DOCSLIB.ORG

The Neurological Effects of Repeated Exposure to Military Occupational Blast Implications for Prevention and Health

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Neurological Effects of Repeated Exposure to Military Occupational Blast Implications for Prevention and Health THE SEVENTH ANNUAL DEPARTMENT OF DEFENSE STATE-OF-THE-SCIENCE MEETING The Neurological Effects of Repeated Exposure to Military Occupational Blast Implications for Prevention and Health PROCEEDINGS, FINDINGS, AND EXPERT RECOMMENDATIONS 12 – 14 March 2018 C O R P O R A T I O N For more information on this publication, visit www.rand.org/t/CF380z1 Library of Congress Cataloging-in-Publication Data is available for this publication. ISBN: 978-1-9774-0206-6 Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2019 RAND Corporation R® is a registered trademark. Cover photos (clockwise from top left): U.S. Army photo by Spec. Donald Williams; U.S. Air Force photo by Staff Sgt. Evelyn Chavez; U.S. Marine Corps photo by Sgt. Mauricio Campino; Department of Defense photo by Cpl. Tyler Main; U.S. Air Force photo; U.S. Army photo by Sgt. Michael Eaddy. Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org Preface There has been growing concern over potential subconcussive neurological injury following repetitive low-level military occupational blast exposure (MOB). Examples include heavy weapons training and activities such as breaching. To address this issue, the Seventh Department of Defense (DoD) State-of-the-Science Meeting (SoSM) was held March 12–15, 2018, at the RAND Corporation’s offices in Arlington, Virginia. These proceedings include background information on the meeting and its theme, summaries of a systematic RAND Arroyo Center literature review and meeting and poster presentations, and complete working group findings and expert panel conclusions and recommendations. The SoSM expert panel recommended that DoD leaders (1) enforce DoD policies and standards related to low-level MOB; (2) develop high-quality research assessing the occurrence of repeated, low-level occupational blast injury; (3) plan and complete a large-scale population- based longitudinal study of military personnel with long follow-up to assess neurological and general health outcomes after repeated, low-level MOB exposure; (4) emphasize research on large animals, including nonhuman primates, as part of the department’s animal research initiatives to improve the applicability of findings to humans; (5) complete studies that compare extant MOB exposure assessment tools, protective practices, and protective devices with improvement approaches to facilitate incremental gains in safety and outcomes; (6) catalogue, map, and make available to researchers, safety programs, and military end users unclassified weapon system–specific information and service member–specific load profiles for key military occupations, exposures, and contexts; and (7) increase opportunities for embedded scientists to study low-level MOB exposure among training units and in deployed contexts. The meeting and these proceedings were sponsored by the Army Medical Research and Materiel Command. The Project Unique Identification Code (PUIC) for the project that produced this document is RAN177782. This research was conducted within RAND Arroyo Center’s Personnel, Training, and Health Program. RAND Arroyo Center, part of the RAND Corporation, is a federally funded research and development center (FFRDC) sponsored by the United States Army. RAND operates under a “Federal-Wide Assurance” (FWA00003425) and complies with the Code of Federal Regulations for the Protection of Human Subjects Under United States Law (45 CFR 46), also known as “the Common Rule,” as well as with the implementation guidance set forth in DoD Instruction 3216.02. As applicable, this compliance includes reviews and approvals by RAND’s Institutional Review Board (the Human Subjects Protection Committee) and by the U.S. Army. The views of participants are solely their own and do not represent the official policy or position of DoD or the U.S. government. iii Contents Preface ........................................................................................................................................... iii Figures .......................................................................................................................................... vii Tables ............................................................................................................................................. ix Summary ......................................................................................................................................... xi Acknowledgments ....................................................................................................................... xiii Abbreviations ................................................................................................................................ xv 1. Background .................................................................................................................................. 1 2. Literature Review Summary ........................................................................................................ 