Your SlideShare is downloading. ×
Kin 188  Head And Neck Evaluation And Injuries
Upcoming SlideShare
Loading in...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.

Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Kin 188 Head And Neck Evaluation And Injuries


Published on

Published in: Health & Medicine
1 Like
  • Be the first to comment

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

No notes for slide
  • Transcript

    • 1. KIN 188 – Prevention and Care of Athletic Injuries Head and Neck Evaluation and Injuries
    • 2. Anatomy
    • 3. Anatomy
      • Bony anatomy
      • Brain
      • Meninges
    • 4. Bony Anatomy
      • Skull
        • Provides protection for brain
        • Reduces forces transmitted to brain (thickness and shape)
      • Occipital bone
        • Inion – “bump of knowledge”
      • Parietal bones
      • Frontal bone
      • Temporal bones
      • Sphenoid bones
    • 5. Bony Anatomy
    • 6. Brain
      • Cerebrum
      • Cerebellum
      • Brainstem
    • 7. Brain
    • 8. Cerebrum
      • Anatomy
        • Two hemispheres separated by longitudinal fissure
        • Each hemisphere has frontal, parietal, temporal and occipital lobes
        • Sulci and fissures form contours
      • Function
        • Controls primary motor functions
          • Gross and sequenced, coordinated movements
        • Processes sensory information
          • Temp, touch, pain, pressure, proprioception, vision, hearing, smell, taste
        • Cognitive function
          • Spatial relationships, behavior, memory
    • 9. Cerebellum
      • Located at posterior and inferior aspect of brain
      • Two hemispheres separated by fissure
      • Processing center for incoming and outgoing information relative to maintaining balance and coordination
        • Quick link to cerebrum for processing sensory information
        • Quick link to musculoskeletal system to carry out proper muscular contractions and joint movements
    • 10. Brainstem
      • Relays info to and from central nervous system and controls involuntary systems
      • Medulla oblongata
        • Links cerebrum to brainstem and spinal cord
        • Regulates heart and respiratory rates, vascular changes, coughing, vomiting
      • Pons (“bridge”)
        • Links cerebellum to brainstem and spinal cord
        • Regulates respiratory rate
    • 11. Meninges
      • Collectively, support and protect brain and spinal cord
      • Dura mater (“tough/hard mother”)
      • Arachnoid mater (spider web appearance)
      • Pia mater (“little mother”)
    • 12. Meninges
    • 13. Evaluation
    • 14. Primary Survey
      • Stabilize cervical spine
      • A – Airway
        • Ensure that airway is clear (mouthpiece, tongue, etc.)
      • B – Breathing
        • Look, listen and feel
      • C – Circulation
        • Evaluate for presence carotid pulse
      • D – Disorientation/Dysfunction
        • Conscious vs. unconscious
    • 15. Unconscious Athlete
      • Activate EMS
      • Must assume that athlete has head and/or cervical spine injury
      • If ABCs not intact, must initiate rescue breathing or CPR
      • If ABCs intact:
        • Establish and monitor vital signs
        • Evaluate pupil response (PEARL)
        • Palpate skull and c-spine for deformity, swelling, etc.
    • 16. Conscious Athlete – Secondary Survey
      • Assumes ABCs intact – establish and monitor vital signs
      • History
        • Loss of consciousness, mechanism of injury, symptoms (pain, numbness/tingling, etc.)
        • Orientation x 4 (self, others, place, time)
      • Inspection
        • Skull/c-spine alignment
      • Palpation
        • For bony deformity, swelling, muscle spasm (guarding)
      • Neurological screening
        • Sensory testing (dermatomes) compared bilaterally
        • Motor testing not performed clinically – if all other symptoms negative, may ask to wiggle fingers and toes to establish distal motor function
    • 17. History
      • Location of symptoms
      • Mechanism of injury/etiology
        • Head vs. cervical spine
      • Loss of consciousness
      • Prior history of head injury
      • Complaints of weakness
    • 18. Location of Symptoms
      • Cervical pain or muscle spasm
        • More concerning if accompanied by numbness, tingling, burning sensations and/or radiating pain
      • Head pain
        • If localized, may indicate contusion, skull fracture and/or intracranial bleeding
        • Most common complaint is headache
    • 19. Mechanism of Injury
      • Head injuries
        • Coup – stationary skull struck by high velocity object, results in trauma at site of impact
        • Contrecoup – moving skull strikes a non-moving object, brain “floats” and strikes skull opposite impact causing trauma
        • Repeated subconcussive forces – cumulative neurological deficits
