New Haven Athletics & New Haven Athletics & Sports MedicineSports Medicine, LLC, LLC

A Group Dedicated to the A Group Dedicated to the Health and Wellness of Health and Wellness of

Student AthletesStudent Athletes

Presented By:Presented By:

Dr. Bryan W. BarryDr. Bryan W. BarryDirector of Sports MedicineDirector of Sports Medicine

Michele T. CormierMichele T. CormierDirector of Athletic TrainingDirector of Athletic Training

Table of ContentsTable of Contents

Head InjuriesHead Injuries Neck InjuriesNeck Injuries Common Orthopedic Sports Injuries: Common Orthopedic Sports Injuries:

Shoulder, Knee and AnkleShoulder, Knee and Ankle

Hydration for the AthleteHydration for the Athlete Orthopedic tapingOrthopedic taping

Head Trauma:Head Trauma: ConcussionConcussion

What is a concussion?What is a concussion? A concussion is an injury to the head caused A concussion is an injury to the head caused

by a direct or indirect blow to the head. by a direct or indirect blow to the head. It is defined as a complex pathophysiological It is defined as a complex pathophysiological

process affecting the brain, induced by process affecting the brain, induced by traumatic biomechanical forces. traumatic biomechanical forces.

Concussion is an injury to the brain caused Concussion is an injury to the brain caused by impact against the skull. It can often by impact against the skull. It can often involve a loss of consciousness but does not involve a loss of consciousness but does not in all cases. Concussion can be mild, in all cases. Concussion can be mild, moderate or severe. moderate or severe.

IntroductionIntroduction

On-Field Evaluation of Head InjuryOn-Field Evaluation of Head Injury Common signs of mild-to-moderate Common signs of mild-to-moderate

head injury are confusion, head injury are confusion, disorientation, headache, dizziness, disorientation, headache, dizziness, nausea and vomiting. Following a head nausea and vomiting. Following a head injury during a game, a coach or injury during a game, a coach or trainer can make an on-field head-to-trainer can make an on-field head-to-toe assessment: toe assessment:

On-Field AssessmentOn-Field Assessment

Orientation:Orientation: ask the child who he is, where he is, how ask the child who he is, where he is, how old he is, etc. old he is, etc.

Memory:Memory: have athlete recall the names of three have athlete recall the names of three objects; do this right after the injury and then five objects; do this right after the injury and then five minutes later minutes later

Concentration:Concentration: have athlete count backwards from have athlete count backwards from 100 by 3s or 7s, or repeat a series of three numbers (3, 100 by 3s or 7s, or repeat a series of three numbers (3, 1, 5, for example), months of the year, colors of fruits, 1, 5, for example), months of the year, colors of fruits, etc. etc.

Speech:Speech: check for slurred speech; it is often helpful to check for slurred speech; it is often helpful to have a parent or someone familiar with the child s usual have a parent or someone familiar with the child s usual speech to help assess the normalcy of speech after a speech to help assess the normalcy of speech after a head injury head injury

Neurologic:Neurologic: perform a fast check of pupil reaction, perform a fast check of pupil reaction, coordination and sensory (bring finger to nose with eyes coordination and sensory (bring finger to nose with eyes open and closed) open and closed)

Exertion or motor function:Exertion or motor function: have the athlete have the athlete run back and forth 30-40 yards, and do up to five push-run back and forth 30-40 yards, and do up to five push-

ups and sit-ups ups and sit-ups

Medical ClearanceMedical Clearance

If the athlete demonstrates any symptoms If the athlete demonstrates any symptoms of head injury or if mental status cannot of head injury or if mental status cannot be cleared, he or she definitely should be cleared, he or she definitely should not be allowed to go back into the game not be allowed to go back into the game and should be further observed for and should be further observed for progression or resolution of symptoms. progression or resolution of symptoms.

