What causes less strength and stamina after a concussion?

Posted on Mon, 24 Mar 2014

Question: A friend had a concussion. His severe headache, stumbling etc seemed to go away after 2-3 months but he still has less strength and stamina in his hands (which is a problem, because he does fine detailed work with his hands. I wonder what is causing the problem and what can be done (now 2 years since the injury). My friend is a 40 year old male.

Answered by Dr. Sudhir Kumar (27 minutes later)

Brief Answer: Physical therapy is the best option. Detailed Answer: Hi, Thank you for posting your query. I have noted the medical details of your friend and it is unfortunate to note that he still has less strength and stamina in his hands two years after brain injury. At this stage, medications would be of limited benefit. The best treatment option would be muscle strengthening exercises, physiotherapy, and occupational therapy under the guidance of a rehabilitation expert. Further investigations may be needed to establish the severity and cause of his problem. This may include doing an MRI scan of brain and nerve conduction studies of his hands. I hope my reply has helped you. I would be pleased to answer, if you have any follow up queries or if you require any further information. Best wishes, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Sudhir Kumar (11 hours later)

I have spoken with him today. This is now the third concussion injury he has had. The numbness and vibration - tingling in hands has been a symptom each time and each time the symptoms are more severe. This time he recovered to the point that it now occurs only for a matter of seconds, a couple of times per day or when working with head tilted forward. What is the explanation for how the brain injury causes this problem?

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer: The explanation is below. Detailed Answer: Hi, Thank you for getting back. There are specific areas in the brain, which controls different body parts. The frontal lobe controls the legs and parietal lobe the hands, though there may be overlap between the two regions. So, it is possible that your friend has damage to his frontal or parietal lobes due to brain injury. This injury can explain his current symptoms. The area of brain injury can be confirmed, as I said earlier, by doing an MRI scan of brain. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (11 hours later)

Thanks, He says he had an MRI which could not identify anything conclusively. With concussions, s it possible that there could be damage that does not show up on MRI - if so, what might that be called?

Answered by Dr. Sudhir Kumar (1 hour later)

Brief Answer: Yes, it is possible. Detailed Answer: Thank you for getting back. Yes, brain injury may not get picked up on MRI. MRI picks up injuries such as bleeding or hematoma and contusion, however, concussion may not get picked up. This injury happens at the neuronal/cellular level, which is too small to be seen on MRI, which can show problems that are at least 1-2 mm in size. This injury is sometimes called as diffuse axonal injury. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar