Nerve and Vascular Injuries in Sports Medicine (eBook)

Foreword 5
Preface 6
Contents 7
About the Editors 9
Contributors 10
Part 1: Anatomy, Pathophysiology, and Diagnosis 12
Causes of Numbness and Tingling in Athletes 13
The Mystery Is in the History 13
Nerve Pain 13
Vascular Pain 17
Muscle or Myofascial Pain 17
Basic Nerve and Muscle Anatomy 17
Pathophysiology of Athletic Peripheral Nerve Injury 18
Myelin Injury (Conduction Block and Conduction Slowing) 20
Axonal Injury and Wallerian Degeneration 20
Mechanisms of Athletic Nerve Injury 21
Compression 21
Ischemia 21
Traction 22
Laceration 23
Double Crush Syndrome 23
Nerve Recovery 23
References 24
Diagnostic Tests for Nerve and Vascular Injuries 26
Clinical Pearls 26
Introduction 26
Electrodiagnostic Testing 26
Anatomy 26
Specific Electrodiagnostic Studies 27
Nerve Conduction Studies 27
Proximal Nerve Conduction Studies 27
Late Responses 28
Needle Examination 28
Provocation Electrodiagnostics 29
Dynamic or Quantitative Electromyography 29
Indications for Electrodiagnostic Testing 29
Nerve Recovery and Return to Play 30
Limitations of Electrodiagnostic Testing 31
Electromyography Report 31
Vascular Diagnostic Tests 31
Anatomy 31
Upper Limb 31
Lower Limb 32
Vascular Diagnostic Tests 33
Ankle Brachial Pressure Index 33
Duplex Ultrasonography 33
Angiography 33
Advanced Imaging Angiography 34
Magnetic Resonance Imaging 34
References 34
Magnetic Resonance Neurography 36
Introduction 36
Technique of Magentic Resonance Neurography 36
Diffusion Weighted Imaging 37
Coils 38
Anatomy and Imaging Appearance of The Peripheral Nerve 38
Imaging Appearance of Normal Nerves 38
Imaging Appearance of Abnormal Nerves 38
Mechanisms of Injury 40
Indications for Imaging of Peripheral Nerves 41
Trauma 41
Brachial Plexus Injuries 41
Adult Brachial Plexus Trauma 42
Birth-Related Trauma 42
Radiculopathy 44
Entrapment Syndromes 44
Extraspinal Sciatica 44
Brachial Plexus Entrapment 45
Muscle Denervation 47
Summary 47
References 48
Physical Examination of the Peripheral Nerves and Vasculature 49
Systematic Examination 49
Inspection 49
Palpation 49
Neurologic Examination 49
Strength Testing 50
Muscle Stretch Reflexes 50
Sensation Testing 51
Peripheral Nervous System Examination 52
Upper Limb Peripheral Nervous System Examination 52
Special Tests to Detect Upper Limb Muscle Weakness 53
Upper Limb Provocation Tests: Nerve Tension Tests 55
Upper Limb Provocation Tests: Compression Tests 55
Upper Limb Provocation Tests: Other Carpal Tunnel Syndrome Tests 56
Upper Limb Provocation Tests: Other Syndromes 56
Lower Limb Peripheral Nervous System Examination 57
Special Tests to Detect Lower Limb Muscle Weakness 57
Lower Limb Provocation Tests: Nerve Tension Tests 58
Lower Limb Provocation Tests: Piriformis Tests 60
Lower Limb Provocation Tests: Compression Tests 60
Spine and Pudendal Examination 61
Special Tests 61
Pudendal Nerve 62
Vascular Examination 62
Special Upper Limb Vascular Tests 64
Special Vascular Tests for Thoracic Outlet Syndrome 64
Special Vascular Tests for Venous Pathology 65
References 66
Athletic Kinetic Chain Concepts in Nerve and Vascular Injuries 68
What is the Kinetic Chain? 68
Kinetic Chain Assessment Techniques 69
Rehabilitation Using Kinetic Chain Concepts 70
Open Vs. Closed Chain Rehabilitation 71
Principles of Closed Kinetic Chain Training 71
Biomechanical Factors 71
Neurophysiologic Factors 72
Neuromobilization 72
Case Scenarios 72
Sarah 72
Matthew 73
Jennifer 75
Evan 76
Summary 77
References 77
Part 2: Upper Limb Syndromes 79
Peripheral Nerve Injuries of the Elbow, Forearm, and Hand 80
Median Nerve Syndromes 80
Ligament of Struthers 81
Pronator Syndrome 81
Anterior Interosseous Nerve 81
Carpal Tunnel Syndrome 83
Radial Nerve 84
Proximal Radial Nerve Entrapment 84
Forearm Radial Nerve Entrapment 84
Radial Tunnel Syndrome 84
Posterior Interosseous Nerve Syndrome 85
Ulnar Nerve 85
Proximal Ulnar Neuropathies 86
Distal Ulnar Neuropathies 87
Digital Nerves 88
Treatment 89
Activity Modification 89
Special Equipment 89
Medication 89
Surgery 89
References 90
Peripheral Nerve Injuries of the Shoulder and Upper Arm 92
Introduction 92
Suprascapular Nerve Injury 92
Mechanism of Injury in Sport 94
Physical Examination and Diagnostic Tests 94
Treatment 96
Axillary Nerve Injury 97
Mechanism of Injury in Sport 98
Physical Examination and Diagnostic Tests 99