The Bottom line: If you’re not sure- The Bottom line: If you’re not sure- remove athlete from play! Follow-up remove athlete from play! Follow-up with physicianwith physician

Symptoms of a Symptoms of a Mild ConcussionMild Concussion

A mild concussion may involve no A mild concussion may involve no loss of consciousness (being loss of consciousness (being "dazed") after athlete "dazed") after athlete

Symptoms should clear within 5 Symptoms should clear within 5 minutes, including headacheminutes, including headache

May return to play if cleared by May return to play if cleared by physician or trainer physician or trainer

Symptoms of a Symptoms of a Moderate ConcussionModerate Concussion

What are the symptoms of a What are the symptoms of a moderate concussion?moderate concussion?

Mental confusion. Mental confusion. Post traumatic memory loss. Post traumatic memory loss. Moderate tinitus (ringing in the ears). Moderate tinitus (ringing in the ears). Moderate dizziness or headache. Moderate dizziness or headache. Moderate balance disturbance. Moderate balance disturbance. Possible nausea and vomiting. Possible nausea and vomiting. Loss of consciousness. Loss of consciousness.

Symptoms of a Severe Symptoms of a Severe ConcussionConcussion

What are the symptoms of a severe What are the symptoms of a severe concussion?concussion?

Mental confusion lasting 5 minutes or Mental confusion lasting 5 minutes or more. more.

Severe tinitus, dizziness or headache. Severe tinitus, dizziness or headache. Prolonged retrograde amnesia (memory Prolonged retrograde amnesia (memory

loss of events before the accident). loss of events before the accident). Loss of consciousness longer than 5 Loss of consciousness longer than 5

minutes. minutes. Possible increase in blood pressure with Possible increase in blood pressure with

decrease in heart rate. decrease in heart rate.

What should be done?What should be done?

The athlete should be removed from the competition immediately. The athlete should be removed from the competition immediately.

Notify parents immediately Notify parents immediately

The athlete should not be left alone. The athlete should not be left alone.

Professional medical advice and evaluation should be done that day. Professional medical advice and evaluation should be done that day.

Avoid contact or collision sports for at least 1 week without symptoms. Avoid contact or collision sports for at least 1 week without symptoms.

Rest is the best recovery technique. Healing takes time. For Rest is the best recovery technique. Healing takes time. For headaches, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, headaches, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) can be used as well as ice. others) can be used as well as ice.

Avoid aspirin and alcohol as they can increase the risk of bleeding.Avoid aspirin and alcohol as they can increase the risk of bleeding.

Repeated concussions may indicate retirement from contact sports Repeated concussions may indicate retirement from contact sports altogether. altogether.

INITIAL ON-FIELD INITIAL ON-FIELD EVALUATION for Cervical EVALUATION for Cervical TraumaTrauma

During on-field evaluation, the golden rule is to assume that a cervical spinal During on-field evaluation, the golden rule is to assume that a cervical spinal cord injury has occurred until proved otherwise. cord injury has occurred until proved otherwise.

Immediately Call the Doctor, Athletic Trainer, Immediately Call the Doctor, Athletic Trainer, or Ambulance onto the fieldor Ambulance onto the field

The first step is to immobilize the player's head and neck by holding them in a The first step is to immobilize the player's head and neck by holding them in a neutral position. Keep helmut on!neutral position. Keep helmut on!

Check for the ABCs--Airway, Breathing, Circulation, and Consciousness. Check for the ABCs--Airway, Breathing, Circulation, and Consciousness.

If the athlete is breathing and has a pulse, maintain his or her current position If the athlete is breathing and has a pulse, maintain his or her current position until transportation is available or until the athlete regains consciousness. until transportation is available or until the athlete regains consciousness.

(4) Simply remove the mouth guard, if present, and maintain an unobstructed (4) Simply remove the mouth guard, if present, and maintain an unobstructed airway. airway.

Shoulder InjuriesShoulder Injuries

Sprain vs StrainSprain vs Strain Separation vs Dislocation / Separation vs Dislocation /

SubluxationSubluxation

Strain-Rotator Cuff InjuryStrain-Rotator Cuff Injury

Supraspinatus Infraspinatus Subscapularis

Supraspinatus Infraspinatus Teres Minor

Subscapularis

Sprain-AcromioclavicularSprain-Acromioclavicular

Grade 1 A/C Sprain

Grade 3 A/C SeparationGrade 2 A/C Sprain

Shoulder Instability / Shoulder Instability / Subluxation Subluxation

What is shoulder instability?What is shoulder instability? Multiple structures involvedMultiple structures involved Glenoid Labrum Glenoid Labrum Shoulder CapsuleShoulder Capsule Rotator cuff involvementRotator cuff involvement

                            

                                                                    

                               

            

Shoulder DislocationShoulder DislocationWhat are the symptoms of a dislocated shoulder?

