The Bare Bones of Concussion: What the Sideline Orthopaedic Surgeon Needs to Know

Abstract

Concussions have become one of the highest profile and most controversial injuries in sport with scrutiny by athletes and their families, coaches, medical personnel, and the media dramatically increasing in recent years. With growing awareness and knowledge of concussion, assessment has progressed from minimal on-field examination and rapid return to play, to extensive on- and off-the-field comprehensive physical and neurologic examinations, computerized neurocognitive testing, advanced oculovestibular evaluations, and individualized return-to-play protocols. Orthopaedic surgeons covering sporting events as team physicians are expected to have competency in recognizing mechanisms of concussive injury, participate in on-field assessments, and contribute to the initial management and return-to-play protocols of athletes. Having an awareness of concussion epidemiology, available diagnostic testing, possible complications associated with repetitive concussions, and local legislation involving concussed athletes will prepare the team physician-surgeon to be a critical contributing member of the medical team. Key Concepts: • Concussion is a common injury in sport with variable presentation requiring a multidisciplinary team for assessment, diagnosis, and management. • Concussion is primarily a functional neurologic injury rarely requiring structural imaging. • Validated assessment tools for concussion have been developed that, while not designed to diagnose or rule out concussion as stand-alone tools, assist in the initial evaluation of an injured athlete. • Athletes suspected of or diagnosed with concussion may not return to play on the day of injury and must undergo a formalized return to play protocol: “When in doubt, sit them out.” • Sideline orthopaedic surgeons should be aware of initial recognition and management of concussion, as well as the potential for prolonged recovery.