Cryoneurolysis for Digital Neuralgia in Professional Baseball Players: A Case Series.

Background: Thumb injuries are common in baseball players and can sometimes be challenging to effectively manage. A subset of patients experience failed nonoperative management yet do not have a clear indication for surgery. Cryoneurolysis or cryoanalgesia is a form of neuromodulation for pain that has been approved by the US Food and Drug Administration; it has been used safely and effectively on a variety of peripheral nerves. The mechanism of action involves percutaneous introduction of a small probe under local anesthetic to nerve tissue using ultrasound guidance. The probe is then cooled to -88°C using nitrous oxide, which results in secondary Wallerian degeneration. Axonal and myelin regeneration occurs completely in 3 to 6 months. Purpose: To describe a nonsurgical approach to refractory digital neuralgia using cryoneurolysis in a series of professional baseball players. Study Design: Case series; Level of evidence, 4. Methods: Included were 3 professional baseball players, each presenting with thumb pain in his top batting hand refractory to nonoperative modalities. Visualization of the superficial radial sensory and ulnar digital nerves was obtained using ultrasound. The skin was prepared in sterile fashion. A 22-gauge, 1.5-inch (3.8-cm) needle was then advanced using ultrasound guidance, and local anesthetic was applied. Both treatment sites were marked using a skin marker. Cryoneurolysis was performed using a 5-mm tip, and 60-second treatment cycles were performed at each site. Each of the cycles resulted in a roughly 5 × 7-mm lesion visible as hypoechoic signal. Results: All 3 players endorsed significant and prolonged relief and were able to return to an elite level of play. Conclusion: Study findings indicated marked efficacy and safety of using cryoneurolysis of the ulnar digital nerve and the superficial radial sensory nerve in a small group of elite baseball players with refractory digital neuralgia.

Machine Learning in Modeling High School Sport Concussion Symptom Resolve.

INTRODUCTION: Concussion prevalence in sport is well recognized, so too is the challenge of clinical and return-to-play management for an injury with an inherent indeterminant time course of resolve. A clear, valid insight into the anticipated resolution time could assist in planning treatment intervention. PURPOSE: This study implemented a supervised machine learning-based approach in modeling estimated symptom resolve time in high school athletes who incurred a concussion during sport activity. METHODS: We examined the efficacy of 10 classification algorithms using machine learning for the prediction of symptom resolution time (within 7, 14, or 28 d), with a data set representing 3 yr of concussions suffered by high school student-athletes in football (most concussion incidents) and other contact sports. RESULTS: The most prevalent sport-related concussion reported symptom was headache (94.9%), followed by dizziness (74.3%) and difficulty concentrating (61.1%). For all three category thresholds of predicted symptom resolution time, single-factor ANOVA revealed statistically significant performance differences across the 10 classification models for all learners at a 95% confidence interval (P = 0.000). Naïve Bayes and Random Forest with either 100 or 500 trees were the top-performing learners with an area under the receiver operating characteristic curve performance ranging between 0.656 and 0.742 (0.0-1.0 scale). CONCLUSIONS: Considering the limitations of these data specific to symptom presentation and resolve, supervised machine learning demonstrated efficacy, while warranting further exploration, in developing symptom-based prediction models for practical estimation of sport-related concussion recovery in enhancing clinical decision support.

Sports neurology as a multidisciplinary field.

A multidisciplinary approach within sports neurology fills a critical role in the management of athletes with neurologic injury. This model promotes streamlined access to sports medicine providers who can offer high-quality multispecialty care in a collaborative manner, to provide optimal outcomes for athletes. This chapter highlights the rise of the multidisciplinary care approach in nonathletic healthcare settings and introduces the concept of the interdisciplinary sports medicine care model. Next, we review the roles of medical providers who are integral in effective management of sport-related concussion, followed by a discussion of the athletic healthcare teams that treat other sport-related neurologic injuries and athletes with pre-existing neurologic conditions. Finally, we note important educational, legal, and independent medical care issues in athletic healthcare settings, and summarize the applicability of multidisciplinary and interdisciplinary care models to the subspecialty of sports neurology.

A Historical Perspective on Sports Concussion: Where We Have Been and Where We Are Going.

The approach to sports concussion diagnosis and management has been evolving at an unprecedented rate over the last several years. So much so, that committees at all level of sports have implemented concussion protocols and made adjustments to certain league rules in an effort to minimize the risk of head injury. With this newfound attention has come an even greater push by the scientific community to address the many questions that remain. The aim of this review article is to present the topic of sports concussion by means of discreet eras. It begins by introducing the very first mentions of concussion, dating back to ancient Greece, to present day, highlighting important periods along the way. It then goes on to review emerging scientific data, from biomarkers and serum studies, to imaging modalities, and brain networking. All of which will hopefully contribute to both the diagnostic and therapeutic approach to sports concussion.

Neurologic emergencies in sports.

PURPOSE OF REVIEW: Sports neurology is an emerging area of subspecialty. Neurologists and non-neurologists evaluating and managing individuals participating in sports will encounter emergencies that directly or indirectly involve the nervous system. Since the primary specialty of sports medicine physicians and other practitioners involved in the delivery of medical care to athletes in emergency situations varies significantly, experience in recognition and management of neurologic emergencies in sports will vary as well. This article provides a review of information and elements essential to neurologic emergencies in sports for the practicing neurologist, although content may be of benefit to readers of varying background and expertise. RECENT FINDINGS: Both common neurologic emergencies and less common but noteworthy neurologic emergencies are reviewed in this article. Issues that are fairly unique to sports participation are highlighted in this review. General concepts and principles related to treatment of neurologic emergencies that are often encountered unrelated to sports (eg, recognition and treatment of status epilepticus, increased intracranial pressure) are discussed but are not the focus of this article. Neurologic emergencies can involve any region of the nervous system (eg, brain, spine/spinal cord, peripheral nerves, muscles). In addition to neurologic emergencies that represent direct sports-related neurologic complications, indirect (systemic and generalized) sports-related emergencies with significant neurologic consequences can occur and are also discussed in this article. SUMMARY: Neurologists and others involved in the care of athletes should consider neurologic emergencies in sports when planning and providing medical care.