Nerve and Vascular Injuries in Sports Medicine PDF
Preview Nerve and Vascular Injuries in Sports Medicine
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 Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewritten permissionofthepublisher(SpringerScienceþBusinessMedia,LLC,233SpringStreet,NewYork, NY10013,USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis.Usein connection with any form of information storage and retrieval, electronic adaptation, computer software,orbysimilarordissimilarmethodologynowknownorhereafterdevelopedisforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,evenifthey arenotidentifiedassuch,isnottobetakenasanexpressionofopinionastowhetherornottheyare subjecttoproprietaryrights. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateofgoing topress,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityfor anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with respecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScienceþBusinessMedia(www.springer.com) 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
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