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Concussions

Concussions & Young Athletes

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Sports Performance

Daily Dose

Ice Burns!

1.00 to read

Many schools are in spring sports or playoff season which means I'm seeing a few strains and sprains in the office. 

The treatment recommendation for a sprain or strain is usually RICE which stands for rest, ice, compression, elevation.  I just saw an adolescent volleyball player who had started back to her volleyball work outs and “pulled a muscle”. So, she followed her coaches directions to “ice it”.  Unfortunately, she just put the ice pack directly onto her skin and she came in with an ice burn! OUCH!

Yes, ice can burn the skin and cause frostbite as well. When treating an injury with ice you need to make sure that you put a towel or sheeting between the ice and your skin.  In this patient’s case the ice burn looked similar to a sunburn, and did not blister or cause any severe damage. In fact, when she pulled up her pants to show me her leg she “quizzed me” to see if I could guess what had caused the redness.......guess what, knowing that she was an athlete helped me guess correctly!

The picture above shows her injury as well.

The treatment is similar to a thermal burn, apply a lubricant like Aquaphor or aloe vera, and let the skin slowly heal.  If it is blistered or has had severe damage to the skin you may need to see your doctor.

Remember, ice is good for injuries but cannot be applied directly to the skin.  

Your Teen

Head Injury Linked To Violent Behavior

2.00 to read

A new study says that children who have suffered a head injury are more likely to get into a fight or take part in other types of violent behavior. Every parent knows that childhood often comes with bumps, bruises, cuts and falls. Sometimes those accidents include head injuries. A new study says that children who have suffered a head injury are more likely to get into a fight or take part in other types of violent behavior.

The connection between head injury and violence was particularly strong if the head injury had occurred within the past year, the authors of the study note in the journal Pediatrics. According to the U.S. Centers for Disease Control and Prevention, some 1.7 million Americans experience a traumatic brain injury every year, due to bumps, blows, jolts, or any injury that disrupts the brain's normal functioning. The study author, Dr. Sarah Stoddard with the University of Michigan in Ann Arbor, told Reuters Health that- with this type of research- it is difficult to figure out if brain injury is really the root of the aggression or if some other factor is the reason. Stoddard also notes that activities like drinking, drug use ,and a history of violence didn’t seem to explain the findings. Stoddard and a colleague analyzed several years' worth of data from 850 kids in high school and followed them until five years after they left school. All of the participants had a grade point average of 3 or lower, putting them at risk for dropping out. In the fifth year of the study, 88 of the young adults said they had suffered a head injury. Of those individuals, 43 percent said they had gotten into a fight, hurt someone, or taken part in some type of violence over the following year. That compared to 34 percent of those who didn't report a head injury. The findings suggest that the more recent a head injury is, the more likely a young adult is to be aggressive. According to Stoddard, "The brain does recover over time." Stoddard also adds that researchers should investigate the long-term effects of head injuries in young people, as well as preventive measures such as protective gear for sports and interventions that help kids with head injuries manage their behaviors before they lead to violence. A different study conducted by researchers at the Center for Injury Research and Policy Institute at Nationwide Children's Hospital, of young athletes 15-to-24 years old, reveals that sports are second only to motor vehicle crashes as the leading cause of injury to the brain. And concussions represent 10 percent of all high school athletic injuries. Previous studies have also shown that brain injuries can also cause changes in memory, reasoning, and emotions, including impulsivity and aggression. In studies with prisoners, researchers have found that those with a history of brain injuries are more likely to engage in violence. The study "does suggest there is a link between head injury and violence particularly early on," said Dr. Huw Williams, who has found the same relationship in prisoners, but was not involved in the new work. And if they believe their children experienced a brain injury in the past, they should also get expert advice on what to look for to make sure brain function doesn't deteriorate, he added. "It's important to monitor." Brain injury can range from mild to severe causing a short loss of consciousness and confusion to amnesia and coma. The American Academy of Pediatrics says that head injuries should be observed, and treatment should be sought if any of the following symptoms appear: •       A constant headache, particularly one that gets worse •       Slurred speech or confusion •       Dizziness that does not go away or happens repeatedly •       Extreme irritability or other abnormal behavior •       Vomiting more than 2 or 3 times •       Stumbling or difficulty walking •       Oozing blood or watery fluid from the nose or ears •       Difficulty waking up or excessive sleepiness •       Unequal size of the pupils (the dark center part of the eyes) •       Double vision or blurry vision •       Unusual paleness that lasts for more than an hour •       Convulsions (seizures) •       Difficulty recognizing familiar people •       Weakness of arms or legs •       Persistent ringing in the ears If your child does well through the observation period, there should be no long-lasting problems. Remember, most head injuries are mild. However, be sure to talk with your child's doctor about any concerns or questions you might have. The Center for Disease Control and Prevention’s website, www.cdc.gov/traumaticbraininjury also contains a free online training course on preventing sports-related brain injuries in young athletes.

