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athijny final
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  1. Cervical spine normal ROM
    • flextion
    • extension
    • lateral flextion
    • rotation
  2. MOI cervical injuries
    bending, shear and axial forces
  3. Cervical Fractures etiology and sign and symptoms
    • –Etiology
    • •Generally an axial load w/ some degree of cervical flexion
    • –Signs and Symptoms
    • •Neck point tenderness, restricted motion, cervical muscle spasm, cervical pain, pain in the chest and extremities, numbness in the trunk and or limbs, weakness in the trunk and/or limbs, loss of bladder and bowel control
  4. Cervical Sprain (Whiplash)
    • –Etiology
    • •Generally
    • the same mechanism as a strain, just more violent
    • •Involves a snapping of the head and neck -  compromising the anterior or posterior
    • longitudinal ligament, the interspinous ligament and the supraspinous ligament
    • –Signs and Symptoms
    • •Pain will usually arise the day after the trauma (result of muscle spasm)
  5. Acute Torticollis (Wryneck)
    • –Etiology
    • Pain on one side of the neck upon wakening
    • •Result of synovial capsule impingement w/in a facet
  6. Cervical Spine Stenosis
    • –Etiology
    • •Syndrome characterized by a narrowing of the spinal canal in the cervical region that impinges on the spinal cord
    • Result of congenital condition or changes in vertebrae (bone spurs, osteophytes or disk bulges)
  7. Brachial Plexus Neurapraxia (Burner or stinger)
    • –Etiology
    • •Result of stretching or compression of the brachial plexus - disrupts peripheral nerve function w/out degenerative changes
  8. Low Back Muscle Strain
    • –Etiology
    • •Sudden extension contraction overload generally in conjunction w/ some type of rotation
    • •Chronic strain associated with posture and mechanics
  9. Sciatica
    • –Etiology
    • Inflammatory condition of the sciatic nerve
    • Nerve root compression from intervertebral disk protrusion, structural irregularities w/in the intervertebral foramina or tightness of the piriformis muscle
  10. Spondylolysis and Spondylolisthesis
    • –Etiology
    • Spondylolysis refers to degeneration of the vertebrae due to congenital weakness (stress fracture results)Pars Interarticularis Fracture
    • Slipping of one vertebrae above or below another is referred to as spondylolisthesis and is often associated with a spondylolysis
    • L5 slips most often
  11. Describe Return to play protocol*
    • Athletes should not be returned to play the same day of injury.When returning athletes to play, they should be medically cleared and then follow a stepwise supervised program, with stages of progression.
    • There should be at least 24 hours (or longer) for each stage and if symptoms recur the athlete should rest until they resolve once again and then resume the program at the previous asymptomatic stage. Resistance training should only be added in the later stages.If the athlete is symptomatic for more than 10 days, then consultation by a medical practitioner who is expert in the management of concussion, is recommended.
  12. Assessment of Head Injuries
    • •May or may not result in loss of consciousness, disorientation or amnesia; motor coordination or balance deficits and cognitive deficits
    • –Determine loss of consciousness and amnesia
    • –Additional questions (response will depend on level of consciousness)
    • •Do you know where you are and what happened?
    • •Can you remember who we played last week? (retrograde amnesia)
    • •Can you remember walking off the field (antegrade amnesia)
    • •Does your head hurt?
    • •Do you have pain in your neck?
    • •Do you have tinnitus (ringing in ears)?
    • •Can you move your hands and feet?
  13. Head Injury Observation
    • –Is the patient disoriented and unable to tell where he/she is, what time it is, what date it is and who the opponent is?
    • –Is there a blank or vacant stare? Can the patient keep their eyes open?
    • –Is there slurred speech or incoherent speech?
    • –Are there delayed verbal and motor responses?
    • –Gross disturbances to coordination?
    • Inability to focus attention and is the patient easily distracted?
    • Memory deficit?
    • –Does the patient have normal cognitive function?
    • –Normal emotional response?
    • –How long was the patient’s affect abnormal?
    • –Is there any swelling or bleeding from the scalp?
    • –Is there cerebrospinal fluid in the ear canal?
