropathies
Operative Management Strategies
Primary Nerve Repair
Nerve Grafting
Nerve Transfer Reconstruction
Secondary Reconstruction
Adaptive Sports
Conclusion
References
Chapter 10: Concussion in Sports: What Is It and How Is It Managed?
Introduction: Defining Sports-Related Concussion
Epidemiology
Concussion Diagnosis
Concussion: Signs and Symptoms
Acute Concussion: On-Field Assessment and Sideline Assessment Tools
Adjuncts to the Clinical Assessment for Concussion
Neuropsychologic Testing
Advanced Neuroimaging
Cerebrospinal Fluid and Serum-Based Biomarkers of Injury
Concussion Management
Recommendations for Concussion Management
Post-concussion Syndrome
Repetitive Mild Traumatic Brain Injury: Cumulative Effects
Conclusion
References
Chapter 11: Sport-Related Structural Brain Injury
Introduction
Definition/Pathology
Subdural Hemorrhage
Subarachnoid Hemorrhage
Epidural Hemorrhage
Intraparenchymal Hemorrhage
Diffuse Cerebral Edema and Second-Impact Syndrome
Epidemiology
Diagnosis and Management
Outcomes
Return to Play
Conclusions
References
Chapter 12: Neuroimaging and Blood Biomarkers of Sport Concussion
Introduction
Neuroimaging in Sports-Related Concussion
Computed Tomography Imaging
Magnetic Resonance Imaging
Advanced MRI Techniques
Blood Biomarkers for Sports-Related Concussion
Neuronal Injury
Axonal Injury
Astroglial Injury
Future of Blood and Imaging Biomarkers in SRC
Conclusion
Bibliography
Chapter 13: Active Rehabilitation and Return to Play After Concussion
Introduction
Foundations of Active Rehabilitation of Concussion
Concussion History
Headache History
Neck Pain History
History of Vestibular-Related Symptoms
Cognitive Symptoms
Other Historical Considerations
The Concussion Physical Examination
Concussion Exercise Tolerance Testing
Active Rehabilitation Approaches for Concussion
Cervical Physical Therapy
Vestibular Physical Therapy
Psychological Assessment and Treatment Following Concussion
Exercise as Active Rehabilitation During Concussion Recovery
Exercise During the Return to Play Progression and as a Biomarker of Recovery of Sport-Related Concussion
Returning to Academics and Work
Conclusion
Bibliography
Chapter 14: Sports Concussions: Is There a Role for Alternative Treatments?
Introduction
Supplements
Omega-3-Fatty Acids
Resveratrol
Vitamin D3
Curcumin
Magnesium and Vitamin B2 (Riboflavin)
N-Acetyl Cysteine
Vitamins E and C
Nicotinamide Ribose
Melatonin
Caffeine
Green Tea
Branched Chain Amino Acids
Creatine
Key Learning Points
Conclusions
References
Chapter 15: Chronic Traumatic Encephalopathy: Past, Present, and Future
Historical Context
Dementia Pugilista
Stepping Out of the Ring
Defining CTE
Neuropathological Criteria
Clinicopathological Correlation
Implications on Athletic Safety
Future Directions
Conclusion
References
Index
