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Injuries to the Head Injuries to the Head and Neckand Neck

PE 236PE 236Juan Cuevas, ATCJuan Cuevas, ATC

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Anatomy ReviewAnatomy Review

SkullSkull– The skull has 8 The skull has 8

cranial bones & cranial bones & 14 facial bones.14 facial bones.

– Cranial bones Cranial bones have articulations have articulations called suture called suture

joints.joints.

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Anatomy Anatomy Review Review (continued)(continued)

• Soft tissueSoft tissuestructures structures protect the protect the cranium.cranium.

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Anatomy Review Anatomy Review (continued)(continued)

The MeningesThe Meninges– Located Located

underneath underneath cranial bones, cranial bones, consisting the consisting the dura, arachnoid, dura, arachnoid, and pia mater.and pia mater.

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Anatomy Review Anatomy Review (continued)(continued)

Central Nervous System (CNS)Central Nervous System (CNS)– Brain and spinal cord comprise the CNS.Brain and spinal cord comprise the CNS.– CNS is protected by meninges, cranium, and CNS is protected by meninges, cranium, and

vertebrae.vertebrae.– CNS consists of gray and white matter and CNS consists of gray and white matter and

weighs 3.0 to 3.5 lbs (adult).weighs 3.0 to 3.5 lbs (adult).– Brain has three basic components, the Brain has three basic components, the

cerebrum, cerebellum, and brain stem.cerebrum, cerebellum, and brain stem.– Neural impulses travel via 12 pairs of cranial Neural impulses travel via 12 pairs of cranial

nerves and 31 pairs of spinal nerves.nerves and 31 pairs of spinal nerves.

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Anatomy Review Anatomy Review (continued)(continued)

The Neck (cervical The Neck (cervical spine)spine)– The 7 cervical The 7 cervical

vertebrae provide vertebrae provide support for the support for the head and head and protection for the protection for the spinal cord.spinal cord.

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Anatomy Review Anatomy Review (continued)(continued)

• The first cervical The first cervical vertebra (C-1) is vertebra (C-1) is called atlas.called atlas.– Atlas articulates with Atlas articulates with

the occipital bone the occipital bone

– The second cervical The second cervical vertebra (C-2) is vertebra (C-2) is called axis.called axis.

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Head Injuries in Head Injuries in SportsSports

Even minor head trauma can result in Even minor head trauma can result in serious injury.serious injury.– Brain tissue is unable to repair itself; any tissue Brain tissue is unable to repair itself; any tissue

loss results in some level of permanent loss results in some level of permanent disability.disability.

– Severe injuries can result in death. Severe injuries can result in death.

– Coaches can learn to recognize head injuries Coaches can learn to recognize head injuries and render first aid when necessary.and render first aid when necessary.

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Mechanisms of Head Mechanisms of Head InjuryInjury

Direct injury to the head involves a blow to Direct injury to the head involves a blow to the head that causes injury at impact site. the head that causes injury at impact site.

– Contrecoup injuryContrecoup injury– Coup injuryCoup injury

Indirect injury to the head results from Indirect injury to the head results from damaging forces traveling to the head from damaging forces traveling to the head from other parts of the body.other parts of the body.

Treat every head injury as if there is a Treat every head injury as if there is a neck injury and vice versa.neck injury and vice versa.

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Head Injuries in Head Injuries in SportsSports

Cranial injury:Cranial injury:– Involves the bones of the skull.Involves the bones of the skull.– May be associated soft tissue injury.May be associated soft tissue injury.

Depressed skull fracture:Depressed skull fracture:– Involves bone fragments being pushed Involves bone fragments being pushed

into the cranial region.into the cranial region.

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Head Injuries in Sports Head Injuries in Sports (continued)(continued)

ConcussionConcussion is “a clinical syndrome is “a clinical syndrome characterized by immediate and characterized by immediate and transient impairment of neurologic transient impairment of neurologic function secondary to mechanical function secondary to mechanical forces.”forces.”

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• Concussion signs and symptomsConcussion signs and symptoms– HeadacheHeadache– NauseaNausea– Balance problemsBalance problems– Double or fuzzy visionDouble or fuzzy vision– Sensitivity to light or noiseSensitivity to light or noise– SluggishnessSluggishness– Felling “foggy”Felling “foggy”– Concentration and memory problemsConcentration and memory problems

• Symptoms may worsen with exertionSymptoms may worsen with exertion

• Athlete should not return to play until symptom-Athlete should not return to play until symptom-free! free!

