Title and Text-Orange - Cayuga Medical Center

Report
Figure Skating Medical
Symposium
Ithaca, NY December 6, 2010
Andrew Getzin, MD
[email protected]
www.cayugamed.org/sportsmedicine
Program
• Andrew Getzin, MD,
Medical Treatment of
figure skaters
• Jake Veigel, MD,
Injury Prevention
• Deb King, PhD,
Figure Skating
Stretching and Warm
Up
• Discussion
Incidence of Injuries in Elite Junior
Figure Skaters- Acute Injuries
Ankle Sprain
Laceration,Leg
Head Injury
Fracture, arm
Fracture, leg
Knee ligament sprain
Knee injury
Shoulder dislocation
Fracture, wrist
Fracture, finger
Dubravcic-Simunjak, AJSM 2003
Incidence of Injuries in Elite Junior
Figure Skaters- Overuse Injuries
Stress Fracture
Jumper's knee
Shin splints
Osgood Schlatter
Groin pain
Hamstring Syndrome
Achilles tendonitis
Ankle Impingement
Plantar fasciitis
Dubravcic-Simunjak, AJSM 2003
What is a Concussion?
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Mild traumatic brain
injury
A disruption in
normal brain
function due to a
blow or jolt to the
head
CT or MRI is
normal
Invisible injury
Neurometabolic Cascade
(Giza and Hovda 2001)
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Abrupt neuronal depolarization
Release of excitatory neurotransmitters
Changes in glucose metabolism
Altered cerebral blood flow
The brain goes into an ENERGY
CRISIS that usually last up to 7 – 10
days
Vulnerable Period
• There exists a
window period when
individual is at
increased risk
• Should factor in return
to play decision
Common Physical Symptoms
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Headache
Nausea and vomiting
Clumsiness and poor balance
Dizziness and lightheadedness
Blurred vision and light
sensitivity
• Fatigue and lack of energy
• Sleep disturbance
• Symptoms often get worse
before they get better
Common Emotional Symptoms
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Irritability
Anxiety
More extreme moods
Easily overwhelmed
Personality change
Lack of motivation
Common Cognitive Symptoms
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Feeling ‘dazed’ or ‘foggy’ or ‘fuzzy’
Easily confused
Slowed processing
Easily distracted
Memory problems
Trouble reading
Poor mental stamina
Predictions
• Outcome after
concussion is difficult
to predict
• Don’t be fooled by
severity of injury at
the time of injury
Physical Exam
• Regular physical exam including HEENT,
neck, and neurological exam
• 5 Word Recall- immediate and 5 minutes
• Months of the year backwards
• Digits backwards
• Speech
• Pronator drift: Rhomberg
• Finger-to-nose
• Gentle push with their eyes closed
Neuropsychological Testing
• Computerized tests that measure
attention, memory, and processing speed
(reaction time)
• Sensitive to effects of concussions
• Tests can be repeated multiple times to
monitor recovery
• Ideally, a baseline is done but there is
normative date for ImPACT
Who Should Have a CT Scan?
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GCS < 15
LOC
History of emesis
Severe headaches
Signs of basilar skull fracture
Severe mechanism
Kuppermann Lancet 2009
Principles of Concussion Treatment
• No cure for concussion, but treatment can
help the person feel better and function
better while symptomatic
• Early diagnosis and education is critical,
and can improve outcome
• Rest early (7-10 days?) and then gradually
increase activity
Treatment Strategy
• Education and reassurance
• Medications for sleep, headache, etc.
• Physical & Occupational Therapy
• Neck & back problems
• Balance (fall prevention)
• Vision and Cognition
• Neuropsychological Testing
Academic Accommodations
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Out of school if necessary
Communicate!
Limit study time
Possibly hold on testing
Stress Fractures
• Overuse from
attempted skill over
and over again
• Usually insidious
onset
• Most common
location is long bones
of the feet
Pecina, Stress Fractures in Figure Skaters.
AJSM 1990
Stress Fracture Treatment
• Unload the affected
area
• Pain is a helpful guide
• What can the skater
do while he/she
heals?
Stress Fracture Prevention
• Listen to your body for warning signs
• Ensure good bone health
– Sufficient Vitamin D
– Calcium
– Energy balance
• Increase activity by <10%/week
• Jump counts?
• Biomechanics
Asthma in Figure Skating
• 1/3 – ½ of all figure skaters suffer from
exercise induced bronchospasm
• Symptoms exacerbated by cold, dry air,
and chemicals
• Skaters may present with chronic cough,
decreased aerobic capacity or wheezing
Effect of the Interaction between the Intensity of Exercise and the
Thermal Environment on the Pulmonary Mechanical Response
McFadden E and Gilbert I. N Engl J Med 1994;330:1362-1367
EIB Treatment- Non pharmacologic
• Increase physical fitness
• Warm up for at least 10 minutes at sub-threshold level (60-70%
VO2max) before exercise begins (refractory period)
• Cover mouth and nose with a scarf or mask (balaclava) during cold
weather
• Exercise short bouts in warm, humidified environment
• Avoid aeroallergens and pollutants
• Cool down or gradually lower the intensity of exercise before
stopping
• Wait at least 2 hours after a meal before exercising
• Low salt diet?, Fish Oil Supplementation?
Tan and Spector, Exercise-Induced Asthma, Sports Med. 1998;25(1):1-6
EIB Treatment-pharmacologic
• Inhaled beta 2
agonists
• Inhaled
corticosteroids
• Inhaled cromolyn
• Inhaled nedocromil
• Inhaled ipatropium
• Oral leukotriene
agonist
Not All Shortness of Breath is
Asthma
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Exercise Induced Brochospasm
Vocal Cord Dysfunction/Paradoxical Vocal Cord Motion
Asthma
Lack of Fitness
Bronchitis/URI
Anemia
Reflux
Panic Attack
Overtraining syndrome
Cardiac abnormalities
Thank You

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