3 Literature Review Methods ....................................................................................................................... 3 Literature Review Findings ....................................................................................................................... 4 Literature Review Summary ..................................................................................................................... 7 3. Keynote Address ......................................................................................................................... 9 4. Discussion Panels ...................................................................................................................... 11 Panel on Strategy: DoD Policy and Requirements .................................................................................. 11 Panel on the State of Current Research and Solutions ............................................................................ 12 5. Scientific Presentation Summaries ............................................................................................ 15 Understanding Potential Neurological Consequences and Mechanisms of Repeated Blast Exposure ... 15 Profiling of Blast-Overpressure Effects on the Human Brain in Breacher Training .............................. 19 Quantifying Occupational Blast Exposure During Military and Law Enforcement Training ................ 20 Receiving a Multiple Peak Blast Dose in a Single Complex Blast Event ............................................... 22 Suicide in Combatants with Extensive Blast Exposure: Strictly a Mental Health Issue or Evidence of Underlying Structural Brain Lesions? .......................................................................................... 23 Impaired Stress Coping and Cognitive Function Caused by Blast Exposure ......................................... 23 Occupational Risk Moderates the Relationship Between Major Blast Exposure and Traumatic Brain Injury ....................................................................................................................................... 26 Epidemiologic Study of Occupational Blast Exposure and Subsequent Diagnoses ............................... 27 Blast-Induced “PTSD”: Evidence from an Animal Model ..................................................................... 27 The Dynamics of Structural Changes After Repeated Mild Blast TBI: Acute Pathologies and Lasting Consequences ...................................................................................................................... 28 Neuronal Response to Multiple Shock Tube Overpressure Exposures ................................................... 29 Blood-Brain Barrier Permeability Is a Sensitive Neurological Marker for Single and Repeated Occupational Low-Level Blast Exposures in a Rodent Model ......................................................... 29 Predictive Injury Risk Curves for Blast-Related TBI Through Computational Modeling of Multiparametric Empirical Data ....................................................................................................... 30 Building Translational Bridges Linking Animal Blast Model Pathology to Neuroimaging and Neuropathology Findings in Veterans with Blast-Related mTBI ..................................................... 32 An Enhanced Human Surrogate Head Model for Evaluating Blast Injury Mitigation Strategies .......... 32 v Changes in Monoamine and Galanin Systems Following Single and Repeated
Load more

Recommended publications
  • This Spreadsheet
    2014 Location Association Street Number Address Unit City State Zip Associated Dates Associated Police Agency Campus Abertay University Study Abroad Bell Street Dundee Scotland DD1 1HG Scotland Police-Dundee Area Command NO Action in Comm Through Service WorkForce 3900 ACTS Lane Dumfries VA 22026 Dumfries PD Action Martial Arts 21690 Redrum Dr. #187 Ashburn VA 20147 Loudoun County Sheriff's Office Affinia 50 Hotel NSMH 155 E 50th Street 513,703,121 New York NY 10022 AN 11/07-11/09 New York Police Department Affinia 50 Hotel NSMH 155 E 50th Street 513,703,121 New York NY 10022 AN 11/14-11/16 New York Police Department Alexandria City Public Schools 1340 Braddock Place 7th Floor Alexandria VA 22314 Alexandria City PD Adult Learning Center Alexandria Detention Center CBO 2003 Mill Rd. Alexandria VA 22314 Alexandria City PD Alexandria Renew WorkForce 1500 Eisenhower Ave Alexandria VA 22314 11/20-12/18 Alexandria City PD American Iron Works WorkForce 13930 Willard Rd. Chantilly VA 20151 Fairfax County PD Americana Park Gerry Connelly Jaye 4130 Accotink Parkway Annandale VA 22003 4/3/2014 Fairfax County PD Cross Country Trail 6-18-2014 Annandale High School 4700 Medord Drive Annandale VA 22003 Fairfax County PD NO Annenberg Learner WorkForce 1301 Pennsylvania Ave NW #302 Washington DC 20004 Washington DC PD Arlington Career Center 816 South Walter Reed Dr. Arlington VA 22204 Arlington County PD Arlington County Fire Training 2800 South Tayler Street Arlington VA 22206 Arlington County PD Academy Arlington Dream Project Pathway 1325 S. Dinwiddie Street Arlington VA 22206 Arlington County PD Arlington Employment Center WorkKeys 2100 2014 Arlington County PD (WIB) Washington Blvd 1st Floor Arlington VA 22204 Arlington Mill Alternative High 816 S.
