EYE TRAUMAS IN SPOTS

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HEAD neck INJURY mohammad saleki MDSport
medicine specialist IUMS
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Head Injury

• Occur by head to head or head to knee
• Concussion by contact mat
• Injury rate1-8of all inj
• Most inj are mild

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Wrestling

• Injury rate22.7-50 inj per 100 wrestler
• 42-50 all inj associated takedowns
• Injury rate increase with age
• incidence rate increase durig competitton
• prevalence rate increase durig practice
• Catastrophic inj increase durig competitton

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Head Injury

• Scalp laceration
• Concussion
• Subarachnoid Hemorrhage
• Subdural/Epidural Hematoma
• Skull Fx

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Concussion

• Definition
• A concussion is an alteration of mental
  status due to biomechanical forces affectingthe
  brain. A concussion may or may not cause loss of
  consciousness.

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Concussion

• Centers for Disease Control and Prevention (CDC)
  estimates 300,000 sports-related concussions
  occur per year
• 100,000 in football alone
• An estimated 900 sports-related traumatic brain
  injury deaths occur per year

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Concussion

• Concussion occurs most often in males and
  children, adolescents and young adults
• Risk of concussion in is 4-6 times higher in
  players with a previous concussion

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• Concussions per every 100,000 games and/or
  practices at the collegiate level
• Football 27
• Ice Hockey 25
• Mens soccer 25
• Womens soccer 24
• Wrestling 20
• Womens basketball 15
• Mens basketball 12 (Head and Neck
  Injury in Sports, R.W. Dick

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Concussion (1 of 2)

• Minor traumatic brain injury (TBI)
• Temporary loss or alteration in brain function
• May result in unresponsiveness, confusion, or
  amnesia
• Retrograde amnesia forgetting events leading up
  to injury

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Concussion (2 of 2)

• Anterograde (posttraumatic) amnesia forgetting
  events after the injury
• Perseveration repetitive speech patterns
• .

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Immediate Signs of Concussion(occurring within
seconds to minutes)

• Impaired attention , delayed responses, inability
  to focus
• Slurred or incoherent speech
• Gross incoordination
• Disorientation
• Emotional reactions out of proportion
• Memory deficits
• Any loss of consciousness

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Later Signs of Concussion(occurring within hours
to days)

• Persistent headache
• Dizziness/vertigo
• Poor attention and concentration
• Memory dysfunction
• Nausea or vomiting
• Fatigue easily
• Irritability
• Intolerance of bright lights
• Intolerance of loud noises
• Anxiety and/or depression
• Sleep disturbances

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Immediate Transport

• Diplopia
• Severe or increasing emesis
• Seizure
• Focal neurologic findings
• Pupillary changes

• Rapidly progressive headache Penetrating injury
• LOC gt 5 min
• Confusion gt 30 min
• High risk patient
• gt 1 concussion this season

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Who to Scan?

• GCS lt 15
• ? Any LOC
• Focal neurologic findings

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Return to Play

• No symptomatic athlete should be allowed to
  compete

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Post-concussive Syndrome

• 20 to 40 _at_ 3 months post injury
• Neuropsychiatric impairments
• attention concentration
• Somatic
• headache (71)
• fatigue (60)
• dizziness (53)
• Affective depression or anxiety

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Second impact syndromes

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Skull Fracture

• Indicates significant force
• Signs
• Obvious deformity
• Visible crack in skull
• Raccoon eyes
• Battles sign
• Cerebrospinal fluid

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Intracranial Bleeding

• Major TBI
• Laceration or rupture of blood vessel in brain
• Subdural
• Intracerebral
• Epidural

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Complications of Head Injury

• Cerebral edema is one of the most serious
  complications.
• Ensure airway and provide oxygen.
• Seizure (convulsion) may occur.
• Vomiting may occur.
• Common in children
• Leakage of cerebrospinal fluid may occur.
• Do not pack ears or nose.