        • Rotational or shear forces – sudden acceleration/deceleration forces, can disrupt CNS activity and result in concussive symptoms
      • Cervical spine injuries
        • May involve any ROM (flexion, extension, lateral flexion and/or rotation – may be combined)
        • If flexed ~30 degrees, lordotic curve is lost and cervical spine most susceptible to axial load injury (unable to dissipate forces)
    • 20. Other Historical Elements
      • Loss of consciousness
        • Component of memory evaluation
        • Can athlete or others establish whether there was or was not momentary loss of consciousness
      • History of concussion
        • Recent history of prior concussion increases risk of second impact syndrome
      • Complaints of weakness
        • Reports of weakness in extremities may indicate brain, spinal cord and/or nerve root injury
    • 21. Inspection
      • Bony structures
      • Eyes
      • Nose and ears
        • Otorrhea
        • Rhinorrhea
    • 22. Bony Injuries
    • 23. Eye Ecchymosis
    • 24. Palpation
    • 25. Palpation of Bony Structures
      • Skull
        • Palpate all cranial bones for pain and deformity
      • Spinous processes
        • Palpate cervical spinous processes for pain and crepitus associated with fracture
    • 26. Palpation of Soft Tissues
      • Musculature
        • Palpate sternomastoid and upper trapezius muscles for spasm secondary to strain, sprain, fracture and/or dislocation
      • Throat
        • Palpate thyroid cartilage, cricoid cartilages and hyoid bone to rule out larynx and tracheal injury
    • 27. Special Tests
    • 28. Special Tests
      • Range of motion
      • Functional testing – evaluates function of central nervous system (CNS)
        • Orientation x 4
        • Memory
        • Cognitive function
        • Balance and coordination
        • Vital signs
    • 29. Range of Motion
      • Active/passive/resistive neck flexion
        • Chin to chest
      • Active/passive/resistive neck extension
        • Look directly above head
      • Active/passive/resistive neck rotation
        • Chin almost in line with shoulder
      • Active/passive/resistive neck lateral bending
        • Approximately 45 degrees to each side
    • 30. Orientation
      • Orientation x 4
        • Self
          • Own name
        • Place
          • General sense of location
        • Time
          • General sense, use point in game practice
        • Others
          • Athletic trainer, coaches, teammates, etc.
    • 31. Memory
      • Retrograde amnesia
        • Difficulty or inability to remember events preceding the injury – more severe if can’t remember events of day before as opposed to more recent events
        • Some assessed with orientation x 4, pre-game meal?, who played last game?
      • Anterograde amnesia
        • Difficulty or inability to remember events after the onset of injury
        • Athlete given verbal list of items and asked to repeat them serially over time
    • 32. Cognitive Function
      • Brain injury can present as abnormal behavior, personality changes, inability to process information accurately
      • Behavior
        • May become violent, belligerent, etc. - abnormal
      • Analytical ability
        • Typically assessed with serial number repetitions or spelling forward/backward
      • Information processing
        • Cannot follow simple instructions
    • 33. Balance and Coordination
      • Evaluation for possible cerebellar injury affecting muscle coordination
        • Romberg test – single leg stance with shoulders abducted 90 degrees, eyes closed and head back
        • Tandem walking – heel to toe walking forward and backward along straight line
        • Finger to nose – rapid alternating movements
    • 34. Vital Signs
      • Pulse rate, respiratory rate, blood pressure taken early in evaluation process to establish baseline and repeated serially for comparison
    • 35. Injuries
    • 36. Injuries
      • Head injuries
        • Concussion
        • Post-concussion syndrome
        • Second impact syndrome
        • Intracranial hemorrhage
          • Epidural hematoma
          • Subdural hemtoma
        • Skull fracture
      • Cervical spinal cord injuries
        • Cervical spine fracture/dislocation
        • Quadraplegia
    • 37. Concussion
      • Cerebral concussion = mild traumatic brain injury (MTBI)
      • Hallmark symptoms include mental confusion, altered mental status, amnesia and potential loss of consciousness
      • Multiple occurrences may produce cumulative degenerative effects
      • Ultimate assessment based upon duration of loss of consciousness (if any) and neuropsychological findings
    • 38. Concussion
      • Additional symptoms of concussion may include but are not limited to:
        • Headache
        • Dizziness
        • Tinnitus
        • Nausea/vomiting
        • Motor impairment
        • Memory loss
    • 39. Concussion Rating Systems
