1
|
Pedrosa M, Martins B, Araújo R. It's in the game: A review of neurological lesions associated with sports. J Neurol Sci 2023; 455:122803. [PMID: 37995461 DOI: 10.1016/j.jns.2023.122803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The practice of sports may lead to neurological injuries. While relatively uncommon (overall incidence of approximately 2.5%), and mostly benign and transient, some conditions may be life-threatening and permanent. Thus, both clinical neurologists and sports physicians should be aware of their existence and relevance. We aimed to review all sports-related neurological injuries and illnesses reported in the literature. METHODS Following SANRA guidelines, we performed a narrative review and searched PubMed and Scopus databases. Relevant sports were selected based on their recognition as an Olympic sport by the International Olympic Committee. Chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders were not included. RESULTS A total of 292 studies were included concerning 33 different sports. The most reported neurological injury was damage to the peripheral nervous system. Traumatic injuries have also been extensively reported, including cerebral haemorrhage and arterial dissections. Non-traumatic life-threatening events are infrequent but may also occur, e.g. posterior reversible encephalopathy syndrome, cerebral venous thrombosis, and arterial dissections. Some conditions were predominantly reported in specific sports, e.g. yips in baseball and golf, raising the possibility of a common pathophysiology. Spinal cord infarction due to fibrocartilaginous embolism was reported in several sports associated with minor trauma. CONCLUSION Sports-related neurological injuries are increasingly receiving more social and medical attention and are an important cause of morbidity and mortality. This review may serve as a guide to physicians managing these challenging situations.
Collapse
Affiliation(s)
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rui Araújo
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
2
|
Bowers RL, Cherian C, Zaremski JL. A Review of Upper Extremity Peripheral Nerve Injuries in Throwing Athletes. PM R 2022; 14:652-668. [PMID: 35038233 DOI: 10.1002/pmrj.12762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 11/07/2022]
Abstract
Peripheral nerve injuries in the upper extremities may be common in throwing athletes as the throwing motion places extreme stress on the dominant arm. The combination of extreme stress along with repetitive microtrauma from throwing uniquely places the throwing athlete at elevated risk of upper extremity peripheral nerve injury. However, because symptoms can be non-specific and frequent co-exist with pathology in the upper extremity, the diagnosis of peripheral nerve injury is often delayed. Diagnosis of peripheral nerve injuries may require a combination of history and physical exam, diagnostic imaging, electrodiagnostic testing, and diagnostic ultrasound guided injections. The primary management should include physical therapy focusing on throwing mechanics and kinetic chain evaluation. However, some athletes require surgical intervention if symptoms do not improve with conservative management. The purpose of this focused narrative review is to highlight upper extremity peripheral neuropathies reported in throwing athletes and to provide an overview of the appropriate clinical diagnosis and management of the throwing athlete with a peripheral nerve injury. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Robert L Bowers
- Assistant Professor of Rehabilitation Medicine, Emory University School of Medicine, Emory Sports Medicine Center, Atlanta, Georgia, USA
| | - Chris Cherian
- Department of Sports Medicine, Rothman Orthopaedics, Paramus, New Jersey, USA
| | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, Department of Orthopaedic Surgery & Sports Medicine, University of Florida Health Orthopaedics and Sports Medicine Institute, Gainesville, Florida, USA
| |
Collapse
|
3
|
Kataoka T, Kokubu T, Mifune Y, Inui A, Yamazaki T, Kuroda R. Isolated Musculocutaneous Nerve Injury in a Professional Baseball Player: A Case Report. J Orthop Case Rep 2021; 11:113-116. [PMID: 34239842 PMCID: PMC8241242 DOI: 10.13107/jocr.2021.v11.i03.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Musculocutaneous nerve lesion in a throwing athlete is a rare condition. We report the case of a professional baseball pitcher with an isolated musculocutaneous nerve lesion that occurred during a pitching motion. Case Presentation: The patient had radiating pain in the upper arm and weakness of elbow flexion. Physical examination revealed flaccid paralysis of the biceps brachii muscle and paresthesia in the right lateral forearm. Musculocutaneous nerve injury was suspected. Because some signs of recovery were observed within a few days, the patient received non-operative management. Nerve conduction studies at 2 weeks after the injury showed low-amplitude compound muscle action potential of the right biceps brachii muscle by stimulation of the musculocutaneous nerve. Needle electromyography showed markedly reduced motor unit potential recruitment in the biceps brachii muscle. He was diagnosed as having isolated musculocutaneous nerve injury. At 2 months after the injury, the muscle contraction and strength of the biceps brachii muscle improved. At 7 months after the injury, muscle weakness was fully recovered. His pitching ability returned to that of a competitive player. Conclusion: Because the neuroparalysis was incomplete and began to recover within a few days, we considered the pathology of this injury to be incomplete axonotmesis, which was successfully treated conservatively.
