22
The skullThe skull 8 cranial bones & 14 8 cranial bones & 14
facial bonesfacial bones parietals (2), parietals (2),
temporals (2), frontal, temporals (2), frontal, occipital, sphenoid & occipital, sphenoid & ethmoidethmoid
cranial bones, cranial bones, articulations of the articulations of the suture typesuture type
44
Anatomy ReviewAnatomy ReviewCentral Nervous System (CNS)Central Nervous System (CNS)
brain and spinal cord comprise the CNSbrain and spinal cord comprise the CNSCNS protected by meninges, cranium and CNS protected by meninges, cranium and
vertebraevertebraeCNS consists of gray and white matter and CNS consists of gray and white matter and
weighs 3.0 to 3.5 lbs.weighs 3.0 to 3.5 lbs.
55
The NeckThe Neck Cervical spineCervical spine
7 vertebrae providing 7 vertebrae providing support for the head support for the head and protection for the and protection for the spinal cordspinal cord
C-1 (Atlas) C-1 (Atlas) articulates with the articulates with the occipital boneoccipital bone
C-2 (Axis) articulates C-2 (Axis) articulates with C-1 via atlanto-with C-1 via atlanto-axial jointsaxial joints
66
Head Injuries in SportsHead Injuries in SportsMinor trauma can result in serious Minor trauma can result in serious
injury.injury.brain tissue is unable to repair itself -- any brain tissue is unable to repair itself -- any
damage is permanentdamage is permanentpossible mechanisms of injury are nearly possible mechanisms of injury are nearly
infiniteinfinitecoaches can learn to recognize head coaches can learn to recognize head
injuries and render aidinjuries and render aid
77
Head Injuries in SportsHead Injuries in SportsFrom 1982-91, 1.5 million high school From 1982-91, 1.5 million high school
tackle football participants annually tackle football participants annually generated the greatest number of direct, generated the greatest number of direct, catastrophic injuries in fall sports.catastrophic injuries in fall sports.
1/5 high school players have sustained a 1/5 high school players have sustained a concussion annuallyconcussion annually
88
Head Injuries in SportsHead Injuries in SportsCranial injuryCranial injury
involves the bones of the skullinvolves the bones of the skullmay be associated soft tissue injurymay be associated soft tissue injurydepressed skull fracturedepressed skull fracture
involves bone fragments being pushed into the involves bone fragments being pushed into the cranial regioncranial region
99
Head Injuries in SportsHead Injuries in SportsCerebral concussionCerebral concussion
““clinical syndrome characterized by clinical syndrome characterized by immediate and transient impairment of immediate and transient impairment of neurologic function secondary to neurologic function secondary to mechanical forces”mechanical forces”
unconsciousness, disorientation, amnesia, unconsciousness, disorientation, amnesia, dizziness, disequilibrium dizziness, disequilibrium
related to temporary disruption of blood related to temporary disruption of blood supplysupply
1010
Head Injuries in SportsHead Injuries in SportsColorado Medical Society classificationColorado Medical Society classification
grade 1 - most common -- no amnesiagrade 1 - most common -- no amnesiagrade 2 - either posttraumatic or retrograde grade 2 - either posttraumatic or retrograde
amnesiaamnesiagrade 3 - unique due to loss of consciousnessgrade 3 - unique due to loss of consciousness
Second Impact Syndrome (SIS) – Second Impact Syndrome (SIS) – recently recognized as a potentially serious recently recognized as a potentially serious
problemproblema concussion followed by another such injury prior a concussion followed by another such injury prior
to the resolution of symptoms related to the first to the resolution of symptoms related to the first injuryinjury
1111
Head Injuries in SportsHead Injuries in Sports involves rapid, involves rapid,
catastrophic catastrophic swelling of the swelling of the brain -- putting brain -- putting pressure on the pressure on the brain stem, often brain stem, often resulting in deathresulting in death
Shaded areas of the brain stem represent areas of compression.
1212
Head Injuries in Sports Head Injuries in Sports (continued)(continued)
Any athlete Any athlete sustaining a head sustaining a head injury, no matter injury, no matter how minor, should how minor, should be assessed prior be assessed prior to returning to to returning to competition.competition.