Acute, caused by direct or indirect trauma

Sudden onset of severe pain, and often a feeling of the shoulder 'popping out'.

The shoulder will often look obviously different to the other side

If there is any nerve damage there may also be pins and needles or numbness through the arm to the hand

There is usually quite severe pain associated with a dislocation.

What should the athlete do What should the athlete do about their dislocated about their dislocated shoulder?shoulder?

Call 911Call 911 Stabilize to prevent further Stabilize to prevent further

complications which may arise complications which may arise due to nerve and/or blood vessel due to nerve and/or blood vessel entrapment entrapment

The dislocated shoulder should be The dislocated shoulder should be relocated as soon as possible by relocated as soon as possible by an orthopedic physicianan orthopedic physician

Brachial Plexus Injury “Stinger” or “Burners”

Numbness and weakness in the shoulder or arm.

Symptoms usually come on immediately but only last a few minutes depending on severity.

Treatment may involve

improving the strength and flexibility of the neck

 

Knee injuriesKnee injuries

Knee Anatomy: MCL, LCL , ACL, PCLKnee Anatomy: MCL, LCL , ACL, PCL

Medial MeniscusMedial Meniscus

Lateral MeniscusLateral Meniscus

Ankle SprainsAnkle Sprains

TreatmentTreatment

ACUTE INJURY ADVICEFor immediate self care of simple sprains and strains, what appears to be the most simple intervention is often the most effective:

P ROTECTION  of the injured area from further injury

R EST - avoid any activities that cause pain, swelling or discomfort.

I CE  for 15 minutes every 2-3 hours for the first 48 hours.

C OMPRESSION using an elastic bandage - take off if increased pain, numbness or swelling below the bandage

E LEVATION above the level of your heart to reduce swelling

HydrationHydration

But Seriously,But Seriously, it’s important! it’s important!

Water is the most essential ingredient to a healthy life and optimal sports performance.

Important in all physiological functions

It’s not just about thirst.

If the athlete is thirsty, it’s too late- Dehydration has already taken place

Symptoms of Symptoms of DehydrationDehydration

when the total fluid loss reaches 5%when the total fluid loss reaches 5% Fatigue Fatigue Muscle cramps Muscle cramps Headaches Headaches NauseaNausea Loss of concentration Loss of concentration Increased heart rate Increased heart rate Increased respiration Increased respiration Decreased sweating Decreased sweating Decreased urination Decreased urination Increased body temperature Increased body temperature

Guidelines to Proper Guidelines to Proper Hydration LevelsHydration Levels

Guidelines for proper hydrationGuidelines for proper hydrationMost athletes can use the following guidelines to replace Most athletes can use the following guidelines to replace fluid losses and modify accordingly, if needed.fluid losses and modify accordingly, if needed.

Hydration before exerciseHydration before exercise•    Drink 15-20 fl oz 2-3 hours before exercise•    Drink 15-20 fl oz 2-3 hours before exercise•    Drink 8-10 fl oz 10-15 minutes before exercise•    Drink 8-10 fl oz 10-15 minutes before exercise

Hydration during exerciseHydration during exercise•    Drink 8 fl oz of sports drink (1:3 ratio of sports drink to •    Drink 8 fl oz of sports drink (1:3 ratio of sports drink to water) every 15 -20 minutes of exercisewater) every 15 -20 minutes of exercise

RehyRehydration after exercise- Fluid replacementdration after exercise- Fluid replacement•    Drink 20 fl oz of water for every 1 lb lost (weigh yourself •    Drink 20 fl oz of water for every 1 lb lost (weigh yourself before and after exercise to determine the number of before and after exercise to determine the number of pounds lost)pounds lost)

Thank you!Thank you!