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Concussions

Your Child

Kids Who Specialize In One Sport Have More Injuries

Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries.Because a child’s body is still growing, children who specialize in only one sport suffer repetitive injuries more often, a new study says.

In fact, kids are twice as likely to get hurt –playing just one sport- as those who play multiple sports said Dr. Neeru Jayanthi, medical director of primary care sports medicine at Loyola University Chicago Stritch School of Medicine. "We saw a pretty significant difference with this intensity of training, along with specialization," said Jayanthi. The findings are slated to be presented Monday at the American Medical Society for Sports Medicine annual meeting in Salt Lake City. Research presented at medical meetings should be viewed as preliminary. "It's been accepted for the last five years or so that kids who are not super-specific do better. They're cross-trained, so they're conditioned for other movements," said Dr. Kory Gill, an assistant professor at Texas A&;M Health Science Center College of Medicine. Jayanith’s research team had done earlier studies on 519 junior tennis players and found that the kids who only played tennis were more likely to get hurt. Jayanthi wanted to see if the same findings extended to other sports. "As a physician, you get frustrated seeing kids come in with injuries that keep them out for two to three months. It's devastating," said Jayanthi, who recently saw a young gymnast with a knee injury that will keep her off the mat for at least three months. Here, the researchers looked at 154 young athletes, average age 13, who played a variety of sports. Eighty-five of the participants came to the clinic for treatment for a sports injury, while 69 were just getting sports physicals. The investigation ranked each athlete on how specialized they were, basing the score on factors like how often they trained in one sport, whether they had given up other sports to practice just one, and if they trained 8 months a year or more to compete more than 6 months a year on one sport. What they discovered was that 60.4 percent of the athletes who had been injured were specialized in one sport, compared with only 31.3 percent who came in for physicals. Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries. Why did these injuries occur? "One reason is repetitive use of the same muscle group and stressors to growing areas, for example, the spine," explained Jayanthi, who stressed that the findings were preliminary. His team, in collaboration with Children's Memorial Hospital in Chicago, plans to enroll more athletes in follow-up research, and those athletes will be evaluated every six months for three years, to look more closely at how intense training can affect a young athlete's body during growth spurts. "Second is exposure risk," he added. "If you're getting really good at one sport, the intensity increases because you are getting better. People are developing adult-type sports skills in a child's body. The growing body probably doesn't tolerate this." Younger children -- those who have not entered high school -- tend to be especially vulnerable as their bodies are still growing, said Gill, who recommended that kids cross-train and condition for other movements, or just play another sport. "I tell parents to let kids be kids and play multiple sports," he said. "See what they're good at and what they enjoy." By high school, when bodies are more mature, specializing is safer, he added. When children play different sports in different seasons, they are using a wide range of motions and muscles. But when they begin playing one sport year-round, the risk of overuse injuries increases.

Daily Dose

Summer Means Head Lacerations

Parents are often frantic (as we all can be) when their child falls and you see blood coming from the head and face.Last weekend I had several phone calls about head lacerations. Summer is the season for accidents and it seems the weekends are always the busiest.

Parents are often frantic (as we all can be) when their child falls and you see blood coming from the head and face. Luckily, in most cases there is more blood than one would expect for the size of the injury, as the head is well vascularized and therefore even a small laceration will cause a lot of bleeding. The first thing to do is to get the child calmed down (and you too) and try and wash the area to really get an idea as to how large the laceration is. The patient who called could not get her child to let her look at her head (which showed that her child was okay if she could put up that much of a fight) so we had the idea of taking her toddler to the shower with the mother and to wash off there. That worked wonderfully and by then both mother and child had calmed down. Once you can see the cut, try to establish how deep and wide it is, and then see if you can stop the bleeding with pressure to the cut. If it is a scalp wound and you can stop the bleeding and it is not too deep I often do not put a child through stitches as their hair will cover the scar. That is the antithesis to a facial laceration when we are all concerned about cosmetic appearance and even a smaller cut might get one or two stitches in order to have the best cosmetic result. If in doubt, take your child to the doctor or run them by your pediatrician's house (that works great for me on weekends) in order to decide if stitches are needed. Some clean cuts may be closed with a wonderful product called "Dermabond" which is almost like "super glue" for skin. Do NOT use super glue which one of my own children thought about using for an injury while they were at college. Thank goodness they called home first! Just remember that a lot of blood does not always mean a huge injury. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Twisted Neck?

1:30 to read

Under the heading of “continuing to learn” every day…comes a new case.

 

A patient of mine who is 4 years old was playing with his brother the other morning while his mother was making their breakfast. He was a “well child” and woke up in a good mood, ready to eat and go to preschool.  She could see the boys playing while she was cooking and then suddenly the 4 year old started to scream and cry that his “neck hurt”.  At first she thought “he was pretending or over reacting” as there did not overtly seem to be anything wrong. The only thing she noticed is that he refused to turn his neck and held his head in an awkward position.