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Evaluation and Treatment

• CABs
• If unconscious, immobilize C-spine
• Examine for chest, abdominal, limb injuries
• Glascow Coma Scale
• Mental Status Exam
• Brain imaging-for fracture or contusion
• C-spine X-rays

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• Cervical spine and Neck Injuries

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Epidemiology

• 10,000 C-spine injuries/yr in US
• 5-10 related to sports
• Football, wrestling, gymnastics, diving, surfing,
  skiing, hockey, rugby

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Neck injury

• Inj associated takedowns in hyperextention
• Most inj sprain/strain/stinger
• (noncatastrophic)
• sprain/strain up 50 neck inj
• Cumulative effect mild inj increase incidence of
  djd

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Injury Classifications

• Catastrophic and Potentially Catastrophic
  Injuries
• Cervical Subluxation
• Unilateral and bilateral facet dislocation
• Unstable cervical fractures -- axial load
  teardrop fracture
• Noncatastrophic Injuries
• Nerve root -- brachial plexus injury
• Cervical sprain and strains
• Intervertebral disc injury
• Cervical cord neuropraxia-transient quadriplegia
• Stable fractures

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• Collision-type injury
• Pain
• Limitation of motion
• Radiographs are normal
• resolve without treatment
• Treatment
• soft collar
• analgesics agents
• Taping

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Acute Cervical Sprain Syndrome

• Collision-type injury
• Pain localized to cervical area
• Limitation of cervical spine motion without
  radiation of pain or paresthesia
• Neurologic exam negative
• Radiographs are normal
• Eventually resolve without treatment
• Test AROM -- if abnormal then further work-up
  warranted
• Treatment
• neck immobilization in a soft collar
• analgesics and anti-inflammatory agents

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Burner or Stingers

• Transient UE neuropraxia of root or brachial
  plexus
• Traction-plexus
• Compression-root
• Burning in arm
• Shock likepain
• Dysesthesia paresthesia
• Few sec to few min
• Limit ROM-tendernes

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2. Burner or Stinger

• Weakness in C5 and C6 distribution
• Deltoid, biceps, wrist extensors, pronator teres
• Positive Spurlings
• Is not a spinal cord injury.
• Generally symptoms resolve in 5 minutes,
• Is return before pain tenderness to normal
  recurrence is high
• Repeated osteoghyte foramen narrowing

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• Continued symptom despite stopping truma(37)
• TreatROM.rehab.streght

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Complicated Stingers

• Recurrent, prolonged disability
• Consider EMG and MRI of C-spine and plexus
• Consider equipment changes upon return
• Cervical strengthening

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• burning pain, numbness, tingling, and loss of
  sensation
• weakness to complete paralysis involving upper
  and lower extremities
• Axial loding caused
• In wrestler 2
• Stenosis hypermobility is causative

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transient quadriplegia

• (recovery usually occurs in 10-15 minutes)
• Radiographs are negative for fracture,
  subluxation, or dislocation
• Does not predispose to neurologic sequelae

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Cervical Subluxation

• Uncommon
• Up to 2 mm of translatory displacement is normal
• 3.5 mm translation and 11 degrees of rotation are
  indications for surgical stabilization

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Unilateral and Bilateral Facet Dislocation

• Prompt reduction indicated to relieve cord
  deformation

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Unstable Cervical Fractures- Axial-Load Teardrop
Fracture

• Three-part, two-plane axial-load teardrop
  fracture is most frequently occurring cervical
  spine fracture associated with instability, cord
  compromise and major neurologic sequelae
• 85 of tackle football players sustaining this
  injury were rendered and remain quadriplegic

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Intervertebral Disc Injury

• Acute cervical disc herniation rare in athletes
• Acute central disc deforming the cord, or lateral
  disc associated with pain, limited cervical ROM,
  or neurologic symptoms are absolute
  contraindications to athletic participation
• Degenerative disc changes
• associated with repetitive microtrauma
• disc space narrowing, anterior bony ridging, loss
  of cervical lordosis
• treatment consists of rest, heat, analgesics,
  neck collar until pain free

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Assessment of Spinal Injuries

• Assess CAB
• Avoid any excessive motion.
• Assess strength in each extremity and compare.
• Absence of pain does not rule out injury.
• Ability to move or walk does not rule out injury.

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Stabilization of the Cervical Spine (1 of 3)

• Hold patients head firmly with both hands.
• Support the lower jaw.
• Move to patients head to eyes-forward position.
• Maintain position until patient is secured to
  backboard.

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Cervical Collar

• Provides preliminary, partial support
• Applied to every patient with a suspected spinal
  injury
• Used with manual stabilization until patient is
  secured to spinal immobilization device
• Must be correctly sized

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Thank you for your attention