  14. Head Injury Special Tests
    • –Neurologic exam
    • •Assess cerebral testing, cranial nerve testing, cerebellar testing, sensory and reflex testing
    • –Eye function
    • •Pupils equal and reactive to light (PEARL)
    • –Dilated or irregular pupils
    • –Ability of pupils to accommodate to light variance
    • •Eye tracking - smooth or unstable (nystagmus, which may indicate cerebral involvement)
    • •Blurred vision
    • –Balance Tests
    • •Romberg Test
    • –Assess static balance - determine individual’s ability to stand and remain motionless
    • –Multiple variations (primarily foot position)
    • •Balance Error Scoring System
    • –Quantifiable clinical battery of test that utilizes different stances on both firm and foam surface
    • –Errors are tabulated when the patient opens their eyes, takes hands off hips, steps/stumbles or falls
    • –Coordination tests
    • •Finger to nose, heel-to-toe walking
    • •Inability to perform tests may indicate injury to the cerebellum
  15. Concussion Grading AAN
    • American Academy of Neurology guidelines
    • Grade I: Confusion, symptoms last <15 minutes, no loss of consciousness
    • Grade II: Symptoms last >15 minutes, no loss of consciousness
    • Grade III:  Loss of consciousness (IIIa, coma lasts seconds, IIIb for minutes)
  16. Concussion Management
    • If any loss of consciousness occurs the athletic trainer must remove the patient from
    • competition
    • •With any loss of consciousness (LOC) a cervical spine injury should be assumed
    • Objective measures (BESS, SCAT3, SAC) should be used to determine readiness to play
    • Return to normal baseline requires approximately 3-5 days
    • •Following an initial concussion the chances of a second episode are 3-6 times greater
    • -determine the need for physician referral and be able to decide when the patient should return home vs. being admitted to hospital
  17. Second Impact Syndrome
    • –Etiology
    • •Result of rapid swelling and herniation of brain after a second head injury before symptoms of the initial injury have resolved
    • •Second impact may be relatively minimal and not involve contact w/ the cranium
    • •Impact disrupts the brain’s blood auto-regulatory system leading to swelling, increasing intracranial pressure
  18. Epidural Hematoma
    • –Etiology
    • •Blow to head or skull fracture which tears meningeal arteries
    • •Blood pressure, blood accumulation and creation of hematoma occur rapidly (minutes to hours)
    • –Signs and Symptoms
    • LOC followed by period of lucidity, showing few signs and symptoms of serious head injury
    • Gradual progression of S&S
    • –Head pains, dizziness, nausea, dilation of one pupil (same side as injury), deterioration of consciousness, neck rigidity, depression of pulse and respiration, and convulsion
  19. Subdural Hematoma
    • –Etiology
    • •Result of acceleration/deceleration forces that tear vessels that bridge dura mater and brain
    • •May be:
    • Acute (rapidly progressing)
    • –In association with other brain/skull injury –Chronic (Due to venous bleeding – slow bleed, w/out serious intracranial pressure)
    • –Signs and Symptoms
    • •With a simple subdural hematoma LOC generally does not occur
    • •Complicated subdural hematoma’s result in LOC, dilation of one pupil
    • •Both will show signs of headache, dizziness, nausea or sleepiness
  20. •Mandible Fractures
    • –Etiology
    • •Direct blow (generally fractures at frontal angle)
    • –Signs and Symptoms
    • •Deformity, loss of occlusion, pain with biting, bleeding around teeth, lower lip anesthesia
  21. •Mandibular Dislocation
    • –Etiology
    • •Involves TMJ joint
    • •MOI is generally a blow to an open mouth from the side
    • –Signs and Symptoms
    • •Dislocated jaw presents in locked-open position w/ ROM minimal along w/ poor occlusion
  22. Tooth Subluxation, Luxation and Avulsion
    • Managment
    • •For a subluxed tooth, referral should occur w/in the first 48 hours
    • •With a luxated tooth, repositioning should be attempted along w/ immediate follow-up
    • Avulsed teeth should not be re-implanted except by a dentist (use a Save a Tooth Kit, milk or saline)
  23. •Auricular Hematoma (Cauliflower Ear)
    • –Etiology
    • •Occurs either from compression or shear injury to the ear (single or repeated)
    • •Causes subcutaneous bleeding
  24. •Rupture of Tympanic Membrane
    • –Etiology
    • •Fall or slap to the unprotected ear or sudden underwater pressure variation can result in a rupture
  25. •Foreign Body in the Eye
    • •No attempt should be made to remove by rubbing or by recovering with fingers
