Kinesiology 171 Chapter 9 (Week 5)

Jaw dislocation

Extreme pain and deformity in the region of the temporomandibular joint (TMJ).• Inability to move lower jaw.• Jaw is "locked."• Do NOT attempt to put back into place.• Treatment includes application of ice pack and medical referral.

depressed skull fracture

More severe forms of cranial injury involve bone fragments being pushed into the cranial region.

post concussive syndrome

PCS (when symptoms of concussion last of weeks months and even years passed the injury)

peripheral nervous system

PNS

Mandible Fracture

Pain and swelling.• Deformity and malocclusion.

brachial plexus nerve injury

Pain radiates into the affected arm.• Decrease in voluntary use of the arm (often the arm appears limp).

Neck fractures/dislocations

Pop of snap heard.• Burning, numbness, or tingling and extremity dysfunction is likely.

anisocoria

Rare but naturally occurring condition where the pupils are of unequal size, not related to any acute condition such as head injury

second impact syndrome (SIS)

Results when an athlete with a head injury receives another head injury before the symptoms of the initial injury have resolved., it involves rapid, catastrophic brain swelling that can result in death.

somatic changes: Headache, vomiting, nausea, confusion, poor concentration, forgetful, and sleepiness Memory loss: anterograde amnesia and retrograde amnesia

Somatic changes concussion signs and symptoms? Memory loss?

chromic traumatic encephalopathy (CTE)

A conditions that can only be identified after death with a brain autopsy, it is a degenerative disease characterized by a distinct collection of tau proteins in several areas of the brain that effect function

septal hematoma

Bleeding between the septum and the mucous membrane, it can lead to septal erosion.• Swelling that is usually visible both inside and outside the nose. Must be referred to medical doctor for evaluation and treatment.

central nervous system, brain and spinal cord, gray and white matter

CNS, what is composed of?

cerebrospinal fluid

CSF

sideline assessment

The objective of this phase of the evaluation is to determine the presence of any signs or symptoms of head injury that may have developed since the time of the initial injury. • This information is of vital importance when confronted with making decisions regarding medical referral, as well as clearance for return to participation.

consciousness, extremity strength, mental function, eye signs and movement, neck pain, neck musculature spasm

What does physical examination include assessment of? (CEMEPS)

ball-like structure housed within the orbit.• Globe is filled with vitreous body.• The posterior interior surfaceis covered by the retina.• Most of the eyeball is encased in the sclera.

What does the eye consist of?

Mouth guards.• Protective eye wear.• Face shields.

What has reduced the maxillofacial injuries?

cauliflower ear, ruptured ear drum, no participation in aquatic

auricle has some vascularity and can develop a hematoma leading to ...., vs severe blows to the ear drum, should athletes with ear infections play?

subdural hematoma

bleeding below the dura mater

epidural hematoma

bleeding between the dura and the cranial bones

intracerebral hematoma vs cerebral contusion

bleeding within the brain tissue vs bruising the brain tissue

yes, no

can a minor head injury be serious? does brain tissue repair itself?

concentration deficits: Information processing deficits - slurred speech, unable to follow directions. emotional changes: Excessive anger or apathy. Depression or sadness.

concentration deficits with concussion? emotional changes?

no (only can on severity of symptoms maybe), 10 days

do we classify concussions? how long do they last?

diplopia vs epistaxis

double vision vs nosebleed

zygomatic bone fracture

pain and swelling at site of injury.• Diplopia - double vision.• Swelling and discoloration spreads to the region of the orbit.• Refer athlete to a physician for diagnosis and treatment.

myelin

performs an insulating function to the axon of a nerve, composed of fats and proteins

Dental Injuries

result from direct blows that result in tooth displacement or avulsion, a tooth fracture, or fracture of jaw or other facial bones.

indirect mechanisms

results from damaging forces traveling from other parts of the body.• Blow to jaw, nose, or landing on tailbone.

insidious

slow onset or signs and symptoms occur with no obvious mechanisms

pia mater

the innermost meningeal layer which is attached to the brain tissue and serves as framework for an extensive vasculature that supplies the brain. Thin and delicate, more susceptible to trauma

arachnoid

the middle layer which is less dense and avascular, separated by the layer on top of it by a small amount of fluid

contusional injuries

vary in severity from simple corneal abrasions to major injuries such as rupture of the eye, fracture of orbit, or combinations of the two. Detached retina can also occur.

skull fracture

May also have associated soft tissue injury.

fracture

nosebleed, deformity, and swelling at the bridge of the nose.• Control any bleeding and refer to a medical doctor.

Sports Concussion Assessment Tool (SCAT)

Glasgow Coma Scale, an interview for determining if consciousness was lost, Maddocks Score, graded symptom scale checklist, a cognitive, a neck examination, balance error scoring system [BESS], a coordination test, and a delayed-recall test.

intracranial injury

Head injury characterized by disruption of blood vessels, either veins or arteries, resulting in the development of a hematoma or swelling within the confines of the cranium

The skull has 8 cranial bones and 14 facial bones

How many cranial bones does the skull have? How many facial bones?