    [Show full text]
  • Military Academy Established Ibbd - Lexington, Mo
    ^ UIENTIUDRTH MILITARY ACADEMY ESTABLISHED IBBD - LEXINGTON, MO. HIGH SEHOOL AND JUNIOR COLLEGE •l»li!PT»«vlW WENTWDHTH'S PURPOSE It is the purpose of Wentworth Military Academy to provide the best conditions possible for the all 'round development of worthy boys and young men. To attain this high purpose, the Academy places greatest emphasis upon these four points: First, It is the Academy's aim to assemble only the highest types of students—deserving youths of good parentage—to assure wholesome associations and greater progress. Every pre­ caution is taken to keep undesirable boys—all those that might prove detrimental to others out of the Academy. Second, to employ only men of highest character and ability for Its faculty. It is not enough for a Wentworth faculty member to be merely a scholar and a splendid instructor. He must also possess a spirit of friendliness and a sincere desire to give kindly help whenever necessary. He must thoroughly understand the Innermost problems of boys—be patient with them—and be ready to serve each boy to the best of his ability. Third, to provide the very best equipment throughout every department to the end that every boy will have all those things necessary to his health and happiness and that none shall want for anything that will help him to make progress. Fourth, to provide a program for each day that will best serve the Interests of every student o ;f ; 3'^ o jtHi^ ^ # WEIVTWDRTH FROM THE AIR No. I. Administration Building, "D" Company No. 9. New Drill and Athletic Field — Site of Barracks, Music Facilities and Rifle New Athletic Field House.
    [Show full text]
  • Virginia: Birthplace of America
    VIRGINIA: BIRTHPLACE OF AMERICA Over the past 400 years AMERICAN EVOLUTION™ has been rooted in Virginia. From the first permanent American settlement to its cultural diversity, and its commerce and industry, Virginia has long been recognized as the birthplace of our nation and has been influential in shaping our ideals of democracy, diversity and opportunity. • Virginia is home to numerous national historic sites including Jamestown, Mount Vernon, Monticello, Montpelier, Colonial Williamsburg, Arlington National Cemetery, Appomattox Court House, and Fort Monroe. • Some of America’s most prominent patriots, and eight U.S. Presidents, were Virginians – George Washington, Thomas Jefferson, James Madison, James Monroe, William Henry Harrison, John Tyler, Zachary Taylor, and Woodrow Wilson. • Virginia produced explorers and innovators such as Lewis & Clark, pioneering physician Walter Reed, North Pole discoverer Richard Byrd, and Tuskegee Institute founder Booker T. Washington, all whose genius and dedication transformed America. • Bristol, Virginia is recognized as the birthplace of country music. • Virginia musicians Maybelle Carter, June Carter Cash, Ella Fitzgerald, Patsy Cline, and the Statler Brothers helped write the American songbook, which today is interpreted by the current generation of Virginian musicians such as Bruce Hornsby, Pharrell Williams, and Missy Elliot. • Virginia is home to authors such as Willa Cather, Anne Spencer, Russell Baker, and Tom Wolfe, who captured distinctly American stories on paper. • Influential women who hail from the Commonwealth include Katie Couric, Sandra Bullock, Wanda Sykes, and Shirley MacLaine. • Athletes from Virginia – each who elevated the standards of their sport – include Pernell Whitaker, Moses Malone, Fran Tarkenton, Sam Snead, Wendell Scott, Arthur Ashe, Gabrielle Douglas, and Francena McCorory.
    [Show full text]
  • Stingers That Don’T Get Better
    Stingers That Don’t Get Better Chris Warrell, MD Orthopaedic Sports Medicine Orlando Orthopaedic Center February 3, 2018 Official Collegiate Team of OOC! Stingers That Don’t Get Better Outline • When to be concerned • Evaluation and work-up • Imaging • Electrodiagnostic studies • Treatment • Rehabilitation • Return to Play • When to disqualify / retire • Controversies Stingers That Don’t Get Better Outline • When to be concerned • Evaluation and work-up • Imaging • Electrodiagnostic studies • Treatment • Rehabilitation • Return to Play • When to disqualify / retire • Controversies • Very little high level evidence Stingers That Don’t Get Better When To Be Concerned • Symptoms lasting > 48hrs • Anything indicating a higher lesion • Persistent neck pain, bilateral symptoms, loss of neck ROM, lower extremity symptoms • Two or more stingers in a season Speer K. The Prolonged Burner Syndrome. AJSM 1990. 18:591-94 Stingers That Don’t Get Better Epidemiology • Only 5-10% stingers persist more than a few hours • Brachial plexus injuries and anatomic anomalies more common in younger (high school) athletes • Cervical spine level injuries (esp. disc herniation) more common in collegiate/pro athletes Speer K. The Prolonged Burner Syndrome. AJSM 1990; 18:591-94 Levitz CL, Reilly PJ, Torg JS. The pathomechanics of chronic recurrent cervical nerve root neuropraxia. The chronic burner syndrome. AJSM 1997;25:73-6 Neyer sa, Schulte KR, Callaghan JJ, et al. Cervical spinal stenosis and stingers in collegiate football players. AJSM 1994;22:158-66 Stingers That Don’t Get Better Evaluation • As discussed by Dr. McCleary • Serial examinations • Time of injury • After game • 24 – 48 hours later • Decision point for imaging • Repeatedly over first 2 weeks • Decision point for EMG/NCV Goodwin D, Kalantar SB.
