MSK-17 · Sports Medicine

Sports Medicine. Topics: Concussion, Return-to-Play Protocol, and Stingers. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: Once herniation occurs, the mortality approaches 100%. — Correct: Second impact syndrome carries roughly 50 percent mortality and near-100 percent morbidity. There is no herniation subgroup in which mortality rises to 100 percent; the 100 percent figure belongs to morbidity, and essentially every survivor is left with severe permanent neurologic disability. (2) In the audio: steps that creates a six day absolute floor. — Correct: Six days is the arithmetic of six steps at 24 hours each, but both the 2016 and 2022 consensus statements state a minimum of about one week to complete the graduated return-to-sport strategy. The 24 to 48 hours of relative rest before step 1 sits outside that clock. (3) In the audio: It is functionally impossible to clear the protocol in less than six days. — Correct: The stated consensus minimum is at least one week from the start of the protocol, not six days. (4) In the audio: The rules dictate that you drop back exactly one step. — Correct: The uniform drop-back-one-step rule is the 2016 version. Under the 2022 consensus, more than mild symptom exacerbation during steps 1 to 3 means stopping and retrying the same step the next day, while symptom recurrence during steps 4 to 6 returns the athlete to step 3. (5) In the audio: He drops back to step two. — Correct: The athlete in the example recurred at step 3, which under the 2022 consensus means retrying step 3 the next day rather than dropping to step 2. Only recurrence in steps 4 to 6 sends the athlete back a step, and then to step 3. (6) In the audio: The strict parameters are keeping the heart rate below 70 percent of maximum — Correct: 70 percent is the ceiling for step 2 as a whole. The 2022 consensus grades the step: 2A light activity to about 55 percent of maximum heart rate, then 2B moderate activity to about 70 percent. (7) In the audio: menstrual dysfunction, and bone stress injury. — Correct: The third component of the female athlete triad is low bone mineral density. Bone stress injury is its clinical consequence, not the named component. (8) In the audio: modified balance error scoring system utilizing three 20-second stances with eyes closed and finger to nose. — Correct: The modified Balance Error Scoring System is the three stances only. Finger-to-nose is the separate coordination component of the tool, not part of the balance test. (9) In the audio: His cognitive test is 24 out of 30 — Correct: The SCAT-6 Standardized Assessment of Concussion totals 50 points, not 30, because immediate memory now uses a 10-word list over three trials (30 points) with 10-point delayed recall. The chapter vignette has been rescaled to 38 of 50 against a 46 of 50 baseline. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-17.