Intracranial injuryIntracranial injury potentially life potentially life
threateningthreatening majority result from majority result from
blunt traumablunt trauma disruption of blood disruption of blood
vessels results in intra-vessels results in intra-cranial bleeding and cranial bleeding and hematomahematoma
1313
Head Injuries in Sports Head Injuries in Sports (continued)(continued)
major forms of intracranial bleeding include:major forms of intracranial bleeding include: epidural hematomaepidural hematoma subdural hematomasubdural hematoma intracerebral hematomaintracerebral hematoma cerebral contusioncerebral contusion
epidural hematoma develops quickly due to epidural hematoma develops quickly due to arterial bleeding while subdural hematoma arterial bleeding while subdural hematoma develops slowly due to venous bleeding.develops slowly due to venous bleeding.
1414
Initial Treatment Initial Treatment GuidelinesGuidelines
Primary surveyPrimary surveyalways assume a always assume a
neck injuryneck injurycheck vitals firstcheck vitals firstnote body and note body and
limb position, limb position, helmet, face helmet, face mask, and mouth mask, and mouth guardguard
Stabilizing the athlete’s head and neck
1515
Initial Treatment Initial Treatment GuidelinesGuidelines
if unconscious, attempt to arouseif unconscious, attempt to arouse note approx. time on injurynote approx. time on injury immobilize head and neck immediately, not immobilize head and neck immediately, not
removing athlete’s helmet.removing athlete’s helmet. detect breathing by listening near the airway and detect breathing by listening near the airway and
looking for movements of the abdomen and/or looking for movements of the abdomen and/or thoraxthorax
check carotid pulse with two fingerscheck carotid pulse with two fingers monitor pulse for 30 seconds; if none, alert EMSmonitor pulse for 30 seconds; if none, alert EMS
1616
Initial Treatment Initial Treatment GuidelinesGuidelines
Secondary surveySecondary survey conscious athlete less complicated than unconscious conscious athlete less complicated than unconscious
conscious or unconscious?conscious or unconscious? extremity strengthextremity strength mental functionmental function eye signseye signs pain specific to the neckpain specific to the neck spasm of the neck musculaturespasm of the neck musculature
determining level of consciousness is not always easydetermining level of consciousness is not always easy if conscious, ask a few simple questionsif conscious, ask a few simple questions loss of short term memory can indicate more serious loss of short term memory can indicate more serious
injuryinjury
1717
Initial Treatment Initial Treatment GuidelinesGuidelines
Don’t arouse someone with ammonia Don’t arouse someone with ammonia capsules.capsules.
if conscious, use quick neurological tests, if conscious, use quick neurological tests, such as grip strength and skin sensationsuch as grip strength and skin sensation
examine the eyes, noting pupil size, examine the eyes, noting pupil size, responsiveness to light and side-to-side responsiveness to light and side-to-side movementmovement
palpate the neck for deformitypalpate the neck for deformity
1818
Initial Treatment Initial Treatment GuidelinesGuidelines
Emergency Emergency procedures for procedures for footballfootballequipment creates equipment creates
special problemsspecial problemshelmet, face helmet, face
mask, chin strap mask, chin strap and mouth guardand mouth guard
Trainer’s Angel
1919
Initial Treatment Initial Treatment GuidelinesGuidelines
management of the management of the helmeted player is helmeted player is a major issuea major issue
if airway must be if airway must be established, established, removal of the face removal of the face mask is necessarymask is necessary
cut the clips with cut the clips with a device like the a device like the “Trainer’s Angel”“Trainer’s Angel”
2020
Initial Treatment Initial Treatment GuidelinesGuidelines
Plastic clips secure the face mask.
If a Trainer’s Angel is not available, removal of screws that hold the clips is an option.
2121
Initial Treatment Initial Treatment GuidelinesGuidelines
Once the clips are Once the clips are removed the face removed the face mask can be rolled mask can be rolled up, out of the way up, out of the way of the airwayof the airway
2222
Initial Treatment Initial Treatment GuidelinesGuidelines
In the event of a neck injury, the helmet provides an excellent meansof cervical immobilization.
