Dr. Brett Jarosz
BAppSc(CompMed), MClinChiro, ICSSD,
PGradDipSportsChiro, DACNB, CertPT, FICC
Head Injury in Sport – Case Study #1 – 27-year-old male
In the following case study, you will be following a 27-year-old male. As you go along, you will be given information about the patient. You will also be asked to answer a series of questions about the patient.
Make your way through the case studies and at the end, you will be presented with a conclusion for you to reflect on how you went.
Pre-History Question: What history questions would you specifically ask this athlete (a 27-year-old male who was struck in the head during a rugby game)?
HISTORY: Twenty-seven-year-old male presented after having sustained traumatic knee to the right temporal region of his cranium the day before (August 12th, 2017). At the time of trauma, the subject reported a flash of light, minor (4/10) dull headache that followed, and 4/10 pain with extension. Upon presenting to staff working rugby tournament on August 13th the headache and pain with extension remained the same as the initial onset. The flashing of light was not present after the initial impact.
The subject reported two previously diagnosed concussions and several other traumas never fully diagnosed or explored medically. The patient has been in football for 8 years of age all the way into college. The patient has played rugby for approximately the past 4 years.
Pre-Examination question: What specific examination procedures would you perform on this athlete?
Post Examination Questions: What are your differential diagnoses now that you have completed the examination portion?
• Have your differential diagnoses changed or stayed the same?
• Are there other examination components you would complete at this time?
Pre-Treatment and Recommendation Questions
Based on the athlete’s current history and your examination findings, does this athlete need to be referred for further testing?
• Is this athlete a candidate for chiropractic care?
• How would you proceed with treatment?
Treatment and Recommendations
During the first treatment, the subject was treated with manual spinal manipulation to the noted segmental dysfunctions and muscle release technique to the upper trapezius bilaterally. Patient-reported immediate 50% improvement of pain with extension and increased extension range of motion.
Two hours later the subject returned for further treatment and assessment. Pain at the site of trauma was similar to previously, headache pain reduced to 2/10, and further increased extension with a reduction to 1/10 pain. Instrument assisted soft tissue mobilization of the sub-occipitals, upper trapezius, levator scapulae, rhomboids, and general musculature of the cervical regions for a duration of 8 minutes was performed during the second encounter.
Headache reduced to 1/10 after the second treatment and neck pain with extension subsided
Conclusion of Care and Outcome:
The patient was referred to a chiropractor in the home region for follow-up care. The patient was called three weeks after the tournament as a follow-up. The patient was unable to receive referred care due to a new job that limited their ability to access a doctor. The headaches and treated symptoms remained minor for one week following treatment then started an increase in intensity. The headache returned during work when the patient had to look at electronic screens for a prolonged period. The patient also noted a slight mental fogginess present during these periods that would last until he rested. They had absentmindedness resulting in them forgetting the name of someone temporarily but was unsure if it was only after the incident or associated with the trauma. They started to have some light sensitivity as well. They did not recall difficulty with cervical range of motion. A headache would begin to return during exertion.
All of these symptoms started to reduce several days before the phone call, approximately two and a half weeks post-trauma. However, the patient was still having minor symptoms off and on. They planned to follow-up with a provider when possible.