Diagnostic testing for concussions. In this video, Michael D. McCleary, M.D., a board-certified orthopaedic surgeon specializing in primary care sports medicine and non-surgical orthopaedics at Orlando Orthopaedic Center, discusses how he goes about diagnosing concussions and the challenges involved in the process.
“We're going to talk a little about the diagnosis of concussions,” says Dr. McCleary. “Diagnosis is a very difficult part when it comes to concussions. Unfortunately, there are not many good or reliable tests that can conclusively diagnose a concussion. What it comes down to is the history of the event that happened which can be told by the athlete.”
“A lot of times recounting the event can come from a coach, an athletic trainer, or a parent that witnessed the injury. And certainly, they depict the aftermath of the injury and how the athlete acted and reacted after the injury. That account ends up being the most critical feature of how we diagnose concussions. There are some physical exam findings that we often look for especially immediately after the injury. Things like checking your balance, testing short-term memory and other types of memory recall from earlier in the day, and those types of things. And those things are best done immediately after the injury.”
“When we see the patient in the office after having had a suspected concussion it gets more difficult,” Dr. McCleary continues. “Most of the time the physical exam findings are going to be normal. One of the things we look for in a physical exam is to see if there is anything that could mimic a concussion but could be a more serious problem. Such as a bleed in the brain or a more severe head trauma. So, that's one of the main things we're looking for on the regular physical exam.”
“Other diagnostic tests such as MRIs and CT scans by definition are going to be normal for concussions. We also conduct computerized testing which is intended to be used for concussion follow-up to monitor the patient’s progress and see how well they're responding. It's typically not used as a true diagnostic tool. There are also a lot of things out there that people are studying such as different types of specialized MRIs, different types of blood tests and things like that. On the horizon, there may be some testing that can be done in the future to more conclusively diagnose concussions. But as it stands on right now, we're relying mostly on the history, a little bit on the physical exam and more importantly, ruling out the other bad things that could look like a concussion initially.”
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