Nerve and Vascular Injuries in Sports Medicine

205 Pages·2009·6.885 MB·English

by  Venu Akuthota, Erin Maslowski (auth.), Stanley A. Herring, Venu Akuthota (eds.)

Venu Akuthota
Editors
Stanley A. Herring
Nerve and
Vascular Injuries
in Sports Medicine
Nerve and Vascular Injuries in Sports
Medicine
Venu Akuthota Stanley A. Herring
l
Editors
Nerve and Vascular Injuries
in Sports Medicine
1 3
Editors
VenuAkuthota StanleyA.Herring
UniversityofColorado DepartmentofRehabilitationMedicine
DenverSchoolofMedicine UniversityofWashington
1635N.AuroraCourt 401Broadway
Aurora,CO80045 Seattle,WA98122
TheSpineCenter USA
Denver,CO
USA
ISBN978-0-387-76599-0 e-ISBN978-0-387-76600-3
DOI10.1007/978-0-387-76600-3
SpringerDordrechtHeidelbergLondonNewYork
LibraryofCongressControlNumber:2009921351
#SpringerScienceþBusinessMedia,LLC2009
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Foreword
The field of sports medicine covers a tremendous territory. Athletes present to
their physician with everything from sprained ankles to bowel problems while
running. Many of the classictextbooks in sports medicine covermany of these
issuesinacursoryway.Twomajororgansystemsthataccountformanyinjuries
in athletes are the nervous system and the vascular system. Because of their
widespread,diffusenature,athletescanpresentwithmyriadsignsandsymptoms
relatedtothesesystems.Drs.AkuthotaandHerringhavedoneanoutstanding
jobintheirtextbookNerveandVascularInjuriesinSportsMedicinetoproducea
commonsense,yetthorough,approachtopotentialnerveandvascularinjuriesin
athletes. The text provides any physician or clinician who evaluates and treats
athletes with a clear path to an appropriate history, physical examination,
imagingstudies,andelectrophysiologicandvascularexaminationsofanyathlete
withpotentialnerveorvascularinjuries.
The first third of the book describes the appropriate evaluation of athletes
withnerveandvascularsymptomsandsigns.Emphasisisplacedonkineticchain
contributionstonerveandvascularinjuriestoaddressnotonlythecauseofthe
injurybutpossibleassociated,contributingbiomechanicaldeficiencies.Thelast
two-thirds of the book cover regional specific nerve and vascular injuries with
special attention to stingers, thoracic outlet syndrome, lumbar radiculopathy,
andcompartmentsyndromes.
In summary, Nerve and Vascular Injuries in Sports Medicine is the perfect
complementtoasportsmedicinelibraryandprovidesathorough,practicaltext
foranysportsclinicianwhoevaluatesandtreatsathleteswithpotentialnerveand
vascularproblems.
JoelPress,MD
Preface
At the 53rd Annual Meeting of the American College of Sports Medicine in
Denver, Colorado in 2006, we hosted a symposium on neurovascular injuriesin
the athlete. The presentations and conversations that occurred as part of that
symposiumconfirmedthechallengesthatsportsmedicinepractitionersfacewhen
diagnosing and treating athletes with suspected vascular, peripheral nerve, or
nerverootinjuriesrangingfromthecommonlyoccurring‘‘stingers’’and‘‘handle-
bar palsies’’ to the rare but emergent effort vein thrombosis. These types of
problemsoftendonotreceivemuchattentioninthesportsmedicineliterature.
Afterthesymposium,wewerepresentedwiththeopportunitytoeditatextbook
onnerveandvascularinjuriesinsportsmedicine.Wegladlyagreedandnowhave
seenthisprojectcometocompletion.Thistextbookisorganizedintothreesections.
The first section addresses anatomy, pathophysiology, and diagnosis, including
physical examination and rehabilitation concepts for neurovascular injury as well
as chapters devoted to electrodiagnostic evaluation, imaging, and vascular assess-
ment. The second section of the book addresses upper limb neurovascular syn-
drome, including nerve entrapments, neurogenic and vascular thoracic outlet
syndrome,andradicularandbrachialplexusinjury.Thethirdsectionofthebook
approaches the lower extremity in the same comprehensive fashion, including
peripheralnerveinjuryintheproximalanddistallowerextremity,lumbarradiculo-
pathy,compartmentsyndrome,andemergentvascularissuesinthelowerextremity.
Wearegratefultoourauthors,whohavebusyprofessionalandpersonallives,
forcreatingreadable,practical,evidence-basedwork. Theircontributions have
