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