injuries of the head, knee and heart

Monday, December 10, 2012

A sampling of the medical stories in the sports world this weekend.

Manny Pacquiao was knocked out the victim of a big overhead right. Boxing is a sport where inflicting a concussion upon one’s opponent is the key to victory. According to the NY Times: “from Pacquiao’s camp…his CT scan had been negative for neurological damage”. Sadly, this is not necessarily the case. The purpose of the CT scan is to look for bleeding in the brain caused by the blow to the head. The scan itself has no ability to assess how well the brain works. To pretend that a normal CT equals a normal brain is more than a little foolish and not only puts Mr. Pacquiao’s health at risk but also advertises medical quackery. Interestingly, based upon guidelines that exist to help decide who needs a CT scan after a head injury and who doesn’t, being knocked unconscious is not an indication for scanning. Concussion symptoms may be difficult to appreciate and can range from the obvious, for example significant headache or vomiting, to the very subtle like difficulty concentrating or sleeping. There is no great test for brain function that can determine that the brain is completely healed, therefore return to play decisions are usually best guess estimates by doctors.

Robert Griffin (RG III) the Washington Redskin’s rookie quarterback took a nasty hit to his knee over the weekend. The fear of a season ending ACL injury was put to rest when an MRI showed “only” a grade 1 lateral collateral ligament sprain. Ligaments hold joints stable and a sprain equals a ligament injury. Stretched ligament fibers is a grade 1 sprain, a partially torn ligament is grade 2 and completely torn is grade 3. Even grade 1 sprains can cause significant pain and swelling. Treatment will aim at decreasing the inflammation and RICE is the key (rest, ice, compression and elevation), along with anti-inflammatory medications like ibuprofen. The pro football player gets the added benefit of physical therapy for hours a day and may be able to return to play more quickly than a normal human. Some of that is due to better physical conditioning and perhaps also a higher pain tolerance and competitive toughness that can overcome the pain signals from a damaged body part. RG III may be able to play but only if signals from his brain to his leg asking it to run are stronger than the pain signals returning from his knee to his brain asking him to limp.

There is nothing but sadness surrounding the death of Jerry Brown in a car wreck, where the drive, his teammate, was charged with intoxicated manslaughter. Every year in the US, more than 10,000 people die in alcohol impaired traffic crashes (more than one person an hour). The Center for Disease Control and Prevention reports that there are more than 112 million alcohol impaired episodes every year.  It is a testament to the emotional strength of his teammates, that the Dallas Cowboys could play a football game just a few hours later. It’s interesting to work in a trauma center when the ambulance radio goes off reporting a major car wreck with injuries. Everybody has their job to get ready before the victims arrive, but there is a line on everybody’s checklist…”what time is it and where are my kids, husband or wife?” In larger cities, the trauma center gets the badly injured. The fear always exists that the patient being rolled in on the stretcher will be a loved one. Emotional detachment is easy when the patient is a stranger. It’s hard enough caring for somebody you know; it’s impossible caring for somebody you love.

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