 

He continued to cry and actually scream - so she tried to calm him down and gave him some ibuprofen as well. Despite this he would not move his neck and was unconsolable, to the point that she almost took him to the ER but instead she brought him to the office.  He was noted to be crying and seemed uncomfortable and refused to move his neck at all.  His exam was otherwise normal. Even with careful questioning there was no history of trauma. He had slept through the night before this had occurred. He had a cold several weeks before, but had since improved. He did not have a fever.

 

He seemed to be in such pain that he was sent for neck X-rays which were read as normal. But he continued to be miserable….so who do you call?? 

 

I spoke to a pediatric orthopedic surgeon and he said he really did not have any ideas. Next call, the pediatric neurosurgeon. After hearing the symptoms he immediately said that he thought this little boy had “rotatory dislocation/subluxation” of the two upper cervical vertebrae in his neck (C-1 and C-2). He explained to me that in most cases the displacement resolves spontaneously, but in some cases the child continues to be uncomfortable as there is associated spasm of the sternocleidomastoid muscle, which causes the torticollis. (twisted neck).It may be seen in children after a recent upper respiratory infection and is then called Grisel Syndrome.

 

Treatment for the acute condition…pain control and muscle relaxation.  This was all news to me and I had to go to textbook (online of course) to even read about the condition.  The neurosurgeon walked me through treatment and the child was sent home on a very low dose of valium and continued ibuprofen. When I spoke to the mother later that evening the child was already more comfortable and had started to move his neck. 

 

I called her the following morning and she said that he had not required any further valium and slept well and was actually on his way to preschool! WOW….I was thrilled he was better so quickly and that I was that much “smarter”. Wonder if I will ever see rotatory subluxation of the cervical vertebra again? I’ll be ready.

Your Teen

Concussions: Boys and Girls May Have Different Symptoms

1.45

The findings suggest that boys are more likely to report amnesia and confusion/disorientation, whereas girls tend to report drowsiness and greater sensitivity to noise more often.A new study of high school athletes, finds that boys and girls who suffer concussions, may differ in their symptoms. The findings suggest that boys are more likely to report amnesia and confusion/disorientation, whereas girls tend to report drowsiness and greater sensitivity to noise more often. "The take-home message is that coaches, parents, athletic trainers, and physicians must be observant for all signs and symptoms of concussion, and should recognize that young male and female athletes may present with different symptoms," said R. Dawn Comstock, an author of the study and an associate professor of pediatrics at the Ohio State University College of Medicine in Columbus. More than 60,000 brain injuries occur among high school athletes every year, according to the U.S. Centers for Disease Control and Prevention. Although more males than females participate in sports, female athletes are more likely to suffer sports-related concussions, the researchers note. For instance, girls who play high school soccer suffer almost 40 percent more concussions than their male counterparts, according to NATA. The findings suggest that girls who suffer concussions might sometimes go undiagnosed since symptoms such as drowsiness or sensitivity to noise "may be overlooked on sideline assessments or they may be attributed to other conditions," Comstock said. For the study, Comstock and her co-authors at the University of Virginia, Charlottesville, and the University of California, Santa Barbara, examined data from an Internet-based surveillance system for high school sports-related injuries. The researchers looked at concussions involved in interscholastic sports practice or competition in nine sports (boys' football, soccer, basketball, wrestling and baseball and girls' soccer, volleyball, basketball and softball) during the 2005-2006 and 2006-2007 school years at a representative sample of 100 high schools. During that time, 812 concussions (610 in boys and 202 in girls) were reported. During the first year of the study, the surveillance system included only the primary concussion symptom for each athlete. In the second year, high school athletic trainers were able to record all the symptoms reported by the concussed athlete. In both years, headache was the most commonly reported symptom and no difference was noted between the sexes. However, in year one, 13 percent of the males reported confusion/disorientation as their primary symptom versus 6 percent of the girls. Also in the first year, amnesia was the primary symptom of 9 percent of the males but only 3 percent of the females. In the second year, amnesia and confusion/disorientation continued to be more common among males than females. In addition, 31 percent of the concussed females complained of drowsiness versus 20 percent of the males, and 14 percent of the females said they were sensitive to noise, compared with just 5 percent of the males. Concussion researcher Gerard A. Gioia, chief of pediatric neuropsychology at Children's National Medical Center in Washington, D.C., called the findings "relatively subtle" and "at best hypothesis-generating, meaning they are suggestive but in no way conclusive." Gioia said one of the study's limitations is that the reporting system didn't explain about how the injuries occurred. "The presence of increased amnesia and confusion, two early injury characteristics, in the males suggests that the injuries between the males and females may have been different," he said. Future studies will likely address this theory, said Comstock, now that the surveillance system has been expanded to include much more detailed information. Preliminary data suggest, for instance, that football players tend to get hit on the front of the head, while girls who play soccer or basketball often suffer a blow to the side of the head, she said. The findings will also be published in the January issue of the Journal of Athletic Training.

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