:Traumatic and sport-related sternoclavicular (SCJ) injuries in adolescent athletes are more commonly physeal fractures rather than true SCJ dislocations. Although rare, posterior displacement of the medial clavicular metaphysis after a physeal fracture necessitates prompt evaluation and treatment. Despite the inherent healing ability of physeal separations, delayed or failed diagnosis has the capacity to cause serious complications or fatality secondary to injury of retrosternal structures. Even with the potential severity, a lack of consensus exists in the literature regarding the most appropriate treatment modality. We report an adolescent football player with a medial clavicular physeal fracture with posterior metaphyseal displacement abutting the left brachiocephalic vein. After nonsurgical management and progression to play, the patient returned to play football. This case not only highlights the diagnostic principles of medial clavicular physeal fractures with posterior metaphyseal displacement but also discusses how these challenging injuries can be managed successfully with conservative treatment.
Purpose The assessment of concussed athletes uses standardized tools like the Sport Concussion Assessment Tool (SCAT). The purpose of this study was to evaluate whether concussed athletes accurately recalled baseline functioning. Methods A retrospective cohort analysis of University football student-athletes from 2014-16 seasons was conducted. Forty-six student-athletes (M=19.7, SD=1.8) who suffered a concussion during the competitive season underwent a post-concussion assessment with a sports medicine physician within 24 hours of injury. Assessments included use of the symptom report from The SCAT3. Athletes were asked to recall their pre-injury baseline functioning. Results Of the 46 athletes who underwent assessments, 22 reported having at least 1 symptom (M=1.4, SD=2.0) at baseline evaluations. Yet at the initial medical evaluation, only 10 of these athletes correctly recalled having symptoms prior to injury, and none of them accurately reported their total symptom report. Paired t-tests revealed significant differences between an athletes predicted recall of the number of symptoms (M=0.7, SD=1.2) and total symptom scores (M=2.1, SD=3.4) conditions; t(45)=-3.28, p=.002, d=0.48. Conclusion Having accurate information for diagnosing concussions is important during concussion medical evaluations. Many clinicians depend on an athlete’s subjective reporting of symptom change. Our results indicate that an athlete’s accuracy of pre-injury functioning is poor, consistent with what has been termed “the good old days bias.” The findings suggest having baseline assessments can be helpful and clinicians may need to carefully understand an athletes pre-morbid functioning.
Purpose Examine the relationship between demographic and health factors, and oculomotor functioning during baseline testing in professional Canadian Football League (CFL) athletes. Methods 428 male athletes participated in baseline concussion testing. Athletes ranged in age from 21 to 40 years (M=26.44, SD=2.87) and reported a history of 0, 1, or 2+ sport-related concussions (SRCs). All athlete participants completed the Head Check questions of demographics and medical history, and the EYE-SYNC saccade test to explore how the presence of a history of concussions, Attention-Deficit/Hyperactivity Disorder (ADHD), Learning Disability (LD), age, and post-exertion influenced baseline measures of oculomotor functioning using the EYE-SYNC saccade outcomes of accuracy and precision. Results Correlations revealed no significant relationships between combined vertical and horizontal saccade outcomes and the demographic/health variables (p>05). Independent t-tests indicated no significant differences in mean saccade performance between athletes with and without ADHD and/or LD (p>.05). A three-way multiple analysis of variance, run with age group and four saccade outcomes (LeftAccuracyXY, LeftPrecisionXY, RightAccuracyXY, RightPrecisionXY), showed no main effect of age group on the combined saccade outcomes F(8, 844)=.91, p=.50. Finally, a one-way repeated measures analysis of variance also revealed no significant differences from pre- to post-exertion assessments, F(4, 56)=.41, p=.80. Conclusions The oculomotor functioning of CFL athletes at baseline does not appear to be influenced by a history of concussion, ADHD, LD, age, or physical exertion. This information may help professionals with their clinical decision-making regarding SRC diagnosis.
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