American Medical Society of Sports Medicine Position Statement: Mononucleosis and Athletic Participation.

ABSTRACT: Infectious mononucleosis (IM) is a common illness in children and young adults caused primarily by the Epstein-Barr Virus (EBV). Transmission occurs primarily through sharing oral secretions, thus IM is known as the "kissing disease." Common clinical manifestations include fever, pharyngitis, posterior cervical lymphadenopathy, and splenomegaly. Atypical lymphocytosis and transaminase elevations are common, and the diagnosis of IM is confirmed with laboratory findings of a positive heterophile antibody ("Monospot"), polymerase chain reaction, or antibodies specific to EBV. Individuals with acute IM may be quite symptomatic and not feel well enough to participate in sports. Splenic enlargement is common, with rupture a relatively rare occurrence, typically occurring within a month of symptom onset, but this risk complicates sports participation, and is often the reason for restricting activity. The management of IM is primarily supportive, with no role for antivirals or corticosteroids. The variability of clinical presentation and the risk of splenic rupture in patients with IM present clinicians with challenging return to play/return to sport (RTS) decisions. This position statement updates the Evidence-Based Subject Review on Mononucleosis by the American Medical Society for Sports Medicine published in 2008 and reviews the epidemiology, clinical manifestations, laboratory assessment, and management including RTS for the athlete with IM. This statement also addresses complications, imaging, special considerations, diversity and equity considerations, and areas for future clinical research. Understanding the evidence regarding IM and sport is essential when communicating with athletes and their families and incorporating shared decision-making in the RTS decision.

When Is Air Travel Safe after Mild Traumatic Brain Injury/Sports-Related Concussion?

ABSTRACT: While the literature regarding return to play and recovery protocols from mild traumatic brain injury (mTBI) and sports-related concussions (SRC) is growing, there continues to be a paucity of data regarding when air travel is safe for athletes after sustaining certain brain injuries, such as mTBI and SRC. Although it is known hypoxia can negatively affect severe TBI patients, it is unclear whether mild hypoxia, which may be experienced during commercial air travel, is clinically significant for athletes who have recently sustained mTBI injuries. Further research is required to provide more standardized recommendations on when air travel is safe. With the current available literature, clinicians still need to weigh the evidence, consider how it applies to each individual patient, and engage in shared decision making to ultimately decide what is best for the patient.

When Is It Safe to Drive after Mild Traumatic Brain Injury/Sports-related Concussion?

Driving an automobile has inherent danger, and driving after mild traumatic brain injury (mTBI)/sports-related concussion (SRC) can make this task even more hazardous. There is evidence to suggest that restriction from driving for the first 24 to 48 h after mTBI/SRC is probably reasonable. However, after the first 48 h have passed, there is insufficient evidence to make a recommendation regarding return to driving. Clinicians need to weigh the evidence and make decisions on how to advise their patients on a case by case basis. Further research is required to provide a standardized recommendation.

Sports-related Concussion - Genetic Factors.

Genetic biomarkers have been evaluated for validity in predicting risk for sports-related concussion as well as prognosticating recovery from this injury. Research results from predominantly small-scale pilot studies thus far are mixed and preliminary findings have not been adequately replicated. Currently, the use of such genetic biomarkers should be considered investigational and not for routine clinical use.

Zurich to Berlin-"Where" Are We Now with the Concussion in Sport Group?

The Concussion in Sport Group recently published its highly anticipated fifth consensus statement on sports-related concussion. The latest iteration features a new organizational format-the "11 Rs" and has input from a wider range of health care professionals, organizations, and experts in the field from both the sport concussion area and from related areas outside of sport. The stated objective of this current document is to "build on the principles outlined in previous statements and develop further conceptual understanding of sports-related concussion." Its intended audience is "physicians and health care providers who are involved in athlete care, whether at a recreational, elite, or professional level." We review significant updates including recommendations for sideline evaluation, return to play, and return to learn in athletes with sports-related concussion.

Multiple Sclerosis and Exercise: A Literature Review.

Multiple sclerosis (MS) is the most common autoimmune disabling neurological conditions of young adults and affects more than 2.3 million people worldwide. Given the high likelihood for disability and decreased neurological function, there have been concerns about the role of exercise in MS patients with a fear of increased injury. This article looks at recent articles evaluating the role of exercise in MS and can hopefully be used by patients, caregivers, and health care providers to guide decision making about the role of exercise in patients with MS.

Risk of Concussion During Sports Versus Physical Education Among New Mexico Middle and High School Students.

OBJECTIVES: To measure the risk of concussion among New Mexico middle and high school students during both sports and physical education. METHODS: Athletic directors or athletic trainers in 147 schools were asked to report the number of concussions occurring during sports and physical education in the 2013 to 2014 school year. We calculated 1-year cumulative incidence rates. RESULTS: Of the 147 schools, 99 responded (67%). During the school year, 598 students were removed from athletics because of a concussion, a 1-year cumulative incidence of 3.5 per 100. The concussion rate during sports was 3.0: 3.5 for boys and 2.4 for girls (relative risk [RR] = 1.5; 95% confidence interval [CI] = 1.2, 1.7). An additional 335 students experienced concussions during physical education. Concussion rates during physical education were 60% higher than during sports (RR = 1.6; 95% CI = 1.4, 1.8). CONCLUSIONS: In our data, the risk of concussion was higher in physical education than in sports. This suggests that concussions should be tracked for a wide range of youth athletic activities, not just for sports. Monitoring cumulative incidence, in addition to other measures, may allow comparisons across schools and regions. More prevention efforts are needed.

Does a Unique Neuropsychiatric Profile Currently Exist for Chronic Traumatic Encephalopathy?

There is evidence that repetitive mild traumatic brain injury leads to specific patterns of neuropathological findings, labeled chronic traumatic encephalopathy (CTE). However, questions remain about whether these neuropathological changes produce changes in behavior, cognition, and emotional status that are associated with a unique neuropsychiatric profile that can be assessed using currently available clinical tools. Our review of the literature indicates that insufficient evidence currently exists to suggest a distinct neuropsychiatric profile for CTE. Major limitations to the field presently include the relatively nascent nature of the topic, reliance on retrospective next-of-kin reporting, the lack of prospective studies, and similarities in neuropsychiatric symptoms between CTE, other neurodegenerative disorders and forms of psychopathology. Clinicians and researchers alike have a responsibility to adopt a cautious and balanced approach for antemortem assessments to minimize the potential unintended negative consequences of both overdiagnosing and underdiagnosing a clinical entity that has yet to be clearly established.

Headaches in athletes.

The physician who cares for athletes and physically active patients will encounter various headache syndromes. These symptoms can be debilitating and result in a spectrum of time away from the patient's exercise routines to death. Knowing key symptoms and signs of headache syndromes may lead to faster recovery and be rewarding for both the patient and physician. This article reviews major headache syndromes and their treatment, with attention to those found in patients who participate in competitive sports and lead active lifestyles.

Sudden cardiac death in competitive athletes.

Sudden cardiac death in competitive athletes is a rare event in spite of the large numbers participating in organized sports. These tragic episodes usually receive significant media coverage and stimulate intense discussion in the lay and medical communities about how future occurrences might be avoided. This clinical commentary will review a variety of issues concerning sudden cardiac death in competitive athletes, including epidemiology, causes, screening methods, and potential for prevention.