2323
Initial Treatment Initial Treatment GuidelinesGuidelines
General GuidelinesGeneral GuidelinesDon’t move the athlete until the secondary Don’t move the athlete until the secondary
survey is complete.survey is complete. if the athlete is recovered, escort to the if the athlete is recovered, escort to the
bench for observationbench for observationany suspicious signs/symptom -immobilize any suspicious signs/symptom -immobilize
and summon EMSand summon EMS in most cases, there is NO reason to move in most cases, there is NO reason to move
the athlete prior to arrival of EMSthe athlete prior to arrival of EMS
2424
Initial Treatment Initial Treatment GuidelinesGuidelines
level of consciousness - single most important level of consciousness - single most important factorfactor
in the majority of incidents, the athlete never in the majority of incidents, the athlete never loses consciousnessloses consciousness
athlete with a head injury usually appears athlete with a head injury usually appears dazed and unstabledazed and unstable
may also have tinnitus and memory lossmay also have tinnitus and memory loss if there any doubts about severity, refer to a if there any doubts about severity, refer to a
physician immediatelyphysician immediately
2626
Initial Treatment Initial Treatment GuidelinesGuidelines
CMS guidelines -- CMS guidelines -- pull any athlete pull any athlete with a grade I with a grade I concussion for a concussion for a minimum of 20 minimum of 20 minutes for minutes for observationobservation
Anyone Anyone sustaining a sustaining a Grade II or III Grade II or III concussion concussion should be should be referred to a referred to a physician physician immediately.immediately.
2727
Cervical InjuriesCervical Injuries Neck injuriesNeck injuries
majority occur in football, rugby, ice hockey, soccer, majority occur in football, rugby, ice hockey, soccer, diving and gymnastics, however cervical injuries can diving and gymnastics, however cervical injuries can occur in almost any sportoccur in almost any sport
catastrophic injuries are rare -- 2/100,000 of all neck catastrophic injuries are rare -- 2/100,000 of all neck injuries, since 1977 less than 10 players/year suffer injuries, since 1977 less than 10 players/year suffer permanent cord injuriespermanent cord injuries
mechanisms include: hyperflexion, hyperextension, mechanisms include: hyperflexion, hyperextension, rotation, lateral flexion, and axial loadingrotation, lateral flexion, and axial loading
axial loading places the neck in a slightly flexed axial loading places the neck in a slightly flexed positionposition
1976 NCAA enacted the rule barring “spearing” 1976 NCAA enacted the rule barring “spearing” however recent research indicates that the rule may however recent research indicates that the rule may not be effective.not be effective.
2929
Background Information Background Information (continued)(continued)
Spearing incidence Spearing incidence has not changed has not changed much from 1975.much from 1975.
cervical injuries cervical injuries include sprains, include sprains, strains, strains, intervertebral disks intervertebral disks and brachial plexusand brachial plexus
strains generally strains generally more painful than more painful than seriousserious
severe injuries severe injuries involve fractures involve fractures that are displacedthat are displaced
3030
Cervical InjuriesCervical Injuries
spinal cord may sustain secondary injury due to spinal cord may sustain secondary injury due to disruption of blood supplydisruption of blood supply
neck strains rarely involve nerve damageneck strains rarely involve nerve damage brachial plexus injuries can produce significant, brachial plexus injuries can produce significant,
but transient, symptomsbut transient, symptoms critical that coaching personnel take great care critical that coaching personnel take great care
when conducting a primary and secondary survey when conducting a primary and secondary survey of an athlete suspected of having a neck injuryof an athlete suspected of having a neck injury
3131
Initial Treatment of Neck Initial Treatment of Neck Injury GuidelinesInjury Guidelines
Determine if the Determine if the athlete is athlete is conscious, if conscious, if unconscious, the unconscious, the first priority is basic first priority is basic life support.life support.
Emergency plan Emergency plan should designate a should designate a “team leader.”“team leader.”
3232
Initial Treatment of Injury Initial Treatment of Injury GuidelinesGuidelines
If conscious, If conscious, question the question the athlete regarding athlete regarding numbness, numbness, weakness, weakness, dysesthesia.dysesthesia.
Appearance of Appearance of such symptoms -- such symptoms -- immediately immediately stabilize head and stabilize head and neck and summon neck and summon EMS.EMS.
