EXS 203 Test 1

mandibular

- Mandibular •Common: mandibular angle and condyles •S&S: malocclusion, changes in speech, oral bleeding, + tongue blade •Management: ice, immediate referral

subdural hematoma

- acceleration force - involves bleeding of the veins - S&S slower to develop.

management of epidural hematoma

- active EMS and ABCs - vitals - shock

subdural hematoma simple

- blood in subdural space ( no cerebellum injury)

subdural hematoma complicated

- cerebral swelling

blood vessels

- common carotid - vertebral

blood supply

- common carotid -vertebral

anatomy of the eyes

- conjuctiva -lacrimal glands - cornea - tunics, sclera, chord and retina.

epidural hematoma

- direct blow to side of head - meningeal artery tear - rapid "high pressure" hematoma.

cerebral contusion

- focal injury without mass- occupying lesion. - acceleration/deceleration.

subdural hematoma S&S

- headache, nausea, dizziness and sleepiness. - simple no LOC - complicated unconscious, pupil dilation on 1 side.

spinal assessment palpations

-Patient prone •Pillow under the hip region to tilt the pelvis back and relax the lumbar curvature

Impacted cerumen (wax)

-Possible hearing loss or muffled hearing -Management: irrigate canal with warm water

lumbar disk conditions

-Protruded disc (A) •Eccentric accumulation of nucleus with slight deformity of annulus -Prolapsed disc (B) •Eccentric nucleus produces a definite deformity as it works its way through fibers of annulus fibrosus

vitals

-Pulse •Small weak pulse •Short, rapid weak pulse •Slow bounding pulse •Accelerated pulse

Cauliflower ear (auricular hematoma)

-Repeated trauma pulls cartilage away from perichondrium - hematoma forms -Untreated - forms a fibrosis -Management: ice; possible aspiration by physician -Key is prevention!

•njunctival hemorrhage

-Rupture of small capillaries; sclera appears red, blotchy, inflamed -Requires no treatment

stress and functional test pt 2

-Sacroiliac compression and distraction test -Approximation test -"Squish" test -FABER (Patrick) test -Gaenslen's test -Long sitting test -Babinski -Oppenheim

Scheuermann's disease

-Secondary to osteoporosis

Facet Joints

-Spinous process -Transverse processes

Cervical spinal stenosis

-Structural •Torg ratio -Functional •Loss of CSF around the cord → ¯ cord's ability to decompress -Asymptomatic until external force to head

What structure does the facial bones form?

forms sinuses, orbits of the eyes, nasal cavity and the mouth.

function of scalp

protective function and extensive blood supply.

cranium

protects the brain

facial

provides structure

annular tears

§Back pain > leg pain §Pain ↑ sitting and leaning forward, coughing, sneezing, and straining §May have muscle spasm and loss of lordosis §+ ipsilateral straight leg raising test

epidural hematoma risk

- life threatening - requires surgical decompression

skull fracture types

- linear - comminuted - depressed - basilar

cranial injury depend on:

- material properties of skull - thickness of skull - magnitude and direction of force - size of impact area.

brain acceleration

- shear, tensile and compression strains within brain. - contrecoup injury.

stress and functional test

- slump test -Straight leg raise test -Well straight leg raise test -Bowstring test -Brudzinski's test -Kernig's test -Bilateral straight leg raising -Valsalva's -Milgram test -Piriformis muscle stretch -Prone knee bending -Spring test for joint mobility -Farfan torsion test -Trunk extension test -Femoral nerve traction test -Quadratus lumborum stretch test -Single leg stance -Quadrant test

lordosis

-Abnormal exaggeration of lumbar curve

Interval disk components

-Annulus fibrosus -Thick fibrous ring - nucleus pulposus -gelatinous interior

ligaments

-Anterior longitudinal -Posterior longitudinal -Ligamentum flavum -Interspinous -Supraspinous

pars interarticularis

-Area between superior and inferior facets •Weakest part of the vertebrae

Vertebral structure

-Body -Vertebral arch -Superior and inferior articular processes

eye condition: Detached retina

-Can occur with or without trauma -S&S: floaters and light flashes Management: patch both eyes; refer to ophthalmologist

hyphen

-Caused by blunt trauma -Hemorrhage into anterior chamber -Management: activation of EMS

sway back causes

-Causes include: •Muscle weakness; compensatory muscle tightness -Entire pelvis shifts anteriorly, causing the hips to move into extension -Impact on center of gravity (COG)