      • Guidelines for identifying concussion severity and determining return to play timeline – often considered conservative for athletic population
      • Significant differences between scales – be consistent with scale utilized
      • American Academy of Neurology
      • Cantu Concussion Rating Guidelines
      • Colorado Medical Society Concussion Rating Guidelines
    • 40. Return to Play Criteria
      • Multiple factors to consider include whether or not loss of consciousness occurred, duration of symptoms, total number of concussive episodes, exertional testing
      • Universal agreement that individual who lost consciousness for any period of time should not be allowed to return to activity on the same day even if all symptoms have resolved
    • 41. Post-Concussion Syndrome
      • Individuals may present with concussion symptoms long after “normal” resolution would have occurred
      • Common symptoms include
        • Decreased attention span
        • Difficulty concentrating
        • Memory impairment
        • Prolonged headaches
        • Balance impairments
        • Decreased cognitive function
    • 42. Second Impact Syndrome
      • Defined as symptoms resulting from second concussive episode before symptoms of first concussive episode have resolved
        • Entirely preventable, return to play considerations
      • Second trauma typically not as violent as initial injury – thought to affect brain blood supply causing increased intracranial pressure which impacts brainstem function
      • Quick progression from mild concussive symptoms to comatose state
      • Even if treated appropriately, has ~50% mortality rate
    • 43. Intracranial Hemorrhage
      • Named for location relative to meningeal layers
        • Epidural hematoma
        • Subdural hematoma
      • Caused by injury to blood vessels supplying brain blood supply
      • Increased pressure from bleeding in confined space compresses neural tissue
      • Onset of symptoms associated with nature of bleeding – venous vs. arterial (lucid interval)
    • 44. Epidural Hematoma
      • Arterial bleeding between skull and dura mater
      • Initially may present with concussive symptoms
      • Short lucid interval (typically <48 hours)– individual appears “OK”
        • Due to arterial nature of bleeding
      • Subsequently may c/o disorientation, confusion, drowsiness, increasing headache intensity, signs of cranial nerve changes (esp. pupil changes)
      • If untreated, can be fatal
    • 45. Subdural Hematoma
      • Venous bleeding between brain and dura mater
      • May not present with symptoms of concussion
      • Longer lucid interval – may be hours, days or weeks before symptoms present
        • Due to venous nature of bleeding
      • Subsequent development of headaches, confusion, changes in cognitive/motor abilities, cranial nerve changes
      • More likely to cause death due to lack of recognition of nature/source of symptoms and delay in subsequent treatment
    • 46. Skull Fractures
      • Minimal risk with head protection, but may still suffer bony injury
      • May cause CSF leakage from nose/ear, may have residual/secondary ecchymosis
      • Linear
        • Hairline fractures in bone
      • Comminuted
        • Multiple fracture fragments
      • Depressed
        • Easier to identify on evaluation – gross deformity
        • Potential for fragments to injure meninges/brain
    • 47. Cervical Spinal Cord Injuries
    • 48. Cervical Spinal Cord Injuries
      • Risk minimized with rules and coaching emphasis changes
      • Spinal cord injury caused by
        • Impingement/laceration from bony displacement
        • Compression from bleeding, swelling, ischemia to cord
      • Mechanism of injury is key to decisions on management
        • Must assume worst case scenario until proven otherwise
      • Trauma at spinal cord level affects function distal to level of injury
        • At or above C4 level – death is likely due to impact on brainstem and vital functions
    • 49. Cervical Fracture/Dislocation
      • Spinal cord injury typically secondary to actual bony injury from swelling, bony fragment displacement, etc.
      • With dislocation, diameter of canal for spinal cord is impacted and can compress spinal cord
      • Must differentiate between spinal cord symptoms and brachial plexus injury symptoms (longer duration vs. transient symptoms)
      • Often treat with steroid injections to limit swelling and subsequent pressure on spinal cord with these injuries
    • 50. Quadriplegia
      • Transient quadriplegia often results from cervical hyperextension, hyperflexion and/or axial loading
      • Several predisposing factors
        • Cervical stenosis
        • Cervical spine instability
        • Posterior arch abnormalities of cervical spine
      • If truly transient, symptoms often resolve within 48 hours