    [Show full text]
  • Brachial Plexus Stinger
    SCAPHOID FRACTURE WHAT IS STINGER OR BURNER? A stinger or burner is an injury to a group of nerves known as the brachial plexus. This nerve bundle is often injured during sporting activities and results in loss of sensation to the affected arm (paraesthesia). The brachial plexus includes nerve roots extending from the lower part of the neck (cervical spine) and extending to the top of the mid spine (thoracic spine). CLASSIFICATION OF BRACHIAL PLEXUS STINGER: CAUSES OF A BRACHIAL Grade 1: Known as a neuropraxia and results in PLEXUS STINGER: a temporary loss of sensation and/or loss of motor function. This may last minutes to days. The most common mechanism is when the head is forced to one side while the opposite shoulder Grade 2: Known as axonotmesis, meaning there is depressed resulting in brachial plexus over is actual nerve damage without severing. This stretching. Another common mechanism is a results in more severe sensory and motor direct blow to the side of the neck/shoulder. dysfunction that may take several weeks to regenerate DIAGNOSIS: Grade 3: Known as neurotmesis and classified A complete medical evaluation will be needed as a severe injury. The nerve will be completely for someone who suffers a brachial plexus severed with symptom’s lasting up to a year. injury. A subject history will be taken to Surgery is often required. investigate to mechanism of injury, current symptoms and other behaviours. An objective neurological examination will be completed looking at sensation changes, muscles strength, reflexes and movement patterns. SKIERS THUMB SCAPHOID FRACTURE SIGNS AND SYMPTOMS: INITIAL TREATMENT: Ø Burning sensation in the neck and/or arm Initial treatment will consist of the RICER Ø Arm numbness principle – rest, ice, compression, elevation and Ø Arm weakness rest.
    [Show full text]
  • National Capital Area
    National Capital Area Joint Service Graduation Ceremony For National Capital Consortium Medical Corps, Interns, Residents, and Fellows National Capital Consortium Dental Corps and Pharmacy Residents Health and Business Administration Residents Healthcare Administration Residents Rear Admiral David A. Lane, Medical Corps, U.S. Navy Director National Capital Region Medical Directorate Colonel Michael S. Heimall, Medical Service Corps, U.S. Army Director Walter Reed National Military Medical Center Arthur L. Kellermann, M.D., M.P.H. Professor and Dean, F. Edward Hebert School of Medicine Uniformed Services University of the Health Sciences Jerri Curtis, M.D. Designated Institutional Official National Capital Consortium Associate Dean for Graduate Medical Education Uniformed Services University of the Health Sciences Colonel Brian M. Belson, Medical Corps, U.S. Army Director for Education Training and Research Walter Reed National Military Medical Center Colonel Clifton E. Yu, Medical Corps, U.S. Army Director, Graduate Medical Education Walter Reed National Military Medical Center Program of Events Academic Procession Arrival of the Official Party Rendering of Honors (Guests, please stand) Presentation of Colors...............................Uniformed Services University Tri-Service Color Guard “National Anthem”...............................................................................The United States Army Band Invocation.................................................................................LTC B. Vaughn Bridges, CHC, USA
    [Show full text]
  • Cervical Radiculopathy
    342 REVIEW ARTICLE Cervical Radiculopathy Maury R. Ellenberg, MD, Joseph C. Honet, MD, Walter J. Treanor, MD ABSTRACT. Ellenberg M, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil 1994;75: 342-52. l The history, pathoanatomy and pathophysiology, clinical picture, differential diagnosis, diagnostic evaluation, and treatment of cervical radiculopathy are reviewed. The review is based on a lo-year Medline literature search, review of bibliographies in textbooks, and bibliographies in articles obtained through the search. Cervical radiculopathy, although recognized early in the 20th century, was first associated with disc pathology in the mid- 1930s. It is most commonly caused by disc herniation or cervical spondylosis. History and physical examination using pain location, manual muscle testing, and specialized testing (Spurling’s maneuver) will usually suffice to diagnose the radiculopathy and determine the root level involved. Diagnostic imaging such as magnetic resonance imaging, computed tomography, or myelography should be used as presurgical evaluative tools or when tumor or other etiology besides disc hemiation or spondylosis is suspected. Electromyography is of benefit in distinguish- ing various entities that clinically present similar to cervical radiculopathy and can also help to “date” the lesion. Treatment of this disorder has not been systematically studied in a controlled fashion. However, using a variety of different treatments, the radiculopathy usually improves without the need for surgery. Indications for surgery are unremitting pain despite a full trial of non-surgical management, progressive weakness, or new or progressive cervical myelopathy. Prospective studies evaluating the various treatment options would be of great benefit in guiding practitioners toward optimum cost-effective evaluation and care of the patient with cervical radiculopathy.