Nerve plexus

-Cervical (C1-C4) -Brachial (C5-T1)

what are cervical compression test

-Cervical compression -Spurling's test - cervical distraction - shoulder abduction

Active ROM

-Cervical flexion -Forward trunk flexion -Trunk extension -Lateral trunk flexion (left and right) -Trunk rotation

Passive ROM

-Cervical spine •Do not perform if motor and sensory deficits are present •Normal end feel—tissue stretch -Thoracic is seldom performed

loose teeth

-Displaced outward or lateral: attempt to place back in normal position -Intruded: immediate referral to dentist

fractured tooth

-Enamel: no symptoms -Dentin: pain and increased sensitivity to heat and cold -Pulp or root: severe pain and sensitivity -Management: refer to dentist

Kyphosis

-Excessive curve of thoracic spine -Congenital - deficits in vertebral bodies -Idiopathic

Movements involve a number of motion segments

-Flexion/extension/ hyperextension -Lateral flexion -Lateral rotation

Motion Segment

-Functional unit -Any 2 adjacent vertebrae and soft tissues between them

effects of impact forces

-High speed and collision → risk -Cervical flexion (large bending moment) + axial compression load = danger

spinal assessment physical examination testing

-If, at anytime, movement leads to increased acute pain or change in sensation or the individual resists moving the spine, a significant injury should be assumed and EMS should be activated

nerve plexus

-Lumbar (T12-L5) -Sacral (portion of lumbar [L4-L5])

Cervical fracture/dislocation fracture

-MOI—axial loading with violent flexion of neck -Dislocation: add rotation -S&S •Pain over spinous process with or without deformity •Constant neck pain •Muscle spasm

maxillary fractures

-Maxillary •LeFort fx (upper jaw) •S&S: appearance of longer face, nasal bleeding, malocclusion, nasal deformity, ecchymosis •Management: ice, immediate referral

Spear tackler's spine

-Mechanism: cervical flexion + axial loading -S&S •Immediate pain with sensory changes and motor deficits distal to injury site -Management: activate EMS -Criteria to return to play—controversial

mouth laceration

-Minor lacerations are the same as in other lacerations -Lip and tongue lacerations: require special suturing

Brachial plexus injuries

-Tension (stretching) •Violent lateral movement of head and neck •Arm forced into excessive external rotation, abduction, and extension -Compression •Location where plexus is most superficial (Erb's point) •Forced lateral flexion, causing increased pressure between shoulder pad and superior medial scapula

lumbar fractures and dislocations and causes

-Transverse or spinous process fracture •Due to: §Extreme tension from attached muscles §Direct blow •Additional injury to surrounding soft tissues

Thoracic spinal fractures and apophysitis

-Wedge fracture •Fracture of vertebral end plates

brain major regions

-cerebral hemispheres - diencephalon - brainstem - cerebellum

meningues

-protective tissue that encloses brain and spinal cord. - dura mater, arachnoid mater and pia mater.

Ear major areas

1. outer ear- auricle and external auditory canal. 2. middle ear- tympanic membrane 3. inner ear- labyrinth.

when do you assume cervical injury is present?

Always

subdural hematoma recovery

acute- 48/72 hrs post injury chronic- later

spinal assessment history assessment

ask: •Pain -Location (i.e., localized or radiating) -Type (i.e., dull, aching, sharp, burning) •Sensory changes (i.e., numbness, tingling, or absence of sensation) •Muscle weakness or paralysis

what is the nose composed of?

cartilage and hyaline.

