shoulder acromioclavicular (ac) separation glenohumeral dislocation elbow olecrannon bursitis...

ShoulderShoulder acromioclavicular acromioclavicular (AC) separation(AC) separation glenohumeral glenohumeral dislocationdislocation

ElbowElbow olecrannon bursitisolecrannon bursitis

Upper ExtremityUpper ExtremityUpper ExtremityUpper Extremity

WristWrist distal radius fracturedistal radius fracture scaphoid (navicular) scaphoid (navicular) fracturefracture ECU (tendon) ECU (tendon) subluxation/dislocationsubluxation/dislocation DRUJ (ligament)DRUJ (ligament)sprainsprain


HandHand ulnar collateral (thumb ulnar collateral (thumb ligament) sprainligament) sprain phalanx (finger)phalanx (finger)fracturefracture


Abdomen/Groin/HipAbdomen/Groin/Hip athletic pubalgiaathletic pubalgia adductor (groin) strainadductor (groin) strain iliopsoas/rectusiliopsoas/rectus(hip flexor) strain(hip flexor) strain

Lower ExtremityLower ExtremityLower ExtremityLower Extremity

KneeKnee MCL sprainMCL sprain ACL sprainACL sprainquadriceps contusionquadriceps contusion


AnkleAnklemalleolar bursitismalleolar bursitis distal fibula fracturedistal fibula fracture syndesmosis/lateral syndesmosis/lateral ligamentligamentsprainsprain


• FootFoot contusion/fracturecontusion/fracture calcaneal bursitiscalcaneal bursitis


Catastrophic InjuriesCatastrophic Injuries

• Traumatic Traumatic BrainBrain Injury Injury (Concussion)(Concussion)

• Cervical Cervical SpineSpine Fracture/DislocationFracture/Dislocation (± spinal cord injury)(± spinal cord injury)

• Cervical Cervical SpineSpine Fracture/DislocationFracture/Dislocation (± spinal cord injury)(± spinal cord injury)

• EyeEye Injuries Injuries• EyeEye Injuries Injuries

Catastrophic InjuriesCatastrophic Injuries• Upper AirwayUpper Airway

(larynx, hyoid, soft tissues)(larynx, hyoid, soft tissues)• Commotio CordisCommotio Cordis

(chest blow)(chest blow)• Subarachnoid HemorrhageSubarachnoid Hemorrhage

(neck blow)(neck blow)• Spleen Spleen RuptureRupture• Neck Neck LacerationLaceration

ConcussionConcussion

ConcussionConcussion may be caused by a may be caused by a direct blow to the head, face, direct blow to the head, face, neck or elsewhere on the body neck or elsewhere on the body that results in an that results in an impulsive force impulsive force transmitted to the headtransmitted to the head causing causing a rapid onset ofa rapid onset of short-lived short-lived impairment of neurologic impairment of neurologic functionfunction that that resolves resolves spontaneouslyspontaneously..

ConcussionConcussion may be caused by a may be caused by a direct blow to the head, face, direct blow to the head, face, neck or elsewhere on the body neck or elsewhere on the body that results in an that results in an impulsive force impulsive force transmitted to the headtransmitted to the head causing causing a rapid onset ofa rapid onset of short-lived short-lived impairment of neurologic impairment of neurologic functionfunction that that resolves resolves spontaneouslyspontaneously..

SymptomsSymptoms: unaware of situation, : unaware of situation, confusion, amnesia, loss of confusion, amnesia, loss of consciousness, headache dizziness, consciousness, headache dizziness, nausea, loss of balance, flashing nausea, loss of balance, flashing lights, ear ringing, double vision, lights, ear ringing, double vision, sleepiness, feeling dazedsleepiness, feeling dazed

ConcussionConcussionConcussionConcussion

SignsSigns: altered mental status, poor : altered mental status, poor coordination, seizure, slow to coordination, seizure, slow to answer, poor concentration, nausea, answer, poor concentration, nausea, vomiting, vacant stare, slurred vomiting, vacant stare, slurred speech, personality changes, speech, personality changes, inappropriate emotions, abnormal inappropriate emotions, abnormal behaviorbehavior

ConcussionConcussionConcussionConcussion

ConcussionConcussion

• repeated concussions cause repeated concussions cause cumulative damage cumulative damage increased increased severityseverity with each incident with each incident

• repeated concussions cause repeated concussions cause cumulative damage cumulative damage increased increased severityseverity with each incident with each incident

• initial concussion initial concussion chance of a chance of a 22ndnd concussion is concussion is 44xx greater greater• initial concussion initial concussion chance of a chance of a 22ndnd concussion is concussion is 44xx greater greater

Progressively Progressively resolvesresolves without without complication over 7-10 days:complication over 7-10 days:

• all concussions mandate evaluation by all concussions mandate evaluation by physicianphysician• limit training & competition while limit training & competition while symptomaticsymptomatic• able to resume sport without further able to resume sport without further problemsproblems• managed by certified athletic trainers managed by certified athletic trainers working under medical supervision working under medical supervision • formal neuropsychological testing formal neuropsychological testing unnecessary?unnecessary?