    [Show full text]
  • Theodore Roosevelt Formed the Rough Riders (Volunteers) to Fight in the Spanish- American War in Cuba
    951. Rough Riders, San Juan Hill 1898 - Theodore Roosevelt formed the Rough Riders (volunteers) to fight in the Spanish- American War in Cuba. They charged up San Juan Hill during the battle of Santiago. It made Roosevelt popular. 952. Treaty of Paris Approved by the Senate on February 6, 1898, it ended the Spanish-American War. The U.S. gained Guam, Cuba, Puerto Rico and the Philippines. 953. American Anti-Imperialist League A league containing anti-imperialist groups; it was never strong due to differences on domestic issues. Isolationists. 954. Philippines, Guam, Puerto Rico, Cuba The U.S. acquired these territories from Spain through the Treaty of Paris (1898), which ended the Spanish-American War. 955. Walter Reed Discovered that the mosquito transmitted yellow fever and developed a cure. Yellow fever was the leading cause of death of American troops in the Spanish-American War. 956. Insular cases Determined that inhabitants of U.S. territories had some, but not all, of the rights of U.S. citizens. 957. Teller Amendment April 1896 - U.S. declared Cuba free from Spain, but the Teller Amendment disclaimed any American intention to annex Cuba. 958. Platt Amendment A rider to the Army Appropriations Bill of 1901, it specified the conditions under which the U.S. could intervene in Cuba's internal affairs, and provided that Cuba could not make a treaty with another nation that might impair its independence. Its provisions where later incorporated into the Cuban Constitution. 959. Protectorate A weak country under the control and protection of a stronger country. Puerto Rico, Cuba, etc.
    [Show full text]
  • Medical Conditions Affecting Sports Participation
    CLINICAL REPORT Guidance for the Clinician in Rendering Medical Conditions Affecting Sports Pediatric Care Participation Stephen G. Rice, MD, PhD, MPH, and the Council on Sports Medicine and Fitness ABSTRACT Children and adolescents with medical conditions present special issues with respect to participation in athletic activities. The pediatrician can play an important www.pediatrics.org/cgi/doi/10.1542/ peds.2008-0080 role in determining whether a child with a health condition should participate in certain sports by assessing the child’s health status, suggesting appropriate equip- doi:10.1542/peds.2008-0080 ment or modifications of sports to decrease the risk of injury, and educating the All clinical reports from the American Academy of Pediatrics automatically expire athlete, parent(s) or guardian, and coach regarding the risks of injury as they relate 5 years after publication unless reaffirmed, to the child’s condition. This report updates a previous policy statement and revised, or retired at or before that time. provides information for pediatricians on sports participation for children and The guidance in this report does not adolescents with medical conditions. indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual n 2001, the American Academy of Pediatrics published an analysis of medical circumstances, may be appropriate. 1 Iconditions affecting sports participation. This updated report replaces the 2001 Key Words policy statement and provides additions and changes to increase the accuracy and youth, athletes, risk of injury, contact and completeness of the information. collision sports, prevention management, Health care professionals must determine whether a child with a health con- strenuousness, safety PEDIATRICS (ISSN Numbers: Print, 0031-4005; dition should participate in a particular sport.
