The association of concussion history and symptom presentation in combat sport athletes.

OBJECTIVE: The purpose of this study was to describe the concussion-related symptoms reported among combat sport athletes with and without a history of concussion, and a history of neck injury. DESIGN: Cross-sectional survey. SETTING: Data were collected using an online survey instrument. PARTICIPANTS: Three hundred and nine adult combat sport athletes. MAIN OUTCOME MEASURES: Self-reported 12-month concussion history and neck injury history and a 22-item symptom checklist. RESULTS: A history of concussion was reported by 19.1% of athletes, a history of neck injury was reported by 23.0%, and 13.6% reported both injuries. Neck pain was the most frequently reported symptom. Athletes with a history of injury had significantly greater proportions of 'high' total symptoms and symptom severity scores compared with athletes with no history of injury. Athletes with a history of concussion had 2.35 times higher odds of reporting 'high' total symptoms and symptoms severity scores. CONCLUSION: Athletes with a history of concussion or neck injury have greater odds of presenting with higher symptom scores. The presence of high total symptom scores and high symptom severity scores may indicate a need for further investigation into domains commonly associated with concussion.

Improving the staging of neck injuries using a new index, the Neck Functional Holistic Analysis Score: Clustering approach to determine degrees of impairment.

BACKGROUND: Traumatic cervical spine injuries are amongst the traffic injuries that can cause most harm to a person. Classifying subtypes of clinical presentations has been a method used in other pathologies to diagnose more efficiently and to address the appropriate treatment and the prognosis. The management of patients suffering from cervical injuries could be improved by classifying the severity of the impairment. This will allow clinicians to propose better treatment modalities according to the severity of the injury. MATERIALS AND METHODS: The present study is a retrospective cohort study performed with the clinical data from 772 patients stored at Fisi-(ON) Health Group. All the patients treated for cervical spine injuries are evaluated using the EBI-5® system, which is based on inertial measurement unit (IMU) technology. The normalized range of motion of each patient was incorporated into a single index, the Neck Functional Holistic Analysis Score (NFHAS). RESULTS: Clustering analysis of the patients according to their NFHAS resulted in five groups. The Kruskal-Wallis H test showed that there were statistically relevant differences in the ROM values and NFHAS of the patients depending on the cluster they were assigned to: FE X2(4) = 551.59, p = 0.0005; LB ROM X2(4) = 484.58, p = 0.0005; RT ROM X2(4) = 557.14, p = 0.0005; NFHAS X2(4) = 737.41, p = 0.0005. Effect size with ηp2 for the comparison of groups were: FE = 0.76, LB = 0.68, RT = 0.76 and NFHAS = 0.96. CONCLUSION: The NFHAS is directly correlated to the available ROM of the patient. The NFHAS serves as a good tool for the classification of cervical injury patients. The degree of impairment shown by the cervical injury can now be staged correctly using this new classification.

Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study.

INTRODUCTION: Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity. METHOD: A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sample of convenience comprising 7 subjects with MRI confirmed alar ligament lesions and 11 healthy people. Alar ligament lesions were identified using both supine and high-field strength upright MRI. RESULTS: The RST had a sensitivity of 80% and a specificity of 69.2%. The SBST and the LST both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%. DISCUSSION: Tests of manual examination of alar ligament integrity have some diagnostic utility; however, these findings require further corroboration in a larger sample.

Aspectos relacionados às restaurações de lesões cervicais não cariosas com resinas compostas ­ relato de caso / Aspects related to noncarious cervical lesions restorations with composite resins ­ case report

As lesões cervicais não cariosas (LCNCs) têm sido consideradas pela comunidade odontológica um grande desafio para diagnóstico e tratamento restaurador. Não obstante os avanços no campo dos materiais dentários, melhorando a adesividade entre dente e restauração, as falhas ainda são significativas para os cirurgiões-dentistas (CDs), que não aceitaram a multidisciplinaridade envolvida em seu diagnóstico e restauração. O emprego de uma metodologia diagnóstica específica, associada a materiais e métodos restauradores adequados, deve ser considerado de forma minuciosa e objetiva, além da compreensão das limitações aplicadas a cada caso. O presente artigo relata um caso abordado de forma reconstrutiva, permeada por uma análise crítica dos métodos diagnósticos e restauradores (AU).

Non-carious cervical lesions (NCCLs) have been considered by dental community a great challenge for diagnosis and restorative treatment. Despite the advances in dental materials, improving adhesion between tooth and restoration, gaps are still significant for dental surgeons (DS), who did not accept the multidisciplinarity involved in their diagnosis and restoration approach. The use of a specific diagnostic methodology associated to appropriate adequate restorative materials and methods should be considered in a thorough and objective manner in addition to an understanding of the limitations applied to each case. This article presents a case report using a reconstructive approach permeated by diagnosis and restorative methods critical analysis (AU).

Catastrophic head and neck injuries in judo players in Japan from 2003 to 2010.

