Blast-related mild traumatic brain injury in the acute phase: acute stress reactions partially mediate the relationship between loss of consciousness and symptoms.

PRIMARY OBJECTIVE: The objective was to compare symptoms in service members diagnosed with a blast-related mTBI (mild traumatic brain injury) with a loss of consciousness (LOC) to those without LOC. RESEARCH DESIGN: Clinicians saw US military personnel within 72 hours of sustaining a blast-related mTBI and at a follow-up visit 48-72 hours later (n = 210). METHODS AND PROCEDURES: Demographics, post-concussive symptoms, diagnosis of acute stress reaction (ASR) and simple reaction time data from the Automated Neuropsychological Assessment Metric (ANAM) were collected. MAIN OUTCOMES AND RESULTS: ASRs were significantly more likely in patients reporting LOC versus patients reporting no LOC. At the first post-injury visit, LOC was associated with difficulty sleeping, hearing loss, memory problems and reporting more symptoms. A follow-up analysis explored if symptomatic differences were influenced by ASR. Adjusting for ASR, the statistical relationships between LOC and symptoms were weaker (i.e. reduced Odds Ratios). At the follow-up visit, difficulty sleeping was associated with LOC before and after adjusting for ASR. Patients with both ASR and LOC had the slowest simple reaction times. CONCLUSIONS: Results suggest ASR may partially mediate symptom presentation and cognitive dysfunction in the acute phase following blast-related mTBI. Future research is warranted.

IED blast postconcussive syncope and autonomic dysregulation.

Concussions are the most frequent battle injury sustained in Afghanistan. The Concussion Restoration Care Center provides multidisciplinary care to concussed service members in theater. The Concussion Restoration Care Center has managed over 500 concussions, the majority being from improvised explosive device (IED) blasts. Syncope following a concussion without a loss of consciousness is rarely reported in the literature. The pathophysiology of concussion from a blast injury may be distinct from a concussion secondary to blunt trauma. Two cases of syncope following concussions with an alteration of consciousness are presented, and a mechanism of action is proposed. Post-IED blast concussive symptom frequency at initial presentation on a cohort of patients is reported, with 1.3% of patients experiencing postconcussive syncope. Syncope following an IED blast may be related to centrally mediated autonomic dysregulation at the brain stem level. Syncope should be added to the list of possible symptoms that occur following concussions, in particular concussions following a blast injury.

Sports medicine training room clinic model for the military.

A transition from traditional problem-based clinics to the Sports Medicine and Reconditioning Team (SMART) clinic model was completed by January 2009 at Marine Corps Base Camp Lejeune. The SMART clinic model allows for more patients to be seen and enhances coordinated care between providers. The objective of this research is to show the advantages of implementing a training room team approach for the care of musculoskeletal injuries in active duty members by comparing the number of patients seen, the number of limited duty (LIMDU) periods, the number of physical evaluation boards (PEBs), and the percentage of orthopedic referrals. Electronic medical records for patients seen at sports medicine clinics between January 1, 2007 and December 31, 2010 were reviewed. Naval Hospital Camp Lejeune provided a database of patients placed on LIMDU and PEB from 2007 through 2010. Fifty-eight and twenty-four percent more encounters occurred in 2009 and 2010, respectively, than that in 2007. The percentage of LIMDU referred for PEB in 2010 was reduced to 9% compared to that in 2007. In conclusion, the SMART clinic model allows for more patients to be seen and a reduction in the percentage of patients recommended for PEB from LIMDU.

Ultrasound-guided cooled radiofrequency ablation of the genicular nerves: a technique paper.

Aim: Cooled radiofrequency ablation (CRFA) has demonstrated efficacy in the management of knee pain caused by osteoarthritis. A typical procedure involves fluoroscopic placement of internally cooled radiofrequency probes to ensure the probes are located near target genicular nerves. Patients & methods: A new technique was developed to perform CRFA using ultrasound (US) guidance. Patient outcomes were reported using a telephone survey. Results: Ablation procedures were successfully performed using US guidance. A total of 51 patients were retrospectively identified for telephone screening. A total of 22 patients completed the telephone questionnaire. There were no safety concerns identified and the majority of patients reported satisfactory outcomes. Conclusion: Patient outcomes demonstrate that US-guided CRFA procedures provide pain relief and functional improvement. Further studies are needed to compare the efficacy of US-guided CRFA to fluoroscopy-guided CRFA procedures.

Mortarmen's Knee: Adult-Onset Tibial Tubercle Exostoses in 2 Infantrymen.

Two 20-year-old male patients presented together to a multidisciplinary primary care sports medicine clinic with reports of focal swelling and pain at the left anterior knee just distal to the patella. Both patients enlisted together, chose the same occupational specialty, and trained together, resulting in similar exposure to training loads. Following examination, radiographic imaging was ordered for both patients. Radiographs of both patients revealed exostosis and fragmentation, with multiple ossicles of the tibial tubercle. J Orthop Sports Phys Ther 2018;48(6):510. doi:10.2519/jospt.2018.8005.