    • •Close eye and determine location (upper or lower lid)
    • Pull upper lid over lower lid to cause tearing
  26. •Corneal Abrasions
    • –Etiology
    • •Patient attempts to remove foreign object from eye by rubbing - cornea becomes abraded
    • –Signs and Symptoms
    • •Severe pain, watering of the eye, photophobia, and spasm of the orbicular muscle of the eyelid
  27. •Hyphema
    • –Etiology
    • •Blunt blow to the eye
    • Major eye injury that can lead to serious problems with the lens, choroid or retina
    • –Signs and Symptoms
    • •Causes collection of blood to collect in anterior chamber of the eye
    • •Visible reddish tinge in anterior chamber (blood may turn pea green)
    • Vision is partially or completely blocked
  28. •Retinal Detachment
    • –Etiology
    • •Blow to the eye can partially or completely separate the retina from the underlying retinal pigment epithelium
    • –Signs and Symptoms
    • Painless, however, early signs include specks floating before the eye, flashes of light, or blurred vision
    • As it progresses, “curtain falling” over the field of vision occurs
  29. •Acute Conjunctivitis
    • –Etiology
    • •Caused by bacteria or allergens
    • •Conjunctival irritation caused by wind, dust, smoke, air pollution
    • •Associated with common cold or upper respiratory conditions
    • –Signs and Symptoms 
    • Eyelid swelling w/ purulent discharge; itching associated with an allergy; burning or
    • itching
  30. Diplopia
    double vision
  31. Lung Injuries
    Pneumothorax
    • –pleural cavity becomes filled with air, negatively pressurizing the cavity, causing a lung to collapse
    • –Will produce pain, difficulty with breathing and anoxia
  32. •Tension Pneumothorax
    • –Pleural sac on one side fills with air displacing lung and heart, compressing the opposite lung
    • –May cause shortness of breath, chest pain, absence of breath sounds, cyanosis, distention of neck veins, deviated trachea
  33. •Hemothorax
    • Blood in pleural cavity causes tearing or puncturing of the lungs or pleural tissue
    • –Painful breathing, dyspnea, coughing up frothy blood and signs of shock
  34. •Traumatic Asphyxia
    • –Result of a violent blow or compression of rib cage
    • Causes cessation of breathing
    • –Signs include purple discoloration of the trunk and head, conjunctivas of the eye
    • –Condition requires immediate mouth to mouth resuscitation
  35. •Sudden Cardiac Death Syndrome in Athletes
    • Hypertrophic cardiomyopathy- thickening of cardiac muscle w/ no increase in chamber size
    • Anomalous origin of coronary arteries
    • Marfan’s syndrome- abnormality in connective tissue results in weakening of aorta and cardiac vessels
  36. •Kidney Contusion
    • –Etiology
    • •Result of an external force
    • (force and angle dependent)
    • •Susceptible to injury due to normal distention of blood
    • –Signs and Symptoms
    • •May display signs of shock, nausea, vomiting, rigidity of back muscles and hematuria (blood in urine)
  37. •Liver Contusion
    • –Etiology
    • •Blunt trauma -right side of rib cage
    • •More susceptible if enlarged due to illness (hepatitis)
    • –Signs and Symptoms
    • •Hemorrhaging and shock may present
    • May require immediate surgery
    • •Presents with referred pain in right scapula, shoulder and sub-sternal area and occasionally in left anterior side of chest
  38. •Appendicitis
    • –Etiology
    • •Inflammation of the vermiform appendix (chronic or acute)
    • •Result of blockage, lymph swelling, or carcinoid tumor
    • •Early stages it presents as a gastric complaint, that gradually develops from red swollen vessel to a gangrenous structure that can rupture into bowels causing peritonitis

    •Pain may localize in lower right abdomen (McBurney’s point)
  39. •Injury of the Spleen
    • –Etiology
    • •Result of a direct blow or infectious mononucleosis (causing an enlarged spleen)
    • –Signs and Symptoms
    • •Indications of a ruptured spleen involve history of a direct blow, signs of shock, abdominal rigidity, nausea, vomiting
    • •Kehr’s sign
  40. •Abdominal Muscle Strain
    • –Etiology
    • •Result of sudden twisting or reaching of trunk, tearing abdominal musculature
  41. •Hernia
    • –Etiology
    • Protrusion of abdominal viscera through portion of abdominal wall (congenital or acquired)
    • Inguinal vs. femoral hernias
    • •Complications and strangulated hernias
  42. •Blow to Solar Plexus
    • –Etiology
    • •Transitory paralysis of the diaphragm due to direct blow to stomach

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