12 pairs of cranial nerves and 31 pairs of spinal nerves

How many pairs of cranial nerves are there and how many spinal nerves are there?

Listen near the athlete's face for typical breathing sounds and look for movements of the thorax and/or abdomen.• If no signs of breathing or circulation are present, begin CPR and summon EMS.

How to check breathing and circulation?

Hold upper eyelid away from anterior eye. Visible foreign object can be removed with a moist cotton swab; if imbedded, cover both eyes and transport to medical facility.

How to look for objects in the eye?

Upon determination of consciousness, the athlete should carefully be moved from a laying-down position to a sitting position.• Monitor vitals and behavior for 1-2 minutes• If the athlete appears normal, move them to a standing position and continue to monitor vitals and behavior. • As the athlete moves towards the sidelines, the emergency team should provide continued physical support.

How to move athlete to sideline for further physical examination?

Removal of screws that hold the clips with a screwdriver is the best option.• If the screws are stripped, cut the clips with a device like the "Trainer's Angel."• Once the clips are removed, the face mask can be rolled up, and out of the way of the airway.

How to remove facemasks to establish airway?

n cases involving a neck injury, a football helmet provides means of cervical immobilization.Coaches should not remove the helmet.

How to remove football helmet in head and neck injuries?

When rendering first aid, take precautions to avoid bloodborne pathogens.• When examining dental injuries:• Can athlete open and close mouth w/o pain?• What is the general symmetry of the teeth?• Are there any irregularities in adjacent teeth?• Is there bleeding, especially along gum line?• Loosened tooth - Gently push back into place.• If tooth is avulsed, place in sterile saline and refer athlete to dentist or physician immediately.

How to render first aid with dental injuries?

Control bleeding; carefully clean with mild soap and warm water; apply sterile dressing.• Any wound with observable space between margins should be referred to a physician for suturing. Physician needs to make return-to-play decisions.• Any facial wound, even abrasion, can present cosmetic issues.

How to treat facial wounds?

Wear gloves to avoid contact with blood. • Finger pressure applied directly against the nostril that is bleeding. Application of a cold compress against the nasal region.• Having the athlete lie on same side or leaning forward.• Can pack with gauze that protrudes from nostril.

How to treat nose bleed?

neck sprains and strains,

Very similar - location of tenderness and mechanism will vary.

mandible fracture, jaw dislocation, zygomatic bone fracture, facial wound

What are common face injuries?

eye pain, double vision (diplopia), and obvious bleeding within the eye.

What are symptoms of black eye?

Floating particles in field of vision. • Distorted vision. • Changes in the amount of light seen.

What are symptoms of retinal injuries?

do not move athlete, do not take helmet off, do not use ammonia capsules to revive athlete

What are the DO NOT's in the initial check?

mild traumatic brain injury or concussion, intercranial hemorrhage, skull fracture

What are the classifications for head injuries?

corneal abrasion, small foreign object in eye,

What are the common eye injuries?

clude decreases in blood flow, increases in intracranial pressure, or tissue anoxia. • Any brain cells not destroyed remain extremely vulnerable to subsequent trauma.• Players sustaining a concussion had a 3-fold increased risk of sustaining an additional concussion.

What are the damages with concussions?

neck fractures and dislocations, neck sprains, neck strains, nerve compressions/stretching, brachial plexus injuries

What are the different types of cervical spine injuries?

Don't remove the helmet of a football player. Remove other helmets only if they are impeding stabilization and evaluation efforts. • Don't move the athlete. • Don't rush through the physical exam.

What are the do not's of the physical examination?

football, rugby, ice hockey, soccer, diving, and gymnastics

What are the majority of sports have cervical spine injury?

physical: Numbness/tingling, ringing of ears, sensitivity to light or noise, loss of consciousness, unstable gait balance disturbances: inability to maintain equilibrium, visual problems, diminished pupil reaction

What are the physical signs and symptoms of a concussion? Balance disturbances?

skin, dense and loose specialized connective tissue, periosteum, cranial bones, and the meninges, help protect the brain

What are the soft tissue structures in the skull? What do they do?

cerebrum, cerebellum, brain stem

What are the three basic parts of the brain?

stock, mouth formed, custom fitted

What are the three different types of mouth guards that are required by NCAA?

contusional and penetrating (less common)

What are the two categories of eye injuries?

orbits of the eyes, nasal bones, and mandible.

What areas of the face are prone to injury

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

What causes cervical spine injuries to be more serious?

cranial bones form articulations called suture joints and protect and house the brain. Facial bones forms facial form and structure and is protection for eyes, ears, nose, and throat

What do cranial bones do? What do facial bones do?

axial load, spearing in football (emphasis in 2005 to minimizing neck injuries, eliminate spearing, using proper technique)

What do most cervical spine injuries result from?