3434
Injuries to the Injuries to the Maxillofacial RegionMaxillofacial Region
Jaw, teeth, eyes, ears, nose, throat, facial Jaw, teeth, eyes, ears, nose, throat, facial bones and skinbones and skin NEISS recorded 170,000 sports related injuries NEISS recorded 170,000 sports related injuries
within the U.S. to these body areas.within the U.S. to these body areas. Protective equipment has been developed and Protective equipment has been developed and
improved for many of these areas:improved for many of these areas: mouth guardsmouth guards protective eye wearprotective eye wear face shieldsface shields
3535
Maxillofacial RegionMaxillofacial Region Dental injuriesDental injuries
jaw has 32 teethjaw has 32 teeth teeth are vulnerable to teeth are vulnerable to
external blows external blows common in many common in many sportssports
teeth are secured by teeth are secured by cementum and cementum and periosteumperiosteum
3636
Maxillofacial RegionMaxillofacial Regionmajority of dental injuries result from direct majority of dental injuries result from direct
blows that loosen or knock teeth outblows that loosen or knock teeth outWhen rendering first aid, take precautions to When rendering first aid, take precautions to
avoid bloodborne pathogens.avoid bloodborne pathogens.Examining dental injuriesExamining dental injuries
open/close mouth without pain?open/close mouth without pain?general symmetry of the teeth?general symmetry of the teeth?irregularities in adjacent teeth?irregularities in adjacent teeth?bleeding, especially along gum line?bleeding, especially along gum line?
3737
Injuries to the Maxillofacial Injuries to the Maxillofacial RegionRegion
Loosened or knocked outLoosened or knocked outgently push back into placegently push back into placeif knocked out, clean with saline and put back into if knocked out, clean with saline and put back into
placeplace
High risk sports -- use mouth guardHigh risk sports -- use mouth guardrequired in high school since 1966, NCAA in 1974required in high school since 1966, NCAA in 1974stock, mouth-formed and custom fittedstock, mouth-formed and custom fitted
3838
Eye InjuriesEye Injuries
Eye injuriesEye injuries– eye consists of a eye consists of a
round ball-like round ball-like structure housed structure housed within the orbitwithin the orbit
– globe is filled with globe is filled with vitreous bodyvitreous body
3939
Eye InjuriesEye Injuries
– posterior/inferior eye posterior/inferior eye is covered by the is covered by the retinaretina
– eyeball is encased eyeball is encased in the sclerain the sclera
– eye injuries in the eye injuries in the U.S. are on the U.S. are on the increase (basketball increase (basketball and cycling).and cycling). Proper position of the fingers for an
initial examination of the eye
4040
Eye InjuriesEye Injuries– two categories -- contusional and two categories -- contusional and
penetratingpenetratingcontusional injuries vary in severity -- contusional injuries vary in severity --
simple abrasions to rupture of the eyesimple abrasions to rupture of the eyedetached retinadetached retinapenetrating injuries are less common -- penetrating injuries are less common --
shooting sports.shooting sports.
4141
Eye InjuriesEye Injuries Initial evaluation guidelinesInitial evaluation guidelines
majority are simple corneal abrasions or small majority are simple corneal abrasions or small foreign objectsforeign objects
hold upper eyelid away from anterior eyehold upper eyelid away from anterior eyesmall foreign bodies usually found by small foreign bodies usually found by
observationobservationvisible foreign object can be removed with a visible foreign object can be removed with a
moist cue-tip, if imbedded, cover both eyes moist cue-tip, if imbedded, cover both eyes and transport to medical facilityand transport to medical facility
4242
Eye InjuriesEye Injuries
if nothing can be seen in the eye, probably a if nothing can be seen in the eye, probably a corneal abrasioncorneal abrasion
contusions may result in hemorrhage around contusions may result in hemorrhage around the eye known as a “black eye”the eye known as a “black eye”
more severe cases may involve bleeding into more severe cases may involve bleeding into the anterior eye known as “hyphema” -- the anterior eye known as “hyphema” -- refer refer to medical facility immediatelyto medical facility immediatelysymptoms: pain, visual deficit (diplopia) and symptoms: pain, visual deficit (diplopia) and
obvious bleeding into the eyeobvious bleeding into the eye
4343
Eye InjuriesEye Injuries
retinal injuries develop slowly -- early retinal injuries develop slowly -- early symptoms include:symptoms include:floating particles in field of visionfloating particles in field of visiondistorted visiondistorted visionchanges in the amount of light seenchanges in the amount of light seen
4444
Eye InjuriesEye Injuries Contact lens problemsContact lens problems
many athletes wear contacts with few problems; many athletes wear contacts with few problems; however, data show more problems related to hard however, data show more problems related to hard lenseslenses
biggest problem -- lens slipping or debris getting biggest problem -- lens slipping or debris getting trapped between the lens and the eyetrapped between the lens and the eye
coach should have first aid kit to treat common coach should have first aid kit to treat common problems including: wetting solution, small mirror, problems including: wetting solution, small mirror, contact lens casecontact lens case
4545
Nose InjuriesNose Injuries Nose injuriesNose injuries
often injured due to location -- often injured due to location -- bloody nose (epistaxis) may bloody nose (epistaxis) may be the most common facial be the most common facial injury in sportsinjury in sports
Anatomically, the nose Anatomically, the nose consists of mostly cartilage consists of mostly cartilage and skin along with the R & L and skin along with the R & L nasal bones.nasal bones.