produced a textbook that should serve as a helpful roadmap when treating
problems that are often outside the mainstream of many sports medicine prac-
tices. Also, a thank you is certainly in order for Ms. Barbara Lopez-Lucio,
developmental editor for Springer. Without her constant guidance (and gentle
reminders),thispublicationwouldnotexist.
It has been our pleasure and privilege to be involved in the creation of this
textbook. We hope this reference serves as a useful guide to all of the sports
medicinepractitionerstryingtohelpathleteswithneurologicandvascularinjuries.
Denver,Colorado VenuAkuthota
Seattle,Washington StanleyA.Herring
Contents
PartI Anatomy,Pathophysiology,andDiagnosis
1 CausesofNumbnessandTinglinginAthletes ................... 3
VenuAkuthotaandErinMaslowski
2 DiagnosticTestsforNerveandVascularInjuries................. 17
VenuAkuthotaandEllenCasey
3 MagneticResonanceNeurography............................ 27
CynthiaT.Chin
4 PhysicalExaminationofthePeripheralNervesandVasculature..... 41
BrianWhite,PeterGonzalez,GerardA.Malanga,
andVenuAkuthota
5 AthleticKineticChainConceptsinNerveandVascularInjuries ..... 61
MarkA.HarrastandNaynaPatel
PartII UpperLimbSyndromes
6 PeripheralNerveInjuriesoftheElbow,Forearm,andHand ........ 75
JacquelineJ.WertschandAnneZeniHoch
7 PeripheralNerveInjuriesoftheShoulderandUpperArm.......... 87
KellyC.McInnisandLisaS.Krivickas
8 ThoracicOutletSyndrome.................................. 113
ScottLaker,WilliamJ.Sullivan,andThomasA.Whitehill
9 Stingers:UnderstandingtheMechanism,Diagnosis,Treatment,
andPrevention........................................... 127
StuartM.Weinstein
PartIII LowerLimbSyndromes
10 PeripheralNerveEntrapmentandCompartmentSyndromesof
theLowerLeg ........................................... 139
AndreaJ.BoonandMansourY.Dib
x Contents
11 PeripheralNerveInjuriesoftheProximalLowerLimbinAthletes ... 161
MarlaS.KaufmanandMarkE.Domroese
12 LumbarRadicularandReferredPainintheAthlete............... 171
JonathanT.Bravman,HectorMejia,VikasV.Patel,
andVenuAkuthota
13 VascularInjuriesintheLowerLimbofAthletes ................. 183
EllenCasey,PaulH.Lento,JosephM.IhmandHeronRodriguez
Index...................................................... 199
About the Editors
VenuAkuthota,MD
Associate Professor, Department of Physical Medicine and Rehabilitation;
Director, The Spine Center of the University of Colorado Hospital; Pain
Medicine Fellowship Director; University of Colorado School of Medicine,
Aurora, CO; Team Physician, University of Colorado, Aurora, CO; Team
Physician,UniversityofDenver,Denver,CO,USA
StanleyA.Herring,MD
Medical Director of Spine Center and Clinical Professor, Departments of
RehabilitationMedicine,OrthopaedicsandSportsMedicine,andNeurological
Surgery, University of Washington, Seattle, WA; Team Physician, Seattle
Seahawks,Seattle,WA;TeamPhysician,SeattleMariners;Seattle,WA,USA
Contributors
Editors
Venu Akuthota Department of Physical Medicine and Rehabilitation, Aurora,
CO,USA;TheSpineCenteroftheUniversityofColoradoHospital,Aurora,CO,
USA;UniversityofColoradoSchoolofMedicine,Aurora,CO,USA;University
ofColorado,Aurora,CO,USA;UniversityofDenver,Denver,CO,USA
StanleyA.Herring DepartmentsofRehabilitationMedicine,Orthopaedicsand
SportsMedicine,andNeurologicalSurgery,UniversityofWashington,Seattle,
WA,USA;SeattleSeahawks,Seattle,WA,USA;SeattleMariners,Seattle,WA,
USA
Authors
Andrea J. Boon Department of Physical Medicine and Rehabilitation, Mayo
Clinic,Rochester,MN,USA
JonathanT.Bravman ResidentPhysicianinOrthopaedicSurgery,Department
ofOrthopaedics,UniversityofColorado,Aurora,CO,USA
Ellen Casey Resident Physician, Department of Physical Medicine and
Rehabilitation, Rehabilitation Institute of Chicago/Northwestern Memorial
Hospital,Chicago,IL,USA
Cynthia T. Chin Department of Radiology, University of California San
Francisco,SanFrancisco,CA,USA
Mansour Y. Dib Department of Physical Medicine and Rehabilitation,
AUBMC,Beirut,Lebanon
Mark E. Domroese Department of Physical Medicine and Rehabilitation,
GundersenLutheranMedicalCenter,LaCrosse,WI,USA
Peter Gonzalez Department of Physical Medicine and Rehabilitation,
UniversityofColoradoSchoolofMedicine,Aurora,CO,USA