Stabilize the head and neck.• Determine if the athlete is conscious. If unconscious, check airway, breathing, and pulse (circulation). • Summon EMS.• Continue monitoring "ABCs." If conscious, question the athlete regarding extremity numbness or loss of feeling, weakness, and/or neck pain.• If athlete reports the inability to move a limb or limbs or significant strength loss, stabilize head and neck and summon EMS.

What is guideline for cervical injuries

A list of red flags that warrant transportation to a hospital and advice to avoid cognitive and physical exertion.• Athletes should be allowed to sleep and should not be awakened every 2 hours. • Acetaminophen is recommended.

What is included in the at home instruction?

cranial, spinal, and autonomic nerves

What is the PNS composed of?

bone-cartilage framework with skin attached. The nose includes nasal bones and the frontal processes of the maxilla.• The two nostrils are separated by the cartilaginous septum. Nose bleeds (epistaxis)

What is the anatomy of the nose? What is the most common nose injuries?

skin placed over underlying bones, subcutaneous muscles, cartilage and fat

What is the face composed of and what provides protection for the face? What gives it protection?

Check vitals first.• Note body and limb positions, as well as helmet, face mask, and mouth guard positions. • If unconscious, attempt to arouse and note approx. time of injury, immobilize head and neck (do not remove helmet)

What is the first step with the initial check (always assume neck injury if head injury or head injury with neck injury)

The first vertebra is called the atlas, it articulates with the occipital condyles and forms the right and left atlanto-occipital joints, the second vertebra is called the axis, it articulates with the skull and axis to form the atlantoaxial joint

What is the first vertebra of the neck called, what does it articulate with and what does it form? What about the second vertebra?

No activity—limited cognitive and physical activity; general rest• Light aerobic exercise • Sport-specific exercise• Noncontact training drills and resistance training• Full contact practice• Return to play

What is the return to play (RTP) process?

Perform bilateral grip strength tests and dorsiflexion strength.• Check for sensations on both sides of body by pinch tests.• Check pupil sizes and response to light. Evaluate ability of eyes to follow moving object side to side.• Note loss of peripheral vision or jerking eyeball movements.• Palpate neck for deformity, moving from base of skull to bottom of neck.

What to do for physical examination if conscious?

trained medical personnel available then the injured athlete can be placed on a properly constructed spine board.• This requires the coordinated effort of at least 5 people.

What to do if EMS is delayed?

monitor vitals and summon EMS

What to do with athlete who is unconscious?

underneath the cranial bone, dura mater, arachnoid, and pia maters

Where are meninges found? What are the three meninges called?

external ear, abrasions and contusions to auricular, headgear

Where do most ear injuries occur? What are they called? What prevents them?

concussion

a complex pathophysiological process affecting the brain, induced by biomechanical forces

Standardized Assessment of Concussions (SAC)

a convenient and reliable way to quickly assess neurocognitive function in the areas of orientation, immediate memory, concentration and delayed recall.

ar has a cartilaginous framework covered with a layer of skin.• The external ear has large expanded portion (auricula) and opening to ear canal (external acoustic meatus). • The middle ear contains small group of bones that transmit sound vibrations to tympanic membrane. • Inner ear contains the labyrinth, which has a role in equilibrium.

anatomy of ear

dura mater

highly vascularized and contains tough, fibrous dense connective tissue. Functions as a periosteum to the inside surfaces of the cranial bones and as a protective membrane of the brain

32 teeth, cementum and periosteum

how many teeth do humans have? what are they secured with?

dysesthesia

impairment of the sense of touch

anterograde amnesia

inability to recall events that have transpired since the time of the injury.

retrograde amnesia

inability to recall events that occurred prior to the injury.

Maxillofacial injuries

injuries include those to the jaw, teeth, eyes, ears, nose, throat, facial bones, and skin.

Direct mechanism

involves a blow to the head that causes injury at impact site (coup injury) or on the opposite side of the skull from impact (contracoup injury).

Cerbrospinal Fluid (CSF)

its purpose is to protect the brain from acute blood pressure changes, transport chemicals, and cushion the brain and spinal chord from external forces

aving a lens slip out of place or debris become trapped between the lens and the eye.

what are some contact lens problems? (more problems occur with hard lenses)

hyperflexion, hyperextension, rotation, lateral flexion, and axial loading.

what are the mechanisms of this injury?

black eye, most severe cases involve bleeding into the anterior of the eye and orbital blowout

what is the result of a contusion and hemorrhaging around the eye?

7 cervical vertebrae, the construction allows for wide range off motion, both stability and range of motion

what provide support for the head and protection spinal cord? What does the construction allow for?