Concussion

concussion
A blow to the head that makes the brain hit the skull

What’s up ? This is THE stephane ANDRE. With my training, I’m interessed in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

A concussion is a traumatic brain injury that alters mental state or creates others symptoms. Many people think they have no concussion because they have not lost consciousness. You must know that it’s possible to have a concussion without losing consciousness. Often football or rugby players say : « I just got my bell rung » when they have been hit on the head that makes the ears rings, but these symptoms are often consistent with concussion.

Signs

  • Balance problems

  • Difficulty communicating, concentrating

  • Dizziness

  • Drowsiness

  • Fatigue

  • Feeling emotional

  • Feeling mentally foggy

  • Headache

  • Irritability

  • Memory difficulties

  • Nausea

  • Nervousness

  • Numbness or tingling

  • Sadness

  • Sensitivity to light or noise

  • Sleeping more than usual or difficulty falling asleep

  • Visual problems (blurry or double vision)

  • Vomiting

Diagnostic

diagnostic

As soon as a concussion is suspected, a trained coach, certified athletic trainer or the team physician should immediately perform an initial « sideline » evaluation, including :

  • Symptoms list review

  • Focused neurological exam

  • Focused orientation exam that tests short-term memory recall such as the event, play, opponent, score or last meal.

  • Focused orientation exam that tests long-term recall such as name, birth date, place of birth.

  • Assessment of athlete’s ability to stay attentive to a complex task such as reciting months backwards.

If a person is suspected of having a concussion and there is no diagnosis, a concussion may place an athlete at risk of developing second impact syndrome. It’s a potentially fatal injury that occurs when an athlete suffers a second head injury before the old head injury has completely healed.

Second impact syndrome

Second impact syndrome is a potentially fatal injury that occurs when an athlete suffers a second head injury before the old head injury has been fully healed. Unfortunately, it’s complicated to know if the brain has been healed from the first injury. Even after all symptoms resolved, it’s possible that the healing isn’t complete and that it increases the risk to the brain of having the second impact syndrome. Neurocognitive testing can help doctors or physician decide when the athlete can return to the competition in the best conditions.

Neurocognitive testing

Neurocognitive testing

Neurocognitive testing is a questionnaire (usually on the computer) that athletes do that deals with several areas of brain function, including memory, problem solving, reaction times, brain processing speed and post-concussion symptoms. It’s most valid if the athlete has a pre-injury baseline test on file to compare the post concussion test. This information can be really helpful for the doctor or physician to decide when the athlete can return to the competition.

When to return to the competition

All athletes suffer concussion (whatever the gravity) should pass an evaluation by a qualified health care provider before returning to the competition. Athletes should return to competition after they have been completely cleared of all concussion symptoms and have no symptoms during and after physical tests.

Baseline testing is important for assessing concussion symptoms after an incident. The baseline testing often includes neurocognitive tests, symptom checklists, sideline assessment tools such as the Sideline Concussion Assessment Tool and balance testing.

Statistics

  • Athletes who have already had a concussion are more likely to have another concussion.

  • Children and teenagers are more likely to have concussion and take longer to heal than adults.

Subscribe to my newsletter and share this article if you think it can help someone you know. Thank you.

-Steph

Articular Cartilage Injuries

articular cartilage injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interessted in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Definition

Articular cartilage is difficult to understand because there are 3 types of cartilages in the body : articular of hyaline cartilage (covers joint surfaces), fibrocartilage (knee meniscus, vertebral disk) and elastic cartilage (outer ear). These cartilage’s types differ in their structure, elasticity and strength.

Articular cartilage is a complex element, it’s a living tissue that is on the joint’s surface. The function is to provide a low friction surface to allow the joint to withstand weight loads through the range of motion needed to perform activity of daily living. To put it simply, articular cartilage is a very thin shock absorber. It’s built in 5 distinct layers and each layer has a structural and biochemical difference.

Injury

articular cartilage injury

Articular cartilage injury may be due to trauma or progressive degeneration (wear and tear). This can be mechanical destruction, a direct blow or other trauma. The healing of articular cartilage cells depends on the severity of the damage and the location of the lesion. Articular cartilage has no direct blood supply so it has very little ability to repair itself. It the lesion penetrates the bone under the cartilage, the bone provides blood in the area which improves the chances of healing.

Mechanical degeneration (wear and tear) of articular cartilage occurs with progressive loss of normal cartilage structure and function. This loss begins with the softening of the cartilage, then progresses to fragmentation. As the loss of articular cartilage lining continue, the underlying bone no longer has any protections against normal wear and tear of daily life and begins to get damaged leading to osteoarthritis.

In many cases, a patient experiences knee swelling and vague pain. At this stage, continuous physical activity isn’t possible. If a loose body is present, words such as « locking » or « catching » might be used to explain the problem. With wear and tear , the patient often experiences stiffness, decreased range of motion, joint pain and/or swelling.

Diagnostic

The physician examines the knee to look for a decrease in range of motion, pain along the joint line, swelling, fluid on the knee, abnormal alignment of the joint’s bones, and ligament or meniscal injury.

Cartilage lesions are difficult to diagnose and it’s possible that the use of magnetic resonance imaging (MRI) or arthroscopy may be necessary. Plain X- rays don’t usually diagnose articular cartilage problems but they used to rule out other abnormalities.

Treatment

articular cartilage injury treatment

 

Articular cartilage injury that doesn’t penetrate the bone doesn’t repair itself. A lesion that penetrates the bone can heal but the type of cartilage created is structurally unorganized and doesn’t work as well as the original cartilage.

Lesion less than 2 cm have the best prognosis and the best treatment options. These options are arthroscopic surgery using techniques to remove damaged cartilage and increase blood flow from the underlying bone (drilling, pick procedure or microfracture ).

For smaller lesion of articular cartilage surgery is not required.

For larger lesion, it’s necessary to transplant the articular cartilage from another area of the body. Talk to your doctor or specialist to have more information about the decision to have a surgical operation.

For patients with osteoarthritis, non-surgical treatment consists of physical therapy, lifestyle modification (for example reducing activity), bracing, supportive devices, oral and injection drugs (like non-steroidal inflammatory drugs, cartilage protective drugs) and medical management.

Surgical options depend on the severity of osteoarthritis and may provide a reduction in symptoms that are usually short-lived. Total osteoarthritis may relieve the symptom of advanced osteoarthritis but this usually requires a change in the lifestyle and/or level of activity of the patient.

Statistics

Based on published studies, the overall prevalence of articular cartilage injury in the knee is 36% among all athlete and 59% among asymptomatic basketball players and runners.

Subscribe to my newsletter and share this article if you think it can help someone you know.

-Steph