Athletic Injuries ATC 222 Head, Face, Eyes, Ears, Nose, and Throat Chapter 27

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Athletic Injuries ATC 222Head, Face, Eyes, Ears,
Nose, and ThroatChapter 27
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Facial Injuries

• Mandible Fracture
• deformity
• malocclusion
• malalignment
• bleeding around teeth/gums
• lower lip anesthesia
• pain with biting
• Treatment

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Facial Injuries

• Mandible Dislocation/Subluxation
• commonly from lateral force
• malalignment
• malocclusion
• open, locked jaw

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Dental Injuries

• Types
• fracture
• dislocation/subluxation
• Treatment
• realign subluxation
• replace/preserve dislocation or fracture
• 30 minute survival rate

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Nasal Injuries

• Fracture or Cartilage Separation
• S/S
• deformity
• profuse bleeding
• immediate swelling
• crepitus
• treatment
• control hemorrhaging
• referral
• most return to activity in 3-4 days

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Nasal Injuries

• Epistaxis (nosebleed)
• sit upright
• ice (nose and ipsilateral carotid)
• direct pressure on nostril
• cotton/gauze plug
• refrain from nose blowing for 2 hours

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Eye Injuries

• Causes and Prevention
• S/S or Serious Eye Injury
• prolonged blurred vision
• loss of part/all of visual field
• sharp, stabbing, throbbing pain
• double vision
• embedded object
• blood in anterior chamber (hyphema)

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Treatment of Serious Eye Injury

• immediate referral
• cover both eyes with embedded object
• ice only to surrounding tissue
• no pressure applied to eyes

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Orbital Blowout Fx

• Blunt trauma
• Inability to look upward
• Diplopia
• Sunken eye

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What is wrong with this picture?
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Orbital Hematoma

• Black Eye
• Bleeding in orbit area and poss. Sclera
• Rule out serious eye injury

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Foreign Body in Eye

• Embedded?
• Removal
• Close eye
• eye rinse
• removal with gauze pad

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The ole finger in the eye play!!!!
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Ear Injuries

• Hematoma Auris (cauliflower ear)
• causes
• S/S
• swelling
• redness, warmth
• pain
• treatment
• ice
• protection
• aspirate

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Otitis Media and Externa

• Etiology
• Signs and Symptoms
• Treatment

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• Neurological System and Evaluation

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Neuron (Nerve Cell)

• dendrites
• cell body
• axon
• Schwann cells
• motor end plate

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Functional Classification of Neurons

• Sensory
• Associational
• Inter-neurons
• Motor
• Upper motor neuron
• Lower motor neuron

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Synapse

• Functional connection between 2 neurons
• chemical or electrical
• Neurotransmitters
• acetylcholine
• norepinephrine
• Motor Unit

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Nervous System Divisions

• Central Nervous System (CNS)
• Brain
• Spinal Cord
• Peripheral Nervous System (PNS)
• Cranial Nerves
• Spinal Nerves
• R.T.D.C.B.

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PNS

• Somatic NS
• Autonomic NS
• sympathetic
• parasympathetic
• enteric NS

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Somatic Nervous System

• Functions
• voluntary control of skeletal muscle
• convey conscious/unconscious sensory (afferent)
  information
• vision, pain, touch, unconscious muscle sense

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Autonomic Nervous System

• Functions
• convey sensory input from visceral organs, glands
  and cardiovascular system
• involuntary control of smooth and cardiac muscle
• maintain homeostasis
• Divisions of ANS
• Sympathetic Nervous System
• thoracolumbar
• Parasympathetic Nervous System
• craniosacral
• Enteric Nervous System

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Sympathetic Nervous System

• Dominates in stress conditions
• physical and psychological
• very rapid effects
• Fight or Flight theory
• increased sweating, HR, RR
• blood diverted to skeletal muscles
• pupil dilation
• conversion of glycogen to glucose

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Parasympathetic Nervous System

• Opposite actions of sympathetic nervous system
• dominates in relaxed states
• decreased HR and RR
• increased peristalsis
• increased saliva and intestinal secretions
• pupil constriction

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Enteric Nervous System

• innervates GI tract, pancreas, gall bladder

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CNS

• Gray matter nerve cell bodies
• White matter axons
• Efferent neurons
• motor neurons
• Afferent neurons
• sensory neurons

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Meninges

• Dura Mater
• tough, inelastic membrane
• adheres to inner part of cranium
• Arachnoid Mater
• delicate, web-like tissue
• avascular
• Pia Mater
• thin, delicate tissue hugging brain
• no space between pia mater and brain
• capillary rich to supply brain with blood

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Meninges Cont.

