میحرلا نمحرلا الله مسب

HEAD &

neck

INJURY

mohammad saleki MD Sport medicine specialist

IUMS

Head Injury

 Occur by head to head or head to knee  Concussion by contact mat  Injury rate:1-8%of all inj  Most inj are mild

Wrestling

 Injury rate: 22.7-50 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

Head Injury

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

يگديشارخ ،يدوبك یگتفوک یگراپ

بیسا مسیناکم هب هجوت هارمه تاعیاضو مدعو پلاکسا ینغ یریگنوخ ثعاب قورع ضابقنا دیدش یزیرنوخ یگتسکش ندرک در : نامرد وشتسش یزیرنوخ لرتنک زازک مخز نتسب   

Concussion

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

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

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

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

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

Concussion

(2 of 2)

.

 Anterograde (posttraumatic) amnesia: forgetting events after the injury  Perseveration: repetitive speech patterns

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

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

Immediate Transport

     Diplopia Severe or increasing emesis Seizure Focal neurologic findings Pupillary changes      Rapidly progressive headache Penetrating injury LOC > 5 min Confusion > 30 min High risk patient > 1 concussion this season

موس هعفد

وتناک یدنب هجرد

مود هعفد لوا هعفد ر یغ شزرو لصف نایاپ ات رتدوز یدروخرب هتفه 1 هقیقد 20 یشوهیب نودب 1 هجرد هقیقد 30 زارتمک یشومارف یا هفرح شزرو متخ هام 1 هتفه 1 زارتمک یشوهیب 2 هجرد زارتشیب یشومارف هقیقد هقیقد 5 30 یا هفرح شزرو متخ لصف نایاپ ات هام 1 زا رتشیب یشوهیب 3 هجرد 24 ز ا رتشیب یشومارف هقیقد 5 تعاس

Who to Scan?

 GCS < 15   ? Any LOC Focal neurologic findings

Return to Play

No symptomatic athlete should be allowed to compete

Post-concussive Syndrome

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

Second impact syndromes

رتعیاش درم – ناناوجون زا لبق هقباسم هب تشگرب لماک یدوبهب   للاتخا لوا هبرض زا دعب هبرض زا سپ زغم یقورع زغم مروت مود  حطس شهاک رد گرم امک : مئلاع یرایشوه هقیقد 2 ضرع 

Skull Fracture

  Indicates significant force Signs: – – – – – Obvious deformity Visible crack in skull Raccoon eyes Battle’s sign Cerebrospinal fluid

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.

Evaluation and Treatment

 CAB’s  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

Cervical spine and Neck Injuries

Epidemiology

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

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

هعلاطم

) يتشك لاس 10 لقادح هقباس اب ( يا هفرح ریگ يتشك 40 MRI و كیتسونگایدورتكلا ياهیسررب  يبصع هشیر نمزم هعیاض راچد هعلاطم دروم دارفا % 45 .

دندوب ندرگ دراوم % 61 رد ) دراوم % 28 رد ) degenerative ( ویتارنژد تارییغت protrusion ( كسید يگدز نوریب    دراوم % 19 رد يعاخن لاناك يگنت دراوم % 9 رد ) extrusion ( كسید جورخ  

هعلاطم

) C6 ( زونگایدورتكلا رد ریگرد يبصع هشیر نیرتعیاش .

دوب هفرط ود لكشب  يطیحم بصع بیسآ راچد هعلاطم تحت دارفا % 5/27 دندوب يناقوف مادنا  يریگرد سپس و % 15 اب هفرطود لنوت لاپراك مردنس دوخب ار رامآ نیرتشیب % 12 اب جنرآ رد رانلوا بصع .

دنداد صاصتخا  نار یگ یتشک رد ندرگ بیسآدهدیم ناشن تاعلاطم یضعب یگ نرف ناریگ یتشک زا رتشیب یراد ینعم روط هب دازآ تسا 

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

یندرگ تلاضع یگدیشک

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

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

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

2. “Burner” or “Stinger”

      Weakness in C5 and C6 distribution  Deltoid, biceps, wrist extensors, pronator teres Positive Spurling’s 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

 Continued symptom despite stopping truma(37%)  Treat:ROM.rehab.streght

Complicated Stingers

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

ارذگ یاپو تسد راهچ جلف

     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

transient quadriplegia

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

تارقف نوتس یاهبیسا مئلاع

هرهم یور تیساسحو درد اه  اه هرهم نوتس لکش رییغت  ندش رومرومو یسحیب ینلاضع فعضو  راردا یرایتخا یب 

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

Unilateral and Bilateral Facet Dislocation

 Prompt reduction indicated to relieve cord deformation

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

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

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.

Stabilization of the Cervical Spine

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    Hold patient’s head firmly with both hands.

Support the lower jaw.

Move to patient’s head to eyes-forward position.

Maintain position until patient is secured to backboard.

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