Why I Like The King-Devick Concussion Tool

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • The King Devick test is an easy, fast, and reliable objective assessment tool used as part of a concussion assessment program
  • The test involves rapid number naming on an iPad screen and can be used by non-medically trained individuals as well as medical personnel
  • We find it to be a very useful tool and use it often with our young athletes

I really like the King Devick rapid number naming test as part of a comprehensive concussion assessment program. We find it to be easy, fast, reliable, and with a large amount of independent scientific studies vouching for its validity. At the high schools I work with we use the King Devick in our preseason concussion baseline assessment and then use it as a part of our comprehensive evaluation for in-game concussions. I’d recommend you consider using it too. (Neither I, nor Sideline Sports Doc have any financial relationship with the company).

The test is performed on an iPad (there is a paper version available but you may need to contact the company directly for details on this), and involves the individual reading out loud a series of numbers that are shown at irregular intervals on the screen. The test is timed. The method tests the athlete’s ability to concentrate as well as the eye movements. We obtain a pre-season healthy baseline and then perform the test immediately after a suspected concussion on-field. Any increases in time post-injury compared to the baseline are suggestive of a concussion.

Concussion assessment involves evaluation of several areas and at least so far, there is no single perfect tool to definitively provide a sideline concussion diagnosis. A skilled athletic trainer or physician will assess how the injury occurred, check the athlete for concussion symptoms, and then perform a number of tests to assess cognitive function, memory, and balance. We use the King Devick as one component of the evaluation.

Our practical experience shows that the test is well accepted by the young athletes, and it’s difficult to “game” the system. We emphasize the importance of proper baseline testing to the athlete and have found very few who intentionally take a long time to do the baseline test. Plus there are well established ranges for “normal” and if an athlete deviates from the normal range we investigate further.

As we head into fall sports seasons for schools and leagues I’d like to remind everyone of some basic safety principles. First, make sure you spend some time on preventive planning!  If you’re a club or league be sure to have an emergency action plan and practice it in advance.

Make sure your coaches are properly trained in injury recognition, especially for the common injuries specific to your sport as well as concussion recognition. Hire an ATC for tournaments, or for your club if you can afford that. Pay very close attention to field equipment conditions (e.g. goal post properly secured). And finally, I’d strongly recommend an AED kept at a central location.


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Staying Healthy in the NBA vs NFL

Mark Bartelstein from Priority Sports & Entertainment, Dr. Brian Cole (@BrianColeMD) and Steve Kashul discuss Bartelstein’s client Micheal Porter Jr. and protecting his best interest, his rehab and evaluating his long-term prognosis. Bartelstein discusses the difference between staying healthy in the NBA and the NFL.

PRIORITY SPORTS is a full service management firm, with over 25 years of experience, comprised of honest, ethical, hard-working, passionate and productive professionals who make it a point to build long lasting and meaningful relationships with our athletes.

In the NFL

  • PRIORITY SPORTS has been named one of the top football agencies by ESPN in each of their last five rankings.
  • PRIORITY SPORTS has the experience of representing more than 30 First Round Draft Picks.

In the NBA

  • PRIORITY SPORTS has the experience of representing more than 20 First Round Draft Picks.
  • PRIORITY SPORTS has negotiated over a BILLION dollars in contracts in the last 3 years alone.

Sports Medicine Weekly on 670 The Score

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Rotator Cuff Repair For Young Athletes: An Uncommon Operation With Excellent Results

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Rotator cuff tears requiring surgery are uncommon in young athletes
  • Surgery typically leads to excellent function and very high return to sports at the same level or higher, although overhead athletes may need to change positions

The rotator cuff is a term used to describe a group of four tendons at the top of the shoulder responsible for movement and stability of the shoulder joint. We’ll typically see rotator cuff tears in older athletes. In young athletes the most common issue with the rotator cuff is an overuse tendonitis, and occasionally a partial tear. A complete detachment of the rotator cuff from the bone is very uncommon in young athletes, but it can happen. When a detachment happens it will require surgery for the young person to have the best chance of full function. Fortunately surgery can lead to excellent results.

At the James Andrews sports medicine center in Birmingham, Alabama, they have quite a bit of experience with rotator cuff tears. In this published study, they report on 2-year follow up of young athletes with rotator cuff tears who underwent surgical repair. Attesting to the rarity of this problem, in an 8 year period at this very high volume clinic they identified 32 athletes (28 boys and 4 girls) with an average age 16 years.

Each athlete played at least 1 sport, and 27 athletes had no shoulder issues prior to the start of their pain. Twenty-nine of the 32 tears resulted from a traumatic event.

The athletes all had surgery at the Andrews Center. Overall, 25 patients (93%) returned to the same level of play or higher. Among overhead athletes, 13 (93%) were able to return to the same level of play, but 8 (57%) had to change positions.

Surgery for rotator cuff tears can lead to excellent outcomes in young athletes, but what we find from these results is that overhead athletes could have difficulties returning to the same position after surgery.Logo

If you’re a young athlete with a complete detachment of the rotator cuff you’ll likely need surgery to best restore shoulder function for sports as well as other activities. These uncommon injuries would best be managed by a physician with substantial experience in treating shoulder injuries.

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The World’s Most Watched Sports Physicals

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Point:

  • The real purpose of the NFL Combine is to do preparticipation physical exams on the athletes entering the NFL draft

Will Sam Darnold throw? Apparently not. Will a “sleeper” rise to the top of the charts based on stellar performance? We’ll see. This week is the NFL Combine, the annual scouting evaluation taking place in Indianapolis.

My Stanford partners Drs. Tim McAdams (49ers head team physician) and Geoff Abrams will be attending, along with team doctors from all the other NFL teams. Geoff tells me they are expecting to do medical evaluations on close to 400 players in the next 4 days.

Just about every NFL fan is somewhat familiar with the “NFL Combine” held each spring prior to the NFL draft. This event is now a mind-numbing televised display of 40-yard dash times, shuttle runs, bench press reps, etc. But how many of you know the real purpose of the NFL Combine?

Well, the key purpose of the NFL Combine is to provide medical exams for the players entering the NFL draft- it is their preparticipation physical exam. The NFL Combine is properly called the National Invitational Camp and the first camp was held in 1982. The need for the camp arose out of a need from team executives and medical staff to determine the physical health of the players entering the draft.

Prior to 1982 there was no standardized way to assess player health coming out of college. The Combine was a way to do very detailed health assessments including possible heart and lung ailments, concussion history, and of course orthopedic history. Team medical staff will assign clearance classifications or grades to athletes that often attempt to predict future risk or effects on performance. Many millions of dollars ride on these assessments.

The players are broken up into position groups and then cycle through the various examSideLineSportsDoc rooms so that they meet with the medical staff for all 32 teams. The players are required to fill out medical histories but as you can imagine they may be reluctant to disclose everything, given that their athletic futures are on the line here. But these days the teams and their staff are pretty skilled at finding the information they need.

If you’re a true NFL junkie then take heart: the 2018 NFL season is underway.

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