It is estimated that between 1.6 and 3.8 million concussions occur annually in the United States. Although frequently regarded as benign, concussions can lead to multiple different adverse outcomes, including prolonged postconcussive symptoms, chronic traumatic encephalopathy, cognitive impairment, early onset dementia, movement disorders, psychiatric disorders, motor neuron disease, and even death. Therefore it is important to identify individuals with concussion to provide appropriate medical care and minimize adverse outcomes. Furthermore, it is important to identify individuals who are predisposed to sustaining a concussion or to having an adverse outcome after concussion. This article will discuss the current research on serum biomarkers for concussion, genetic influence on concussion, risk factors associated with concussion predisposition and poor outcome, and practical suggestions for the application of this information in clinical practice.

Treatment of musculoskeletal conditions in athletes with extracorporeal shockwave therapy (ESWT) is gaining popularity as greater evidence supports its use. ESWT protocols (describing energy flux density, number of impulses, type of shockwave (focused or radial), number/frequency/duration of treatment session, area of application, and postprocedural therapy protocols) can be adjusted in the clinical setting. Protocols vary across studies, and optimal protocols for most indications are yet to be determined. ESWT can safely be used to treat various musculoskeletal conditions in athletes, including rotator cuff tendinopathy, lateral elbow epicondlyopathy, greater trochanteric pain syndrome, hamstring tendinopathy, patellar tendinopathy, Achilles tendinopathy, other tendinopathies, plantar fasciopathy, bone stress injuries, and medial tibial stress syndrome. ESWT can be used to treat in-season athletes, as it often requires no/minimal time away from sport and may result in rapid benefits. ESWTshould be used in conjunction with physical therapy to facilitate longer-term gains in function and to optimize healing.

Write-zoom magnification may significantly increase the measured CSA of peripheral nerves. These changes appear to be more substantial when smaller nerves are measured.

Calcific rotator cuff tendinopathy caused by symptomatic calcium hydroxyapatite crystal deposition is a well-established cause of shoulder pain. In refractory or acutely symptomatic cases, sonographically guided percutaneous lavage and aspiration can significantly reduce pain in approximately 60%-92% of cases. Although the complication rate of sonographically guided percutaneous lavage and aspiration is apparently low, needle clogging attributable to impacted calcific debris has been described by several authors and in our experience can occur in daily practice. Traditionally, an inability to relieve the obstruction via needle repositioning or increased syringe plunger pressure has required needle removal and replacement. In this article, we outline a simple technique that can be used to restore patency of the obstructed lavage needle without necessitating needle removal and replacement.

High-resolution sonography can identify the PCNF and its distal epicondylar branches. Sonographic evaluation of the PCNF should be included in the evaluation of patients presenting with refractory or atypical lateral elbow pain syndromes. Diagnostic and therapeutic sonographically guided procedures targeting the PCNF or its lateral epicondylar branches are feasible and warrant further investigation.