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Ask Dr. Rick – December 2010

December 8, 2010

Concussions Making Headlines

This is a very timely article on concussions with a great deal of interest being placed on illegal hits in the National Football League, as well as the refocus on concussions. Cerebral concussion is a common condition that comprises approximately 10 percent of all athletic injuries. It is often misdiagnosed and not well understood and unlike many injuries, there is no obvious deformity, swelling or test that can diagnose a concussion.

Concussions are usually due to either a hit to the head or a hit that creates violent acceleration or deceleration of the brain inside the skull. Typical symptoms include headache, nausea, vomiting, dizziness, balance problems, fatigue, trouble sleeping, drowsiness and possibly blurred vision. Concussions cause an immediate and short-lived impairment of brain function and sometimes cause long-lasting symptoms known as post-concussion syndrome. A severe concussion may result in a loss of consciousness but a loss of consciousness is not necessary to diagnose a concussion.

The trauma that is caused to the brain when the brain hits the bony component of the skull results in different amounts of trauma to the brain that heal over time and have no specific treatment other than rest. It is very important for the diagnosis of concussion to be made because a second concussion or secondary trauma can result in
devastating consequences.

Once an athlete has suffered a concussion, she/he is at risk for subsequent head injuries and is 3-to-5 times more likely to suffering a subsequent concussion.

Neuropsyche testing and brain imaging are the hallmarks to assess concussions and physicians need to be very aware of the standardized assessment of the concussion scale used to screen the cognitive abilities of an athlete on the sideline. Although treatment of concussions is variable, it is my opinion that these are under-treated and in general, athletes return to play too early, placing them at risk for a subsequent concussion.

If your son or daughter suffers a concussion and has the diagnosis made, it is important to seek care and treatment from a physician that is well-versed in the care and treatment of concussions and to be very conservative in return to play parameters.

Ask Dr. Rick


“Dear Dr. Rick: Thank you very much for taking my question. I often wake up from a sound sleep with soreness in my shoulder and have pain and aching in my shoulder when I roll over during sleep. Do you have any suggestions?”
– Lindsey R., Wentzville, MO

Lindsey: Thank you very much for your question. Rotator cuff tears and impingement syndrome are common causes of night-time pain in the shoulder. Impingement syndrome is a process where spurs rub on the rotator cuff and create inflammation at the insertion of the rotator cuff. The pain is exacerbated as you roll onto the shoulder and commonly causes discomfort and the loss of sleep. Initially, I would try to stretch the shoulder with basic stretching exercises and take an oral inflammatory. If this persists longer than three weeks, I would seek medical care. You will need an x-ray and possibly MRI of your shoulder to determine if the rotator cuff is torn. This is a common problem and if you are not better in a short period of time, you do need to see a physician. Thanks for your question.


“Dr. Rick: Over the past three months I have had clicking in my hand and as of the last two to three weeks when I wake up in the morning, my fourth finger is stuck and I have to pry it open causing a huge pop in my hand. Do you have any idea what this could be?”
– Tony W., Belleville, IL

Dear Tony: This syndrome is known as a trigger finger and is commonly seen with overuse activities of the hand. People that repetitively grasp or use their hand to squeeze, push or pull on a repetitive basis will commonly get what is known as stenosing tenosynovitis. In English, this means that the tendon gets inflamed and gets caught in the tendon sheath, causing a large pop as the hand is opened. Treatment generally is one to three cortisone injections and in approximately 85 percent of the cases this will resolve the triggering and resolve the pain. If this does not resolve the triggering or pain, a small surgical procedure is necessary to stop the triggering.

Due to the fact that this has been going on for such a long period of time, I would recommend seeing your physician. This is a common problem with excellent results and if it does not improve on its own in a short period of time, you should seek medical care and treatment. Thanks for the question.

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