Collapse
Affiliation(s)
- Takeshi Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Kokubu
- Department of Orthopaedic Surgery, Shin-suma General Hospital, Suma-ku, Kobe, Hyogo, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tetsuya Yamazaki
- Department of Orthopaedic Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| |
Collapse
|
4
|
RESIDENTS CASE REPORT: MUSCULOCUTANEOUS NERVE INJURY IN A COLLEGIATE BASEBALL PITCHER. Int J Sports Phys Ther 2020; 15:804-813. [PMID: 33110700 DOI: 10.26603/ijspt20200804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Literature regarding musculocutaneous nerve injuries among the athletic population is scarce, with only several reported clinical cases among baseball and softball pitchers. Purpose To present a unique case of a musculocutaneous nerve injury to aid in clinician awareness and propose innovative rehabilitation practices that may facilitate improved patient outcomes during recovery. Case Description A 23-year-old Division 1 NCAA collegiate baseball pitcher presented with vague anterior arm pain following a pre-season game. The athlete described the pain as an "intense stretch" of his right arm that occurred during his last pitch. The initial evaluation identified tenderness over the right distal bicep. All shoulder and elbow orthopedic tests to assess shoulder impingement, labral pathologies, and glenohumeral instability were unremarkable. Increased neural tension was also noted with upper limb neurodynamic testing of the median and ulnar nerves on the right arm compared bilaterally. Electromyography (EMG) testing confirmed a right upper and mid-brachial plexus stretch injury with the primary involvement of the musculocutaneous nerve. Rehabilitation focused on restoring strength deficits and diminishing neural tension. Blood flow restriction (BFR) was introduced on the uninvolved limb to reduce deficits in bicep musculature strength. Once the athlete regained bicep strength and forearm sensation, he was progressed from flat-ground throwing activities to throwing off the mound. Outcomes A reduction in neural tension during neurodynamic testing of the right arm, improvement of bicep brachii deficits seen between the right and left limbs, and restoration of sensation in the right lateral forearm enabled a progressive return to sport. Discussion Due to vague reports and inconclusive findings, the initial presentation of musculocutaneous nerve injuries may be mistaken for other conditions such as a biceps brachii strain. Further -documentation of this injury and rehabilitation procedures are needed to enhance patient outcomes.
Collapse
|
5
|
Ghatak S, Potaliya P, Pal R. Entrapment neuropathies due to variations in origin and insertion of biceps brachii muscle. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
6
|
Zanette G, Lauriola MF, Picelli A, Tamburin S. Isolated musculocutaneous nerve injury in a kickboxer. Muscle Nerve 2015. [PMID: 26212117 DOI: 10.1002/mus.24783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Alessandro Picelli
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
7
|
Abstract
: Nontraumatic musculocutaneous nerve palsy is a rare injury that can occur in throwers. We present a case of musculocutaneous nerve injury in a high school pitcher, which has rarely been previously reported. The unique electromyography findings add to the overall spectrum seen with musculocutaneous nerve injuries in throwers. Sensory abnormalities may not be present at initial evaluation, but rather weakness or pain of the biceps is the most common presenting concern. Electrodiagnostic evaluation is paramount for confirmation of diagnosis, yet the timing of this study is critical for its accuracy. Rest and progressive physical therapy remain as the current treatment of choice. Resolution of symptoms, although time consuming, is complete in the majority of cases, including ours.
Collapse
|
8
|
Liu HF, Won HS, Chung IH, Kim SM, Kim IB. Rare communication between the musculocutaneous and median nerves in the forearm: its clinical significance. Am J Phys Med Rehabil 2014; 93:920-4. [PMID: 25122101 DOI: 10.1097/phm.0000000000000164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Morphologic classifications of communication between musculocutaneous and median nerves are not based on the distribution and the function of the communicating branch. The authors report a rare case of such a communication with passage of the median nerve through the pronator teres muscle and discuss its clinical significance. The musculocutaneous nerve was divided into a lateral branch that continued to the lateral antebrachial cutaneous nerve and a medial branch that joined the median nerve in the forearm. The authors separated the nerve bundles and noted that the communicating branch derived from the sixth to seventh cervical nerves and supplied nerve fibers to the pronator teres muscle and the proper palmar digital nerve of the thumb. In addition, the median nerve penetrated the humeral head of the pronator teres muscle. Isolated musculocutaneous neuropathy with such a communication may cause unexpected symptoms such as sensory deficit in the palm and muscular weakness of the forearm and the thumb.