• Epidural Space
• potential space
• between cranium and dura mater
• space created due to epidural hematoma
• middle meningeal artery
• Subdural Space
• filled with a serous lubricant
• prevents dura mater and arachnoid from adhering
  to each other
• Subarachnoid Space
• relatively large
• filled with cerebrospinal fluid
• ventricles

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Cerebrum

• Basal Ganglia
• Limbic system

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Cerebrum

• general appearance and behavior
• level of consciousness (loc)
• intellectual performance
• short term memory (STM)
• long term memory (LTM)
• amnesia?
• calculation
• reasoning
• emotional control
• language skills
• voluntary movement (cerebral cortex)

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Basal Ganglia and Limbic System

• Basal Ganglia
• part of extra-pyramidal system
• inter-connects several part of CNS
• fine tune motor control
• Limbic System
• emotion, hunger, biological rhythms, smell

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Diencephalon

• epithalamus
• thalamus
• hypothalamus
• subthalamus

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Thalamus/Hypothalamus

• Thalamus
• receives input from every sensory system
• sensory and motor integration
• Hypothalamus
• homeostasis (temp), hunger, thirst, emotions

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Cerebellum

• Coordination
• control of timing, speed, and direction of
  movement
• Equilibrium
• balance, posture

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Brain Stem

• midbrain
• eye tracking voluntary movement
• medulla
• decussation of UMN
• pons
• relay info. from cortex to cerebellum
  respiration
• medulla oblongata
• reflexes for vomiting, swallowing, coughing,
  salivation, pupils
• cranial nerves III, IV, V, VI, VII, VIII, IX, X,
  XI, XII

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Movie TimeRated PG
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Reticular Formation

• Extends throughout the length of the brain stem
• Reticular activating system
• wakefulness
• modification of sensory input
• controls motor function via reticulospinal tract
• receives input from hypothalamus and limbic
  system (emotion)

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Vestibular Nuclei

• located in brain stem
• receive input from labyrinthine system, reticular
  formation, and cerebellum
• controls/interprets balance, head control, and
  eye tracking

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Spinal Cord

• Function
• pathway for efferent and afferent nerve fibers
• ascending and descending spinal tracts
• connects peripheral and spinal nerves to brain
• center for spinal (monosynaptic) reflexes
• Location
• foramen magnum to app. L2
• Gives rise to 31 pair of spinal root nerves
• Cauda equina
• lumbrosacral plexus from L2 on down

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Spinal Nerves

• 31 pair
• dorsal spinal root afferent sensory
• ventral spinal root efferent motor
• Doral and ventral root join to form the
  peripheral nerve
• Spinal nerves exit below respective vertebral
  level except for cervical
• Myotome
• voluntary muscle group receiving motor
  innervation from a specific spinal nerve
• Dermatome
• section of skin that receives sensory innervation
  from a specific spinal nerve
• adjacent dermatomes overlap
• partial loss peripheral complete loss cord

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Descending TractsMotor

• corticospinal (Pyramidal Tract)
• voluntary skilled movement in extremities
• reticulospinal
• facilitate or inhibit motor neurons
• posture
• tectospinal
• postural reflexes of head for vision
• rubrospinal
• facilitate/inhibit motor neurons
• posture
• vestibulospinal
• facilitate/inhibit postural muscles of abdomen,
  back, neck

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Ascending Tracts

• Exteroceptive, Proprioceptive, and Interoceptive
• ventral and lateral spinothalamic
• pain and temperature
• spinocerebellar
• proprioceptive and exteroceptive
• vestibular nuclei and joint receptors
• spinoreticular
• muscle, joints, and skin
• gracile and cuneate
• touch, pressure, conscious joint sense

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Cranial Nerves

• Sensory and/or Motor Function
• 12 pairs
• On Old Olympus Towering Top A Fin And German
  Viewed Some Hops
• Oh Oh Oh To Touch and Feel a Girl/Guy Very Sexy
  and Hot
• Motor and/or Sensory Function
• Some say marry money but my brother says bad boys
  marry money.

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Cranial Nerves

• I. Olfactory
• function smell
• testing identify common odors
• II. Optic
• function vision
• testing check visual fields, check vision
• III. Oculomotor
• function eye movement, pupil reflex
• testing tracking, direct/consensual pupil
  reflex, accommodation, nystagmus, drooping eyelid
• IV. Trochlear
• function eye movement
• testing tracking, nystagmus

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Cranial Nerves Cont.

• V. Trigeminal
• function muscles of mastication, facial
  sensation, corneal reflex
• testing check facial sensation, muscles of
  mastication
• VI. Abducens
• function eye movement
• testing tracking, nystagmus
• VII. Facial
• function muscles of facial expression, taste to
  anterior tongue
• testing facial expressions, taste
• VIII. Vestibulocochlear
• function hearing, equilibrium
• testing hearing, check for tinnitus, check
  balance

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Cranial Nerves Cont.

• IX. Glossopharyngeal
• function taste to posterior tongue, muscles of
  larynx/pharynx
• testing taste, gag reflex, speak/swallowing,
  coughing
• X. Vagus
• function swallowing, phonation, taste
• testing speak/swallowing, gag reflex, taste,
  cough
• XI. Spinal Accessory
• function motor control of upper trap and
  sternocleidomastoid
• testing SMT/DMT of trap and SCM
• XII. Hypoglossal
• function tongue movement
• testing tongue protrusion (deviation?)