Evaluation & treatment Evaluation & treatment guidelinesguidelines any blow to the nose can any blow to the nose can
cause a fracturecause a fracture deformity and swelling at the deformity and swelling at the
bridge of the nosebridge of the nose If a fracture is suspected, treat If a fracture is suspected, treat
the bleeding and refer to a the bleeding and refer to a medical doctor.medical doctor.
4646
Ear InjuriesEar Injuries
Ear injuriesEar injuries anatomically, the ear is similar to the noseanatomically, the ear is similar to the nose external opening and extensive internal structureexternal opening and extensive internal structure
external ear (auricula)external ear (auricula) external acoustic meatusexternal acoustic meatus middle earmiddle ear inner ear (labyrinth)inner ear (labyrinth)
inner ear has a role in equilibriuminner ear has a role in equilibrium
4747
Anatomy of the EarSemicircular Canals Vestibular
nerve Auditorynerve
Stapes
Malleus
Incus
Cochlearnerve
Cochlea OvalWindowRoundWindow
Eustachiantube
Tympanicmembrane
External auditorymeatus (canal)
Pinna
Temporalbone
4848
Ear InjuriesEar Injuries
majority of ear problems are related to majority of ear problems are related to the external earthe external ear
sports such as wrestling are related to sports such as wrestling are related to numerous ear problems because of numerous ear problems because of contact with opponents and/or playing contact with opponents and/or playing surface, required head gear has surface, required head gear has reduced incidence of such injuriesreduced incidence of such injuries
4949
Ear InjuriesEar Injuries Cauliflower ear Cauliflower ear
should be treated should be treated with cold pack and with cold pack and immediately referred immediately referred to a medical doctor.to a medical doctor.
severe blows to the severe blows to the outer ear can result outer ear can result in a ruptured ear in a ruptured ear drumdrum
inner ear infections inner ear infections can result in can result in problems in high risk problems in high risk sportssports
5050
Injuries to the Maxillofacial Injuries to the Maxillofacial RegionRegion
Fractures of the Fractures of the facefacecertain sites are certain sites are
more common:more common:lower jawlower jaw
signs/symptoms signs/symptoms include:include:pain/swellingpain/swellingdeformity & deformity &
malocclusionmalocclusion
5151
Face InjuriesFace Injuries– Signs/symptoms include:Signs/symptoms include:
• extreme pain/deformity in the region of the extreme pain/deformity in the region of the TMJTMJ
• inability to move lower jawinability to move lower jaw• jaw is “locked”jaw is “locked”
– Do NOT attempt to put back into place.Do NOT attempt to put back into place.– treatment includes: application of ice pack treatment includes: application of ice pack
and medical referral.and medical referral.– zygomatic bone may be fracturedzygomatic bone may be fractured
5252
Injuries to the Maxillofacial Injuries to the Maxillofacial RegionRegion
– signs/symptoms include:signs/symptoms include:• pain and swelling pain and swelling • discoloration that spreads to the region of the discoloration that spreads to the region of the
orbitorbit
– treatment includes: application of ice pack treatment includes: application of ice pack and medical referraland medical referral
5353
Face InjuriesFace InjuriesWounds of the facial regionWounds of the facial region
wounds can take many forms and treatment wounds can take many forms and treatment should follow basic first aid protocolshould follow basic first aid protocol
carefully clean with mild soap and apply carefully clean with mild soap and apply sterile dressingsterile dressing
such wounds can present cosmetic problemssuch wounds can present cosmetic problems In general, any wound with observable space In general, any wound with observable space
between margins may require suturing.between margins may require suturing.after suturing, return to play decisions are after suturing, return to play decisions are
made by the doctormade by the doctor