    [Show full text]
  • Predicting Chronic Stinger Syndrome Using the Mean Subaxial Space
    PM&R Vol. 2, Iss. 9S, 2010 S89 paresthesias, swelling or erythema. No prior cardiac or pul- Results: Approximately 6 months after her injury, the pa- monary disease except for mild hypertension managed with a tient was seen in our office for initial consultation of torticol- low sodium diet. No history of smoking. Radiographs were lis. Our clinical findings revealed left rotational torticollis, negative for any significant abnormalities. Venous ultrasound significant decrease in range of motion, and normal neuro- did not show any thrombus formation. She continued to logic examination. Her dynamic CT scan was reviewed show- complain of persistent posterior knee pain and calf spasms in ing a right C1-C2 facet joint subluxation without significant spite of several weeks of physical therapy. change upon rotation. She was diagnosed with atlantoaxial Setting: An outpatient physical medicine and rehabilitation rotatory fixation (AARF) and underwent an open reduction clinic at a tertiary medical center. and internal fixation of the C1-C2 vertebrae. At her 3-week Results: She was subsequently referred to our clinic for follow-up visit, there was resolution of her torticollis and a evaluation of intractable posterior knee pain and leg spasms physical therapy program focusing on range of motion, flex- thought to be related to a muscle strain. Our neurologic ibility and strengthening was implemented. examination was essentially normal. She had a non-antalgic Discussion: AARF is a fixed subluxation or dislocation in gait and was able to perform 5 toe raises without pain. There the cervical spine involving the inferior atlantal and superior was mottling and dryness of her skin at the feet with de- axial facets.
    [Show full text]
  • Tackler's Head Position Relative to the Ball Carrier Is Highly Correlated With
    BJSM Online First, published on December 22, 2017 as 10.1136/bjsports-2017-098135 Original article Br J Sports Med: first published as 10.1136/bjsports-2017-098135 on 21 November 2017. Downloaded from Tackler’s head position relative to the ball carrier is highly correlated with head and neck injuries in rugby Shogo Sobue,1 Takayuki Kawasaki,1 Yoshinori Hasegawa,1 Yuki Shiota,1 Chihiro Ota,2 Takeshi Yoneda,2 Shigeyuki Tahara,2 Nobukazu Maki,3 Takahiro Matsuura,3 Masahiro Sekiguchi,3 Yoshiaki Itoigawa,4 Tomohiko Tateishi,5 Kazuo Kaneko1 ► Additional material is ABSTRACT these tackles can potentially cause serious injuries. published online only. To view Objectives To characterise the tackler’s head position However, tacklers are merely protected by their please visit the journal online tackling skill.18 Several attempts have been made to (http:// dx. doi. org/ 10. 1136/ during one-on-one tackling in rugby and to determine bjsports- 2017- 098135) the incidence of head, neck and shoulder injuries prevent injuries during tackling, including specific through analysis of game videos, injury records and a tackle technique and preventive exercises; however, 1Department of Orthopaedic questionnaire completed by the tacklers themselves. no prevention strategy has been established.18 19 In Surgery, Faculty of Medicine, Methods We randomly selected 28 game videos football, head-down contact and spearing increase Juntendo University, Tokyo, Japan featuring two university teams in competitions held in the risk of cervical spine injury. Therefore, football 2Rugby Football Club, Keio 2015 and 2016. Tackles were categorised according rules, education and coaching have been altered to University, Yokohama, Japan to tackler’s head position.
    [Show full text]
  • The Spine in Sports Injuries: Cervical Spine 22
    The Spine in Sports Injuries: The Cervical Spine 377 The Spine in Sports Injuries: Cervical Spine 22 Paul M. Parizel, Jan l. Gielen, and Filip M. Vanhoenacker CONTENTS Box 22.1. Plain radiographs 22.1 Introduction 377 ● Remain useful in mild cervical spine trauma 22.2 Anatomical Considerations 378 ● Underestimate fractures, especially near the 22.3 Biomechanics of the Cervical Spine 379 cervico-thoracic junction 22.4 Radiological Examination 383 ● Flexion-extension views are useful to show 22.5 Cervical Disc Herniation 384 instability 22.6 Impingement Syndromes and Spinal Stenosis 384 22.7 Burners and Stingers 385 22.8 Catastrophic Athletic Cervical Spine Box 22.2. CT Injuries 386 22.9 Nerve Root and Plexus Avulsion 386 ● Preferred technique in more severe trauma (fracture-dislocation) 22.10 Differential Diagnosis 387 Things to Remember 388 ● Very fast (MDCT requires only seconds to scan References 388 the cervical spine) ● Provides limited soft tissue contrast 22.1 Introduction Box 22.3. Myelography and CT myelography Injuries to the spine are commonly associated with ● Have been largely supplanted by non-invasive all kinds of sports activities, both contact and non- cross-sectional imaging techniques contact sports, and at all levels of competition rang- ing from the high school level to the professional level ● Remain useful in the diagnosis of nerve root (Tall and DeVault 1993). The spectrum of potential and brachial plexus avulsion spinal injuries is wide; some resolve on their own, others might require conservative therapy, and still others might require surgical intervention. Sports injuries involving the cervical spine include inter- Box 22.4.
    [Show full text]