BACKGROUND: Few studies have documented catastrophic head and neck injuries in judo, but these injuries deserve greater attention. PURPOSE: To determine the features of catastrophic head and neck injuries in judo. STUDY DESIGN: Descriptive epidemiological study. METHODS: This study was based on the accident reports submitted to the All Japan Judo Federation's System for Compensation for Loss or Damage. A total of 72 judo injuries (30 head, 19 neck, and 23 other injuries) were reported between 2003 and 2010. The investigated parameters were mechanism of injury, age at time of injury, length of judo experience, diagnosis, and outcome. RESULTS: Among head injuries, 27 of 30 (90%) occurred in players younger than 20 years of age. The relationship between age, mechanism, and location of injury was more relevant when players younger than 20 years incurred head injury while being thrown (P = .0026). Among neck injuries, 13 of 19 (68%) occurred in players with more than 36 months of experience. The relationship between experience, mechanism, and location of injury was more relevant when experienced players incurred neck injury while executing an offensive maneuver (P = .0294). Acute subdural hematoma was diagnosed in 94% of head injuries. The outcomes of head injury were as follows: 15 players died; 5 were in a persistent vegetative state; 6 required assistance because of higher brain dysfunction, hemiplegia, or aphasia; and 4 had full recovery. Among neck injuries, 18 players were diagnosed with cervical spine injury, 11 of whom had fracture-dislocation of the cervical vertebra; there was also 1 case of atlantoaxial subluxation. The outcomes of neck injury were as follows: 7 players had complete paralysis, 7 had incomplete paralysis, and 5 had full recovery. CONCLUSION: Neck injuries were associated with having more experience and executing offensive maneuvers, whereas head injuries were associated with age younger than 20 years and with being thrown.

[Medical honey in the treatment of wound-healing disorders in the head and neck area]. / Erste Erfahrungen mit medizinischem Honig in der Wundbehandlung im Kopf-Hals-Bereich.

BACKGROUND: Already in ancient times honey was used as a drug and for the treatment of wounds. In recent years the different effects of honey on wound-healing processes have been reexamined. Based on this, the antibacterial and fungicidal qualities of honey could be confirmed. PATIENTS AND METHODS: Between January 2009 and July 2011 medical honey was used on 36 patients suffering from different wound-healing disorders in the head and neck area after unsuccessful conventional treatment. The healing process was registered by microbiological investigations, measurements of the wound edges and adequate photo documentation. RESULTS: Medical honey can be used without problems or detectable side effects on problematic wounds of the head and neck area. Constant treatment leads to fast wound lavation, granulation, reduction of putrid smells and a decrease in inflammation. CONCLUSIONS: In the treatment of poorly healing and infected wounds within the head and neck area, medical honey can be used successfully without problems as an effective alternative to conventional treatment options.

The association between a lifetime history of a work-related neck injury and future neck pain: a population based cohort study.

OBJECTIVE: The purpose of this study was to investigate the association between a lifetime history of a work-related neck injury and the development of troublesome neck pain in the general population. METHODS: We formed a cohort of randomly sampled Saskatchewan adults with no or mild neck pain in September 1995. At baseline, participants were asked if they had ever injured their neck at work. Six and 12 months later, participants were asked if they had troublesome neck pain defined as grades II to IV on the Chronic Pain Grade Questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of work-related neck injury and the onset of troublesome neck pain while controlling for age and sex. RESULTS: Our cohort included 866 individuals at risk for developing troublesome neck pain. Of those, 73.8% (639/866) were followed up at 6 months, and 63.0% (546/866), at 1 year. We found a positive association between a history of a work-related neck injury and the onset of troublesome neck pain (age- and sex-adjusted hazard rate ratio [HRR], 2.4; 95% confidence interval, 1.3-4.7). CONCLUSION: Our analysis suggests that a lifetime history of work-related neck injury is associated with an increased risk of troublesome neck pain. Occupational neck injuries can lead to recurrent episodes of neck pain.

A congenital anomaly of the atlas as a diagnostic dilemma: a case report.

OBJECTIVE: The purpose of this case report is to draw attention to the differences between a Jefferson fracture and a congenital anomaly of the anterior and/or the posterior arch of the atlas. CLINICAL FEATURES: A 42-year-old woman visited the chiropractic practice complaining of headache, neck pain, dizziness, and numbness in both of her arms after she fell vertically and directly on her head twice on a playground. Before this fall, she had no such complaints. After taking x-rays of the cervical spine, a Jefferson fracture was suspected. INTERVENTION AND OUTCOME: After computed tomography and magnetic resonance imaging scanning, the patient was diagnosed with a congenital anomaly that looked very similar to a Jefferson fracture. After instability of the cervical spine was excluded by the neurosurgeon, chiropractic treatment was delivered. After 6 treatments, the complaints were significantly reduced. CONCLUSION: It is important to be familiar with the differences between a congenital anomaly of the atlas and a Jefferson fracture and to exclude instability of the upper cervical spine before treatment is started.

Characteristics of chiropractic practitioners, patients, and encounters in Massachusetts and Arizona.

