By Alexander E. Merkler, MD, MS
Assistant Professor of Neurology and Neuroscience, Weill Cornell Medical College
This article suggests that certain specific physical examination findings may be helpful in evaluating and monitoring patients with sports-related concussion using oculovestibular responses and balance tests.
Streicher N, Popovich M, Almeida A, et al. Understanding abnormal examination findings during concussion recovery: A retrospective chart review. Neurol Clin Pract 2024;14:e200284.
Sports-related concussion affects hundreds of thousands of people per year. Sports-related concussions can impair an athlete’s ability to return to play and may cause debilitating symptoms. This article describes abnormal physical findings seen in sports-related concussions and suggests that these examination maneuvers may be used as a way to longitudinally follow athletes through recovery.
In this retrospective electronic medical record review, 500 patients aged 6-24 years were evaluated within 15 days of a sports-related concussion at an outpatient concussion clinic. The goal of the study was to report on the frequency of abnormal physical examination findings during the first 30 days post-injury. Examination included multiple maneuvers, including vestibular/ocular-motor screening, vestibular ocular reflex, horizontal alternating saccade testing, horizontal pursuit testing, visual motion sensitivity testing, convergence testing, balance testing, Romberg testing, and the cervical examination. Of importance, many of these tests were considered abnormal based on either objective examination observations (such as saccadic eye movements during horizontal pursuit testing) or subjective patient-reported symptoms during the physical examination maneuver (please see the study for details regarding what was considered abnormal for each test performed).
The authors found that the most common abnormal physical examination findings were vestibular/ocular testing, balance testing (single leg stance with eyes open and closed, tandem stand with eyes open and closed, tandem walk), and the cervical spine and neck examination. The authors found that, over multiple examinations during the first 30 days post-injury, the frequency of abnormal findings decreased.
Overall, the study identified several physical examination findings that are abnormal in patients experiencing sports-related concussive symptoms. Importantly, the authors found that physical examination findings improved over time in patients experiencing sports-related concussions.
The authors did not comment on the severity or type of complaints these patients had and, thus, the incremental benefit of these various physical examination findings compared to the athletes’ complaints remains unclear. Moreover, given the fact that multiple physical examination findings were considered abnormal based on subjective complaints during the maneuver, the incremental benefit of these maneuvers over just taking a history from the athlete must be evaluated further. Regardless, the fact that the frequency of abnormal physical examination findings abated over time is consistent with the literature indicating that symptoms of concussions improve over time. This important and positive message should be relayed to athletes who are pressured to return to play.
COMMENTARY
This study represents an important step in our ability to evaluate patients with sports-related concussion. Patients with sports-related concussion can have abnormal physical examination findings, and these abnormal findings should abate gradually over time as the athlete recovers.