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Head Injuries in Head Injuries in Sports Sports (continued)(continued)

1.1. RetrogradeRetrograde AmnesiaAmnesia: forgets events : forgets events priorprior to hit to hit

2.2. AnterogradeAnterograde AmnesiaAmnesia: forgets : forgets events events after after hit.hit.

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Head Injuries in Head Injuries in Sports (continued)Sports (continued)

Second Impact Syndrome (SIS)Second Impact Syndrome (SIS) can be a serious can be a serious problem!problem!– Results when an athlete with a head injury Results when an athlete with a head injury

receives another head injury before the receives another head injury before the symptoms of the first injury have resolved.symptoms of the first injury have resolved.

– Involves rapid and catastrophic brain swelling.Involves rapid and catastrophic brain swelling.

– SIS can result in death.SIS can result in death.

Any athlete sustaining a head injury, no matter how Any athlete sustaining a head injury, no matter how minor, should be monitored by a physician before minor, should be monitored by a physician before being cleared to return to participation.being cleared to return to participation.

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• Special TestsSpecial Tests– Neurologic examNeurologic exam

• Assess cerebral testing, cranial nerve testing, cerebellar Assess cerebral testing, cranial nerve testing, cerebellar testing, sensory and reflex testingtesting, sensory and reflex testing

– Eye functionEye function• Pupils equal round and reactive to light (PEARL)Pupils equal round and reactive to light (PEARL)

– Dilated or irregular pupilsDilated or irregular pupils– Ability of pupils to accommodate to light varianceAbility of pupils to accommodate to light variance

• Eye tracking - smooth or unstable (nystagmus, which may Eye tracking - smooth or unstable (nystagmus, which may indicate cerebral involvement)indicate cerebral involvement)

• Blurred visionBlurred vision

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– Balance TestsBalance Tests• Romberg TestRomberg Test

– Assess static balance - Assess static balance - determine individual’s ability to determine individual’s ability to stand and remain motionlessstand and remain motionless

– Tandem stance is idealTandem stance is ideal

– Coordination testsCoordination tests• Finger to nose, heel-to-toe Finger to nose, heel-to-toe

walkingwalking• Inability to perform tests may Inability to perform tests may

indicate injury to the indicate injury to the cerebellumcerebellum

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– Cognitive TestsCognitive Tests

• Used to establish impact of head trauma on Used to establish impact of head trauma on cognitive function and to obtain objective cognitive function and to obtain objective measures to assess patient status and measures to assess patient status and improvementimprovement

• On or off-field assessmentOn or off-field assessment– Months in reverse order, counting backwardsMonths in reverse order, counting backwards– Tests of recent memory (score of contest, breakfast Tests of recent memory (score of contest, breakfast

game, 3 word recall)game, 3 word recall)

– http://sports.espn.go.com/broadband/video/http://sports.espn.go.com/broadband/video/videopage?videoId=3094263videopage?videoId=3094263

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Cervical Spine Cervical Spine InjuriesInjuries

Neck InjuriesNeck Injuries– Majority occur in football, rugby, ice Majority occur in football, rugby, ice

hockey, soccer, diving, and gymnastics. hockey, soccer, diving, and gymnastics. Cervical injuries, however, can occur in Cervical injuries, however, can occur in almost any sport.almost any sport.

– Catastrophic injuries are rare--less than Catastrophic injuries are rare--less than 2 in 100,000 of all neck injuries 2 in 100,000 of all neck injuries reported in the United States.reported in the United States.

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• Cervical Spine ConditionsCervical Spine Conditions– Mechanisms of Injury Mechanisms of Injury

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Cervical Spine Cervical Spine Injuries Injuries (continued)(continued)

• Mechanisms include hyperflexion, Mechanisms include hyperflexion, hyperextension, rotation, lateral flexion, hyperextension, rotation, lateral flexion, and axial loading.and axial loading.

• Neck strains rarely involve neurologic Neck strains rarely involve neurologic damage.damage.

• Serious injuries occur when intact Serious injuries occur when intact vertebra or fragments of fractured vertebra or fragments of fractured vertebra are displaced or an vertebra are displaced or an intervertebral disk ruptures and places intervertebral disk ruptures and places pressure on spinal cord or nerve roots.pressure on spinal cord or nerve roots.

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Mechanism of Mechanism of Cervical Spine InjuriesCervical Spine Injuries

• Axial load produces most cervical spine injuries.Axial load produces most cervical spine injuries.• 1976 NCAA enacted the rule barring “spearing.”1976 NCAA enacted the rule barring “spearing.”• Any forced movement of cervical spine can Any forced movement of cervical spine can

result in injury.result in injury.• Brachial plexus injuries can produce significant, Brachial plexus injuries can produce significant,

but transient symptoms.but transient symptoms.

Coaching personnel must take great care when Coaching personnel must take great care when conducting an examination of an athlete conducting an examination of an athlete suspected of having a neck injury.suspected of having a neck injury.