Zurich Panel

diagnosis of a concussion will involve the assessment of a range of clinical signs and symptoms in four categories: physical, emotional, cognitive, and sleep

sway back

increased lordotic curve and kyphosis

bones deforms and bend inward

inner border- tensile strain. outer border- compressed.

nerves and function

motor and sensory functions. - numbers and named in accordance with their functions.

stress and functional test cervical spine test

•Brachial plexus traction

Spinal column: Vertebrae

•Cervical (7)convex anteriorly •Thoracic (12)concave anteriorly •Lumbar (5)convex anteriorly •Sacral (5 fused)concave anteriorly •Coccyx (4 fused)

effects of loading: Primary

•Cervical spine: weight of head •Thoracic: weight of body above and any load in hands

lordosis causes

•Congenital deformities •Weak abdominal musculature •Poor posture •Activities with excessive hyperextension

spondylosis fracture

•Congenital or mechanical stress §Repeated weight loading in flexion, hyperextension, and rotation •Occurs at an early age (<8 years); asymptomatic until ages 10-15 years

kinetics effects

•Effects of body position -Line of gravity passes anterior to spinal column -Trunk flexion • moment arm for body weight; bending moment •Counteract moment via tension in back muscles • tension in back → compression lumbar spine

lumbar spine injuries causes

•Herniated disc §Radiating leg pain > back pain §Pain ↑ sitting and leaning forward, coughing, sneezing, and straining §Neurologic deficits are usually present §+ ipsilateral straight leg raising test

spinal assessment

•History -Important to ask questions about: •Pain §Location (i.e., localized or radiating) §Type (i.e., dull, aching, sharp, burning) •Sensory changes (i.e., numbness, tingling, or absence of sensation) •Muscle weakness or paralysis -Neck injury -Determine both long- and short-term memory loss that may indicate an associated brain injury

compression fracture

•Hyperflexion crushes anterior aspect of vertebral body •Primary danger—possibility of bony fragments moving into spinal canal, damaging cord or spinal nerves

Scheuermann's disease

•Leading cause of fractures among adolescents •Osteochondrosis of the spine •Abnormal epiphyseal plate behavior allows herniation of disc into vertebral body •After physician referral, treatment: activity modification, stretching (shoulder, neck, and back muscles), and strengthening (abdominal and spinal extensor muscles)

kinematics

•Movements are a result of additive motion from multiple segmental levels -Flexion/extension/hyperextension -Lateral flexion -Rotation •Spinal flexion vs. hip flexion vs. forward pelvic tilt •Hyperextension

lumbar spine injuries

•Myogenic or muscle-related disease -Morning pain and muscle stiffness -Pain is unilateral or bilateral, not midline -Pain extends into the buttock and thigh region only -Pain is reproduced with resisted, prolonged muscle contraction and passive stretching of the muscle Contralateral pain with side bending

neurologic test

•Oppenheim •Babinski •Hoffman

spinal assessment palpation and thoracic region

•Palpation -Seated, standing, supine, or prone position -Relax the neck and spinal muscles—lying position -Posterior neck structures •Patient supine -Thoracic region •Patient prone •Pillow under the hip region to tilt the pelvis back and relax the lumbar curvature

ROM

•Passive ROM -Seldom performed •Resisted ROM -Weight of the trunk will stabilize the hips

zygomatic fractures

•S&S: cheek appears flat or depressed, double vision, numbness in affected cheek •Management: ice, immediate referral

Lumbar spine injuries S&S

•Sharp pain and spasm at site of herniation; pain shoots down extremity •Walk in slightly crouched position, leaning away from side of lesion •Compression on spinal nerve •Sensory and motor deficits •Alteration in tendon reflex

interval disk function

•Shock absorption •Allow spine to bend

nerve root impingement

•Valsalva Test •First thoracic nerve root stretch