Physical examination of dizziness in athletes after a concussion: A descriptive study

Jennifer C Reneker; Vinay K Cheruvu; Jingzhen Yang; Mark A James; Chad E Cook

doi:10.1016/j.msksp.2017.11.012

Physical examination of dizziness in athletes after a concussion: A descriptive study

Musculoskelet Sci Pract. 2018 Apr:34:8-13. doi: 10.1016/j.msksp.2017.11.012. Epub 2017 Nov 26.

Authors

Jennifer C Reneker¹, Vinay K Cheruvu², Jingzhen Yang³, Mark A James², Chad E Cook⁴

Affiliations

¹ Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States; Department of Physical Therapy, School of Health Related Professions, University of Mississippi Medical Center, Jackson, MS, United States; Department of Neurosurgery, School of Medicine, University of Mississippi Medical Center, Jackson, MS, United States. Electronic address: jreneker@umc.edu.
² Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States.
³ Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Dept. of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States.
⁴ Division of Physical Therapy, Department of Orthopaedics, Duke University, Durham, NC, United States.

PMID: 29197811
DOI: 10.1016/j.msksp.2017.11.012

Abstract

Background: Dizziness is commonly reported after concussion. With the forces experienced at the time of the injury, several anatomical locations may have been altered, causing dizziness.

Objective: Describe an objective examination and the types of impairment/dysfunction implicated by the results of clinical examination tests in subjects with dizziness after a concussion.

Design: Cross-Sectional.

Methods: Athletes between ages 10-23 were enrolled with a diagnosis of concussion. An examination was completed to identify areas potentially contributing to dizziness, including tests of oculomotor control, the vestibular system, neuromotor control, and musculoskeletal components of the cervical spine. Descriptive analyses were completed to define the anatomical areas/types of dysfunction identified by positive findings of the examination tests.

Results: All (n = 41; 100%) subjects had examination findings consistent with central dysfunction. Of these, 36 (97.8%) had oculomotor control deficits; 29 (70.7%) demonstrated motion sensitivity; and 6 (15%) had central vestibular deficits. Nineteen (46.3%) had peripheral dysfunction, including 18 (43.9%) with unilateral hypofunction, and 2 (4.9%) with Benign Paroxysmal Positional Vertigo. Thirty-four (82.9%) had cervical dysfunction, with 11 (26.8%) presenting with cervicogenic dizziness, and 31 (75.6%) with altered neuromotor control.

Conclusions: Functional injury to centrally-mediated pathways, specifically oculomotor control, and afferent and efferent pathways in the cervical spine are commonly identified through clinical examination tests in individuals with a complaint of dizziness post-concussion. According to results presented here, a high majority (90%) of the participants demonstrated dizziness that appeared to be multifactorial in nature and was not attributable to one main type of dysfunction. The common pathways between the systems make it difficult to isolate only one anatomical area as a contributor to dizziness.

Keywords: Concussion; Differential diagnosis; Dizziness; Physical examination.

MeSH terms

Adolescent
Adult
Athletes / statistics & numerical data*
Benign Paroxysmal Positional Vertigo / diagnosis*
Benign Paroxysmal Positional Vertigo / etiology*
Brain Concussion / complications*
Brain Concussion / physiopathology*
Child
Cross-Sectional Studies
Dizziness / diagnosis*
Female
Humans
Male
Physical Examination / methods*
Postural Balance / physiology*
Young Adult