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EMB Blog: 2022 Regular Season (and beyond?) - NO POLITICS


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3 minutes ago, eagle45 said:

I don’t entirely trust the concussion clearance mechanism in the nfl.

clearly it didnt work in the player's best interest in this case. 

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6 minutes ago, eagle45 said:

I don’t entirely trust the concussion clearance mechanism in the nfl.

That was part of the reason Calvin Johnson retired. He said that there is concussions throughout the game and still get sent back out on the field all the time even with the protocols 

 

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@eagle45

Would you care to go in to some detail on the difference between fencing response/decordicate/decertibrate posturing?

 

As we now know, that was a transient episode and he is conscious. For a while, we didnt know what his status was. What were your clues in the video?

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Look at that Bengals punt returner… I think they should try and lure Desean out of retirement to just do punt returns. 

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1 minute ago, EaglePhan1986 said:

Look at that Bengals punt returner… I think they should try and lure Desean out of retirement to just do punt returns. 

Shutup 

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5 minutes ago, HazletonEagle said:

@eagle45

Would you care to go in to some detail on the difference between fencing response/decordicate/decertibrate posturing?

 

As we now know, that was a transient episode and he is conscious. For a while, we didnt know what his status was. What were your clues in the video?

You may know... I sure don't.   This is all scary stuff.  Makes me sad that the sport I love the most is so dangerous.  

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6 minutes ago, HazletonEagle said:

@eagle45

Would you care to go in to some detail on the difference between fencing response/decordicate/decertibrate posturing?

 

As we now know, that was a transient episode and he is conscious. For a while, we didnt know what his status was. What were your clues in the video?

Didn't he have his eyes shut when his fingers were doing that?

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Incidentally, I don't want to blame the victim, but why on earth didn't he just run the ball to his left?  He went back to his right where the DL were... the field was pretty wide open to his left.    Shame.  Could have been completely avoided had he just moved to his left, and maybe thrown the ball away.

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2 minutes ago, HazletonEagle said:

@eagle45

Would you care to go in to some detail on the difference between fencing response/decordicate/decertibrate posturing?

 

As we now know, that was a transient episode and he is conscious. For a while, we didnt know what his status was. What were your clues in the video?

Fencing response is basically a reflex, just like the knee jerk spinal reflex.  It’s a normal reflex in infants that dissipates.  While the reflex arc is preserved, it’s suppressed by inhibitory tone in adults.  If the brainstem is concussed, that inhibitory done can be transiently interrupted.

True posturing is a result of sustained brainstem dysfunction, decorticate vs decerebrate indicating the level of the injury.  But in these instances, only one signal is making it down to the spinal cord and muscles…ie flexor or extensor posturing.  That can be triggered with a painful stimulus.  
 

immediately after the injury, he had that fencer response and then lost tone, so that’s the reflex.  Posturing would be sustained tone.

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10 minutes ago, Mike030270 said:

Didn't he have his eyes shut when his fingers were doing that?

They were. 

8 minutes ago, eagle45 said:

Fencing response is basically a reflex, just like the knee jerk spinal reflex.  It’s a normal reflex in infants that dissipates.  While the reflex arc is preserved, it’s suppressed by inhibitory tone in adults.  If the brainstem is concussed, that inhibitory done can be transiently interrupted.

True posturing is a result of sustained brainstem dysfunction, decorticate vs decerebrate indicating the level of the injury.  But in these instances, only one signal is making it down to the spinal cord and muscles…ie flexor or extensor posturing.  That can be triggered with a painful stimulus.  
 

immediately after the injury, he had that fencer response and then lost tone, so that’s the reflex.  Posturing would be sustained tone.

Thanks for that. I love learning new stuff. 

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14 minutes ago, eagle45 said:

Fencing response is basically a reflex, just like the knee jerk spinal reflex.  It’s a normal reflex in infants that dissipates.  While the reflex arc is preserved, it’s suppressed by inhibitory tone in adults.  If the brainstem is concussed, that inhibitory done can be transiently interrupted.

True posturing is a result of sustained brainstem dysfunction, decorticate vs decerebrate indicating the level of the injury.  But in these instances, only one signal is making it down to the spinal cord and muscles…ie flexor or extensor posturing.  That can be triggered with a painful stimulus.  
 

immediately after the injury, he had that fencer response and then lost tone, so that’s the reflex.  Posturing would be sustained tone.

Thank you!

I was thinking it looked a lot like decordicate flexion. But the clue was how quickly it went away.  Correct?