SimpleSimple Concussion ConcussionSimpleSimple Concussion Concussion

Specific Specific featuresfeatures, persistent , persistent symptomssymptoms or or recurrencerecurrence with with exertion:exertion:

• prolonged loss of consciousness (>1 prolonged loss of consciousness (>1 minute)minute)• multiple concussions over timemultiple concussions over time• repeated concussions with less impact repeated concussions with less impact forceforce• neuropsychological testing helpfulneuropsychological testing helpful• multidisciplinary managementmultidisciplinary management

(experienced sports medicine physician, sports (experienced sports medicine physician, sports neurologist or neurosurgeon, neuropsychologist)neurologist or neurosurgeon, neuropsychologist)

ComplexComplex Concussion ConcussionComplexComplex Concussion Concussion

A player with A player with ANYANY symptoms or signs: symptoms or signs:

Concussion Concussion ManagementManagementConcussion Concussion ManagementManagement

• should not be allowed to return to should not be allowed to return to play in the current game or practiceplay in the current game or practice• should not be left alone- regular should not be left alone- regular monitoring for deterioration is monitoring for deterioration is essentialessential• should be medically evaluated should be medically evaluated following the injuryfollowing the injury

• should not be allowed to return to should not be allowed to return to play in the current game or practiceplay in the current game or practice• should not be left alone- regular should not be left alone- regular monitoring for deterioration is monitoring for deterioration is essentialessential• should be medically evaluated should be medically evaluated following the injuryfollowing the injury

Return to play must follow a medically Return to play must follow a medically supervised supervised stepwise processstepwise process::


• monitored by a medical doctormonitored by a medical doctor• player should never return to play player should never return to play while symptomaticwhile symptomatic

• monitored by a medical doctormonitored by a medical doctor• player should never return to play player should never return to play while symptomaticwhile symptomatic

““When in doubtWhen in doubt, , sit them sit them outout!”!”

““When in doubtWhen in doubt, , sit them sit them outout!”!”


• physical physical andand cognitive restcognitive rest• monitoring of:monitoring of:

– symptomssymptoms– neurocognitive functionneurocognitive function– postural stabilitypostural stability– neuropsychological testing (?)neuropsychological testing (?)

• graded exertion protocolgraded exertion protocol

• physical physical andand cognitive restcognitive rest• monitoring of:monitoring of:

– symptomssymptoms– neurocognitive functionneurocognitive function– postural stabilitypostural stability– neuropsychological testing (?)neuropsychological testing (?)

• graded exertion protocolgraded exertion protocol


Return to Play ProtocolReturn to Play Protocol1.1. No activity, complete rest No activity, complete rest2.2. Light aerobic activity Light aerobic activity (walking, stationary (walking, stationary cycling)cycling)3.3. Sports specific training- skating. Sports specific training- skating.4.4. Non-contact training drills Non-contact training drills5.5. Full-contact training after medical clearance Full-contact training after medical clearance6.6. Return to competition Return to competition

* * Proceed to the next level only if asymptomaticProceed to the next level only if asymptomatic* * Any symptoms or signs: drop back to the Any symptoms or signs: drop back to the previous level & attempt progression again after previous level & attempt progression again after 24 hours24 hours

Return to Play ProtocolReturn to Play Protocol1.1. No activity, complete rest No activity, complete rest2.2. Light aerobic activity Light aerobic activity (walking, stationary (walking, stationary cycling)cycling)3.3. Sports specific training- skating. Sports specific training- skating.4.4. Non-contact training drills Non-contact training drills5.5. Full-contact training after medical clearance Full-contact training after medical clearance6.6. Return to competition Return to competition

* * Proceed to the next level only if asymptomaticProceed to the next level only if asymptomatic* * Any symptoms or signs: drop back to the Any symptoms or signs: drop back to the previous level & attempt progression again after previous level & attempt progression again after 24 hours24 hours

shoulder acromioclavicular (ac) separation glenohumeral dislocation elbow olecrannon bursitis...

Documents

concussion management

persistent symptoms

time repeated concussions

minute multiple concussions

sports neurologist

concussions mandate

loss of balance

medical doctor player