Treatment 100
Long Thoracic Nerve Injury 100
Mechanism of Injury In Sport 101
Physical Examination and Diagnostic Tests 102
Treatment 102
Spinal Accessory Nerve Injury 104
Mechanism of Injury in Sport 105
Physical Examination and Diagnostic Tests 105
Treatment 106
Dorsal Scapular Nerve Injury 107
Mechanism of Injury in Sports 107
Physical Examination and Diagnostic Tests 107
Treatment 108
Thoracodorsal Nerve Injury 108
Mechanism of Injury in Sports 108
Physical Examination and Diagnostic Tests 108
Treatment 108
Medial Pectoral Nerve Injury 109
Mechanism of Injury in Sports 109
Physical Examination and Diagnostic Tests 109
Treatment 109
Musculocutaneous Nerve Injury 110
Mechanism of Injury in Sports 110
Physical Examination and Diagnostic Tests 111
Treatment 111
Parsonage-Turner Syndrome 112
Case 112
References 113
Thoracic Outlet Syndrome 117
Introduction 117
Historical Perspective 117
Epidemiology 117
Anatomy 118
Etiology 119
History and Physical Examination 119
Special Tests 120
Imaging 121
Electrodiagnosis 122
Conservative Management 123
Effort Thrombosis Syndrome 125
Surgical Approaches 126
Surgical Outcomes 126
Surgical Complications 127
Recurrent TOS 127
Conclusions 128
References 128
Stingers: Understanding the Mechanism, Diagnosis, Treatment, and Prevention 131
Introduction 131
Burners, Stingers, and Burning Hands 131
Mechanism of Injury 132
Clinical Evaluation and Diagnosis 133
Key Diagnostic Tests 134
Imaging 134
Electrophysiologic Testing 135
Treatment and Prevention 135
Controlling Symptoms 136
Postural Corrections 136
Strength Training 137
Protective Equipment 137
Guidelines for Safe Return to Play 137
References 139
Part 3: Lower Limb Syndromes 140
Peripheral Nerve Entrapment and Compartment Syndromes of the Lower Leg 141
Introduction 141
Mechanism of Nerve Injury 141
Saphenous Nerve 142
Anatomy 142
Etiology 142
Clinical Presentation 142
Evaluation 143
Management 143
Sural Nerve 143
Anatomy 143
Etiology 143
Clinical Presentation and Evaluation 144
Management 144
Peroneal Nerve 144
Anatomy 144
Etiology 145
Clinical Presentation 147
Evaluation 147
Management 148
Tibial Nerve 149
Anatomy 149
Etiology 149
Clinical Presentation 149
Evaluation 149
Treatment 150
Neuropathies in the Region of the Foot and Ankle 150
Anatomy 150
Tarsal Tunnel Syndrome 151
Etiology 151
Clinical Presentation 151
Evaluation 152
Treatment 152
Medial Plantar Nerve 153
Medial Calcaneal Nerve 153
Lateral Plantar Nerve 153
Interdigital Neuroma 155
Anatomy 155
Etiology 155
Clinical Presentation 155
Evaluation 156
Treatment 156
Compartment Syndromes 156
Conclusion 158
Case Study 158
History 158
Physical Examination 158
Differential Diagnosis 158
Diagnostic Studies 159
Diagnosis 159
Management and Outcome 159
References 159
Peripheral Nerve Injuries of the Proximal Lower Limb in Athletes 162
Introduction 162
Anatomy 162
Iliohypogastric Nerve 164
Sportsman’s Hernia 164
Lateral Femoral Cutaneous Nerve 165
Obturator Nerve 165
Femoral and Saphenous Nerves 166
Superior and Inferior Gluteal Nerves 167
Sciatic Nerve 167
Cluneal Nerves 168
Posterior Cutaneous Nerve of the Thigh 169
Pudendal Nerve 169
Conclusion 170
References 170
Lumbar Radicular and Referred Pain in the Athlete 172
Introduction 172
Diagnosis 172
History 172
Physical Examination 173
Imaging 173
Specific Conditions 175
Disc Herniation 175
Spondylolysis and Spondylolisthesis 176
Piriformis Syndrome 177
Greater Trochanteric Pain Syndrome 179
Facet-Mediated Pain 180
Sacroiliac Joint 181
Conclusion 181
References 181
Vascular Injuries in the Lower Limb of Athletes 184
Introduction 184
Traumatic Injuries 184
Traumatic Arterial Injuries 185
External Iliac Artery/Common Femoral Artery 185
Popliteal Artery 186
Anterior Tibial Artery 186
Traumatic Compartment Syndrome 187
Traumatic Venous Injuries 188
Deep Vein Thromboses 188
Common Femoral Vein Pseudoaneurysm 189
Nontraumatic Injuries 189
Introduction 189
Nontraumatic Arterial Injuries 190
External Iliac Artery Endofibrosis 190
Superficial Femoral Artery Stenosis 192
Popliteal Artery Entrapment Syndrome 193
Cystic Adventitial Disease of the Popliteal Artery 194
Chronic Exertional Compartment Syndrome 195
Nontraumatic Venous Injuries 195
Effort-Induced Deep Vein Thrombosis 195
Case Presentation 196
23-Year-Old Man With Bilateral Calf Claudication 196
Conclusion 197
References 198
Index 200