I have seen a lot of concussions but I have yet to see a fencing response, or worse (thankfully). How do you know the tone went away? Would he have been too rigid to position they way they had him on the spine board?

 

Something else, speaking of my experience- for the first time ever, this week, I had a kid with head to head impact that had facial numbness and tingling. This happened at an away event. I received a text, and email from the trainer there and the kid was kept out of the rest of the game. All symptoms were said to have resolved within an hour. I didnt see the kid till 2 days later in the training room.  I was concerned if he was going to present with some delayed onset palsy from an injury to his facial or trigeminal nerve and potential skull fracture. Thankfully everything appeared ok. 

That was just something a little different for me, and interesting, and stressful till I got to see him. 

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1 minute ago, HazletonEagle said:

Thank you!

I was thinking it looked a lot like decordicate flexion. But the clue was how quickly it went away.  Correct?

I have seen a lot of concussions but I have yet to see a fencing response, or worse (thankfully). How do you know the tone went away? Would he have been too rigid to position they way they had him on the spine board?

 

Something else, speaking of my experience- for the first time ever, this week, I had a kid with head to head impact that had facial numbness and tingling. This happened at an away event. I received a text, and email from the trainer there and the kid was kept out of the rest of the game. All symptoms were said to have resolved within an hour. I didnt see the kid till 2 days later in the training room.  I was concerned if he was going to present with some delayed onset palsy from an injury to his facial or trigeminal nerve and potential skull fracture. Thankfully everything appeared ok. 

That was just something a little different for me, and interesting, and stressful till I got to see him. 

That’s exactly right…the relaxation of the tone helped give it away.  He was resting on the board without any ongoing tone.  If he was posturing, they still can/should get him on the board, but it would look different.

The trigeminal nerve is about half of my career actually.  It’s extremely robust and is almost never damaged from general head trauma or skull fracture.  Some peripheral branches can be damaged from facial fractures…or simply contused, so that is more likely.

The facial nerve can be damaged more easily though, but that would present with pure motor weakness.

Cranial nerve injuries are *usually* reserved for skull base fractures which *usually* come from traumatic mechanisms more significant that we’d find in sports.

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12 minutes ago, eagle45 said:

That’s exactly right…the relaxation of the tone helped give it away.  He was resting on the board without any ongoing tone.  If he was posturing, they still can/should get him on the board, but it would look different.

The trigeminal nerve is about half of my career actually.  It’s extremely robust and is almost never damaged from general head trauma or skull fracture.  Some peripheral branches can be damaged from facial fractures…or simply contused, so that is more likely.

The facial nerve can be damaged more easily though, but that would present with pure motor weakness.

Cranial nerve injuries are *usually* reserved for skull base fractures which *usually* come from traumatic mechanisms more significant that we’d find in sports.

Good stuff. Thanks for the discussion.

This was a soccer player so no protection like a football helmet. kid had head to head with the opponents head striking him right around the ear area. He pointed just a little behind the ear when he explained the injury to me.

I have had one skull fx before. Again lucked out and it was an away game. Soccer ball blew out a kids orbit. And whatever all those small bones are behind it. He had a bunch of stuff fractured in there.

On this one, I was happy that the trainers email to me mentioned no battle sign, no halo sign, able to make facial expressions... Thats way more detailed than I ever go in to for each concussion eval but I suppose he had the same concerns I did when the kid said his face was numb and tingling. 

A contusion to some facial nerve branch was the top of my differential.

Of course, I had never dealt with that symptom before in a head injury so I was reading online trying to be well prepared for when I saw the kid. I read a case study with some delayed onset stuff from what turned out to be a fx and then my wheels were turning... Like oh crap I hope hes not gonna come in like this tomorrow. Trainer seemed to do all the right stuff but what if there is delayed onset from edema or something compressing the nerve?

I did check in with the AD that day to see if the kid was in school and how he was feeling. At that point, I wasnt going to wait an extra day if I heard anything seemed off. 

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Dolphins should trade for Foles.  He'd be their best option at this stage in the game with that loaded offense.  Teddy is the original Two Gloves.  They aren't going to go anywhere with him.  

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9 minutes ago, MillerTime said:

Wish me luck. 196k people

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Hope that big Chase catch didnt hurt your position there. 

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1 minute ago, HazletonEagle said:

Hope that big Chase catch didnt hurt your position there. 

Nope, just need to dodge edmunds points i think

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1 minute ago, MillerTime said:

Nope, just need to dodge edmunds points i think

another TD for Burrow to give you more cushion. Nice!

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