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Cranial Nerve Quick Test

• Vision
• Visual Fields
• Eye Tracking
• Facial Sensation
• Muscles of Facial Expression
• Muscles of Mastication
• Hearing/Balance
• Swallowing
• Upper Trap/SCM Strength
• Tongue Protrusion
• Pupil Reflexes

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Proprioception

• The awareness of posture, movement, muscle
  length/tension, changes in equilibrium, weight,
  resistance of objects, and speed/range,angle of
  movement
• Proprioceptors
• muscle spindle
• Golgi tendon organ (GTO)
• mechanoreceptors

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Muscle Spindle

• Detects length and rate of length
• Extrafusal vs. Intrafusal fibers
• extrafusal skeletal muscle fibers
• innervated by alpha motor neurons
• intrafusal muscle spindle fibers
• innervated by gamma motor neurons

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Muscle Spindles

• Intrafusal fibers
• located within muscle belly
• stretching a muscle also stretches the muscle
  spindle
• most sensitive to rapid stretching
• Types
• Nuclear Bag 1 (Dynamic)
• rate of change in length
• Ia afferent fires rapidly but adapts quickly
• Nuclear Chain (Static)
• overall length
• II afferent slow firing and non-adapting

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Golgi Tendon Organ

• located within tendons
• Ib afferent
• slow firing and non-adapting
• most sensitive to excessive stretch
• sensitive to excessive tension due to muscle
  contraction
• excessive tension will cause a reflexive
  inhibition of alpha mn

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Myotatic or Stretch Reflexes

• Deep Tendon Reflex
• biceps brachii C5-C6
• brachioradialis C5-C6
• triceps brachii C7
• infrapatellar L3-L4
• posterior tibialis L5
• achilles S1
• Jendrassik Maneuver
• increases facilitative activity of spinal cord

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Superficial Reflexes

• Abdominal
• upper T6-T9
• lower T9-T12
• Cremasteric L1-L2
• Plantar S1-S2
• Gag
• Corneal

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Visceral Reflexes

• Pupillary reflex
• direct
• consensual
• accommodation
• Blink reflex

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Pathological Reflexes

• Babinski sign
• Oppenheim sign
• Decorticate rigidity
• Decerebrate rigidity
• due to lack of cortical/cerebral control

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Lower Motor Neuron Lesions

• weakness/paralysis/paresis of a voluntary motor
  group
• decreased tone (flaccidity) of involved motor
  group
• decreased/absent deep tendon reflex (hyporeflexia
  or areflexia)
• atrophy of muscle/muscle group
• radicular pain specific to a spinal nerve path
• decreases/absent sensation of specific dermatomes
  (hypoesthesia or anesthesia)

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Upper Motor Neuron Lesion

• pathological reflex present (eg Babinski sign)
• weakness distal to lesion
• hemiplegia/paraplegia
• increased deep tendon reflex (hypereflexia)
• hypertonicity
• spasticity
• rigidity
• decreased/absent superficial reflexes
• due to lack of cortical control

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Reflex Grading Scale

• 0 Absent
• 1 Decreased (elicited with reinforcement)
• 2 Normal
• 3 Increased
• 4 Clonus

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Head Injuries

• Incidence of serious injury has decreased
• neck injuries?
• protective gear
• Appr. 250,000 concussions/year
• Focal vs. Diffuse Injuries

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Concussion

• Definition
• clinical syndrome characterized by immediate and
  transient impairment of normal neurological
  function
• Causes
• coup Vs. contrecoup
• Grades
• Return to Play Criteria
• Post-concussion Syndrome
• Second Impact Syndrome

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Intracranial Hemorrhaging

• Epidural hematoma
• arterial bleeding
• rapid onset (poss. 10-20 min.)
• Subdural hematoma
• venous/capillary bleeding
• slow onset
• Intracerebral hematoma
• compressive mechanism/aneurysm
• rapid onset

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Evaluation Process

• Primary Assessment?
• ABCs
• Secondary Assessment
• Mental Status
• Cranial Nerve Exam
• Motor System Exam
• Proprioception, balance, and coordination
• Sensory Exam
• Reflex Examination

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Cranial Nerve Exam

• Test for
• Vision
• Tracking
• Visual Fields
• Pupil Reflex
• Hearing
• Swallowing
• Shoulder Shrug
• Facial Sensation
• Facial Expression
• Tongue Protrusion
• Mastication

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Other Signs and Symptoms

• headache
• nausea, vomiting
• seizures
• unequal pupils
• tinnitus
• unusual drowsiness

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Treatment

• Recheck athlete on regular basis
• Refer if in doubt or in more severe cases
• Monitor throughout the night
• No alcohol, aspirin, ibuprofen
• No activity until asymptomatic
• No new s/s or no worsening of current s/s