Collapse
Affiliation(s)
- Hong-Fu Liu
- From the Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea (H-FL, H-SW, I-HC, I-BK); and Department of Neurology, College of Medicine, Yonsei University, Seoul, Republic of Korea (S-MK)
| | | | | | | | | |
Collapse
|
9
|
Abstract
Injury of the musculocutaneous nerve very rarely occurs in the absence of concomitant injury to other components of the brachial plexus. Until now, the few cases of isolated musculocutaneous nerve palsies have been reported only in adults. We report a case of isolated musculocutaneous neuropathy in a uniquely talented adolescent baseball pitcher. The biomechanics underlying this adolescent's ability to throw with high velocity likely contributed to the musculocutaneous nerve injury in this case.
Collapse
Affiliation(s)
- Dorlyne Henry
- Division of Child Neurology, Departments of Pediatrics and Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA
| | | |
Collapse
|
10
|
US imaging of the musculocutaneous nerve. Skeletal Radiol 2011; 40:609-16. [PMID: 20931188 DOI: 10.1007/s00256-010-1046-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 09/17/2010] [Accepted: 09/21/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the potential value of high-resolution sonography for evaluation of the musculocutaneous nerve (MCN). MATERIALS AND METHODS The normal anatomy of the MCN was evaluated on three cadaveric limbs and correlated with the US images obtained in 15 healthy subjects. Seven consecutive patients with MCN neuropathy were then evaluated with sonography using 17.5 and 12.5-MHz broadband linear array transducers. All patients had abnormal nerve conduction studies and underwent correlative MR imaging on a 1.5-T system. RESULTS One-to-one comparison between cadaveric specimens and sonographic images showed that the MCN can be reliably identified from the axilla through the elbow, including the lateral antebrachial cutaneous (LAbC) nerve. In the patients group with MCN neuropathy, sonography allowed detection of a wide spectrum of abnormalities. In 5/7 cases, a spindle neuroma was depicted in continuity with the nerve. In one case, US identified focal swelling of the nerve and in another case US was negative. The neuroma was hyperintense on T2-weighted sequences in 75% of cases. In one patient, the nerve showed Gd-enhancement on fat-suppressed T1-weighted sequences. The nerve was never detected on unenhanced T1-scans. Owing to its small-size and out-of-plane course, the MCN may be more reliably depicted with sonography rather than with MR imaging. CONCLUSIONS US is promising for evaluating traumatic injuries of the MCN. By providing unique information on the entire course of the nerve, US can be used as a valuable complement of clinical and electrophysiologic findings.
Collapse
|
11
|
Mulvaney SW. Ultrasound-Guided Percutaneous Neuroplasty of the Lateral Femoral Cutaneous Nerve for the Treatment of Meralgia Paresthetica. Curr Sports Med Rep 2011; 10:99-104. [DOI: 10.1249/jsr.0b013e3182110096] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Ligh CA, Schulman BL, Safran MR. Case reports: unusual cause of shoulder pain in a collegiate baseball player. Clin Orthop Relat Res 2009; 467:2744-8. [PMID: 19588212 PMCID: PMC2745474 DOI: 10.1007/s11999-009-0962-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 06/16/2009] [Indexed: 01/31/2023]
Abstract
The objective of reporting this case was to introduce a unique cause of shoulder pain in a high-level Division I NCAA collegiate baseball player. Various neurovascular causes of shoulder pain have been described in the overhead athlete, including quadrilateral space syndrome, thoracic outlet syndrome, effort thrombosis, and suprascapular nerve entrapment. All of these syndromes are uncommon and frequently are missed as a result of their rarity and the need for specialized tests to confirm the diagnosis. This pitcher presented with nonspecific posterior shoulder pain that was so severe he could not throw more than 50 feet. Eventually, intermittent axillary artery compression with the arm in abduction resulting from hypertrophy of the pectoralis minor and scalene muscles was documented by performing arteriography with the arm in 120 degrees abduction. MRI-MR angiographic evaluation revealed no anatomic abnormalities. The patient was treated successfully with a nonoperative rehabilitation program and after 6 months was able to successfully compete at the same level without pain.
Collapse
Affiliation(s)
| | | | - Marc R. Safran
- Stanford Hospital, Palo Alto, CA USA ,Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., M/C 6342, Redwood City, CA 94063 USA
| |
Collapse
|
13
|
Peripheral Nerve Injuries Attributable to Sport and Recreation. Phys Med Rehabil Clin N Am 2009; 20:77-100, viii. [DOI: 10.1016/j.pmr.2008.10.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
14
|
|