OBJECTIVE: To describe chiropractic care using data collected at the time of each patient visit. METHODS: Random samples of chiropractors licensed in Arizona and Massachusetts were recruited to participate in interviews about their training, demographics, and practice characteristics. Interviewees were then recruited to record information about patient condition, evaluation, care, and visit disposition on 20 consecutive patient visits. RESULTS: Data for 2550 chiropractic patient visits were recorded. Care for low back, head and neck pain accounted for almost three quarters of visits. Extremity conditions and wellness care accounted for approximately half of the remaining visits. Spinal and soft tissue examinations were the most frequently reported diagnostic procedures (80% and 56% of visits, respectively), and high-velocity spinal manipulation techniques were the most frequently reported therapeutic procedures (almost 85% of visits). Rehabilitation exercises, thermal modalities, electric stimulation, and counseling/education/self-care were each performed during approximately 25% of visits. Approximately 85% of patients seen were self-referred, whereas only approximately 5% came from medical physicians. Approximately 35% of visits had an expected source of payment directly from the patient. Approximately 80% of visits ended with a plan for the patient to return at a specified time. CONCLUSION: These findings are consistent with the findings of previous studies and confirm that chiropractors use conventional patient assessment approaches with specific attention to spinal and musculoskeletal procedures, infrequently incorporating interventions commonly associated with other complimentary and alternative care providers. These findings illustrate that diagnostic assessment and follow-up are integral to chiropractic clinical encounters and offer a baseline for best practices development. The data also offer insight into chiropractic use and may be of interest to chiropractic leaders and education planners for professional development purposes.

[Medical opinions in court--a challenge for communication between physicians and lawyers]. / Das medizinische Gutachten im Prozess--Kommunikationsprobleme zwischen Arzten und Juristen.

Medical opinions in court constitute a great challenge in regard to communication between physicians and lawyers. Considerable differences in their professional training and requirements frequently result in misunderstandings. Therefore physicians and lawyers need to learn more about each other and interact when evaluating opinions. A synergistic rather than a conflicting approach would help judges to find the happy medium between accepting medical reports unreservedly and coming to their own conclusions in more or less total disregard of the medical opinion presented in court. The expert, on the other hand, must ensure that the judge will understand the opinion as it was meant. Neither of them can call upon a translator.

The amelioration of symptoms in cervical spinal stenosis with spinal cord deformation through specific chiropractic manipulation: a case report with long-term follow-up.

OBJECTIVE: To describe the chiropractic management of a patient with paresthesia on the entire left side of her body and magnetic resonance imaging (MRI)-documented cervical spinal cord deformation secondary to cervical spinal stenosis. CLINICAL FEATURES: A 70-year-old special education teacher had neck pain, headaches, and burning paresthesia on the entire left side of her body. These symptoms developed within hours of being injured in a side-impact motor vehicle accident. Prior to her visit, she had been misdiagnosed with a cerebrovascular accident. INTERVENTION AND OUTCOMES: Additional diagnostic studies revealed that the patient was suffering from cervical spinal stenosis with spinal cord deformation. Two manipulative technique systems (Advanced Biostructural Therapy and Atlas Coccygeal Technique) unique to the chiropractic profession and based on the theory of relief of adverse mechanical neural tension were administered to the patient. This intervention provided complete relief of the patient's complaints. The patient remained symptom-free at long-term follow-up, 1 year postaccident. CONCLUSION: There is a paucity of published reports describing the treatment of cervical spinal stenosis through manipulative methods. Existing reports of the manipulative management of cervical spondylosis suggest that traditional manual therapy is ineffective or even contraindicated. This case reports the excellent short-term and long-term response of a 70-year-old patient with MRI-documented cervical spinal stenosis and spinal cord deformation to less traditional, uniquely chiropractic manipulative techniques. This appears to be the first case (reported in the indexed literature) that describes the successful amelioration of the symptoms of cervical spinal stenosis through chiropractic manipulation. More research into the less traditional chiropractic systems of spinal manipulation should be undertaken.

[Vertebral artery occlusion following neck trauma: report of two cases].

We are reporting two cases of vertebral artery occlusion resulting from cervical spine trauma. A 41-year-old man experienced vertigo and nausea 6 hrs after chiropractic manipulation. On admission, he was alert and demonstrated nystagmus, hypalgia of left leg, and right Horner sign. A MR image revealed infarction in the right cerebellar hemisphere. A MR angiogram did not show the proximal part of the right vertebral artery. A right vertebral angiogram revealed right vertebral artery occlusion at the level of C 1. He underwent anticoagulation and wore a cervical collar. He was discharged with hypalgia of left leg. A 53-year-old man was admitted to our hospital after an automobile accident. A CT scan revealed a subarachnoid hemorrhage and an intraventricular hemorrhage. A cervical CT scan revealed fractures of the C 5 facet joint and C 6 vertebral body. A MR angiogram did not show the proximal part of the left vertebral artery. A subsequent left vertebral angiogram revealed left vertebral artery occlusion at the level of C 6. He underwent anticoagulation and wore a cervical collar. In addition, he underwent coil embolization of the left vertebral artery. He was discharged with no neurological deficits. It is said that traumatic vertebral artery injuries cause cerebral infarction with time lags. The therapeutic point is to prevent propagation of the thrombus and distal embolism; therefore wearing a collar, anticoagulation, and endovascular interventional therapy is recommended.