New Haven Athletics

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New Haven Athletics Sports Medicine, LLC

• A Group Dedicated to the Health and Wellness of
  Student Athletes
• Presented By
• Dr. Bryan W. Barry
• Director of Sports Medicine
• Michele T. Cormier
• Director of Athletic Training

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Table of Contents

• Head Injuries
• Neck Injuries
• Common Orthopedic Sports Injuries Shoulder, Knee
  and Ankle
• Hydration for the Athlete
• Orthopedic taping

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Head Trauma Concussion

• What is a concussion?
• A concussion is an injury to the head caused by a
  direct or indirect blow to the head.
• It is defined as a complex pathophysiological
  process affecting the brain, induced by traumatic
  biomechanical forces.
• Concussion is an injury to the brain caused by
  impact against the skull. It can often involve a
  loss of consciousness but does not in all cases.
  Concussion can be mild, moderate or severe.

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Introduction

• On-Field Evaluation of Head Injury
• Common signs of mild-to-moderate head injury are
  confusion, disorientation, headache, dizziness,
  nausea and vomiting. Following a head injury
  during a game, a coach or trainer can make an
  on-field head-to-toe assessment

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On-Field Assessment

• Orientation ask the child who he is, where he
  is, how old he is, etc.
• Memory have athlete recall the names of three
  objects do this right after the injury and then
  five minutes later
• Concentration have athlete count backwards from
  100 by 3s or 7s, or repeat a series of three
  numbers (3, 1, 5, for example), months of the
  year, colors of fruits, etc.
• Speech check for slurred speech it is often
  helpful to have a parent or someone familiar with
  the child s usual speech to help assess the
  normalcy of speech after a head injury
• Neurologic perform a fast check of pupil
  reaction, coordination and sensory (bring finger
  to nose with eyes open and closed)
• Exertion or motor function have the athlete
• run back and forth 30-40 yards, and do up to five
  push-ups and sit-ups

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Medical Clearance

• If the athlete demonstrates any symptoms of head
  injury or if mental status cannot be cleared, he
  or she definitely should not be allowed to go
  back into the game and should be further observed
  for progression or resolution of symptoms.
• The Bottom line If youre not sure- remove
  athlete from play! Follow-up with physician

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Symptoms of a Mild Concussion

• A mild concussion may involve no loss of
  consciousness (being "dazed") after athlete
• Symptoms should clear within 5 minutes, including
  headache
• May return to play if cleared by physician or
  trainer

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Symptoms of a Moderate Concussion

• What are the symptoms of a moderate concussion?
• Mental confusion.
• Post traumatic memory loss.
• Moderate tinitus (ringing in the ears).
• Moderate dizziness or headache.
• Moderate balance disturbance.
• Possible nausea and vomiting.
• Loss of consciousness.

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Symptoms of a Severe Concussion

• What are the symptoms of a severe concussion?
• Mental confusion lasting 5 minutes or more.
• Severe tinitus, dizziness or headache.
• Prolonged retrograde amnesia (memory loss of
  events before the accident).
• Loss of consciousness longer than 5 minutes.
• Possible increase in blood pressure with decrease
  in heart rate.

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What should be done?

• The athlete should be removed from the
  competition immediately.
• Notify parents immediately
• The athlete should not be left alone.
• Professional medical advice and evaluation should
  be done that day.
• Avoid contact or collision sports for at least 1
  week without symptoms.
• Rest is the best recovery technique. Healing
  takes time. For headaches, acetaminophen
  (Tylenol, others) or ibuprofen (Advil, Motrin,
  others) can be used as well as ice.
• Avoid aspirin and alcohol as they can increase
  the risk of bleeding.
• Repeated concussions may indicate retirement from
  contact sports altogether.

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INITIAL ON-FIELD EVALUATION for Cervical Trauma

• During on-field evaluation, the golden rule is to
  assume that a cervical spinal cord injury has
  occurred until proved otherwise.
• Immediately Call the Doctor, Athletic Trainer,
• or Ambulance onto the field
• The first step is to immobilize the player's head
  and neck by holding them in a neutral position.
  Keep helmut on!
• Check for the ABCs--Airway, Breathing,
  Circulation, and Consciousness.
• 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.
• (4) Simply remove the mouth guard, if present,
  and maintain an unobstructed airway.

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Shoulder Injuries

• Sprain vs Strain
• Separation vs Dislocation / Subluxation

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Strain-Rotator Cuff Injury
Supraspinatus
Infraspinatus
Subscapularis
Supraspinatus Infraspinatus Teres Minor
Subscapularis
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Sprain-Acromioclavicular

Grade 1 A/C Sprain
Grade 3 A/C Separation
Grade 2 A/C Sprain
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Shoulder Instability / Subluxation

                                                                                                                                            

• What is shoulder instability?
• Multiple structures involved
• Glenoid Labrum
• Shoulder Capsule
• Rotator cuff involvement

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Shoulder Dislocation
What 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.
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What should the athlete do about their dislocated
shoulder?

• Call 911
• Stabilize to prevent further complications which
  may arise due to nerve and/or blood vessel
  entrapment
• The dislocated shoulder should be relocated as
  soon as possible by an orthopedic physician

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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  
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Knee injuries

• Knee Anatomy MCL, LCL , ACL, PCL
• Medial Meniscus
• Lateral Meniscus

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Ankle Sprains
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Treatment
ACUTE INJURY ADVICEFor immediate self care of
simple sprains and strains, what appears to be
the most simple intervention is often the most
effectiveP ROTECTION  of the injured area from
further injuryR 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 bandageE LEVATION above the level of
your heart to reduce swelling
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Hydration
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But Seriously, its important!
Water is the most essential ingredient to a
healthy life and optimal sports performance.
Important in all physiological functions Its
not just about thirst. If the athlete is
thirsty, its too late- Dehydration has already
taken place
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Symptoms of Dehydrationwhen the total fluid loss
reaches 5

• Fatigue
• Muscle cramps
• Headaches
• Nausea
• Loss of concentration
• Increased heart rate
• Increased respiration
• Decreased sweating
• Decreased urination
• Increased body temperature

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Guidelines to Proper Hydration Levels

• Guidelines for proper hydrationMost athletes can
  use the following guidelines to replace fluid
  losses and modify accordingly, if
  needed.Hydration before exercise    Drink
  15-20 fl oz 2-3 hours before exercise    Drink
  8-10 fl oz 10-15 minutes before
  exerciseHydration during exercise    Drink 8
  fl oz of sports drink (13 ratio of sports drink
  to water) every 15 -20 minutes of
  exerciseRehydration after exercise- Fluid
  replacement    Drink 20 fl oz of water for
  every 1 lb lost (weigh yourself before and after
  exercise to determine the number of pounds lost)

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Thank you!