THE SPINE

ANATOMY

Bony 7 Cervical Vert 12 Thoracic 5 Lumbar Atlas Axis Spinous Process Transverse Process Facets Body

ANATOMY

Bony 7 Cervical Vert Atlas Axis Spinous Process Transverse Process Facets Body

ANATOMY

Bony 7 Cervical Vert Atlas Axis Spinous Process Transverse Process Facets Body

• Other– Foreman

• Vertebral Foreman

• Intervertebral Foreman

• Transverse Foreman

– Disc

• Annulus Fibrosis

• Nucleus Propulsus

Anatomy

• Other– Foreman

• Vertebral Foreman

• Intervertebral Foreman

• Transverse Foreman

– Disc

• Annulus Fibrosis

• Nucleus Propulsus

Anatomy

Anatomy

• Other– Foreman

• Vertebral Foreman

• Intervertebral Foreman

• Transverse Foreman

– Disc

• Annulus Fibrosis

• Nucleus Propulsus

• Other– Foreman

• Vertebral Foreman

• Intervertebral Foreman

• Transverse Foreman

– Disc

• Annulus Fibrosis

• Nucleus Propulsus

Anatomy

Anatomy

• Other– Foreman

• Vertebral Foreman

• Intervertebral Foreman

• Transverse Foreman

– Disc

• Annulus Fibrosis

• Nucleus Propulsus

Disc

MUSCLESSplenius MuscleTrapeziusSternocleidomastoidScalene

BRACHIAL PLEXUS Roots C5, C6, C7, C8, T1 Trunks Upper, Middle, Lower Divisions Anterior, Posterior Cords Lateral, Posterior, Medial Branches

Suprascapular Musculocutaneous Axillary Radial Median Ulnar

HISTORY

General History Questions What/how happened? When? Location of pain? Type of pain? What makes it better/worse? Time of day? Abnormal sounds/sensations Did you continue to play? Rate pain Previous medical history?

Previous treatments Medications/Allergies

INSPECTION/OBSERVATION OF THE SPINE

Normal Curvature Cervical Thoracic lumbar

Position of the head Bilateral soft tissue comparison Level of the shoulders, iliac crests

SPINE PATHOLOGY

FacetSyndrome

PATHOLOGY

Cervical Instability

DIVING SPEARING

PATHOLOGY

Cervical Fractures

PATHOLOGY

Cervical Fractures

PATHOLOGY - CERVICAL FRACTURES

C4 Fractures and above- likely cause fatality

C5 Fractures and below-survival rate is higher

CERVICAL STENOSIS

CERVICAL DISC HERNIATION

CERVICAL DISC HERNIATION

CERVICAL DISC RUPTURE

BRACHIAL PLEXUS INJURIES

BRACHIAL PLEXUS INJURIES

-Cervical Neuropraxia- stinger or burner

-Signs & Symptoms- upper arm paralysis- pain - burning- tingling- can be very transient- can last months

THORACIC OUTLET SYNDROME

- Compression of the neuro-vascular structures between the:

- scalene- cervical rib- clavicle

LUMBAR SPINE PATHOLOGIES

SPONDYLOLYSIS

Fracture of the pars interarticularis of the vertebrae

Most common at L4/5 or L5/S1

SPONDYLOLYSTHESIS

Fracture of pars interarticularis with associated anterior slippage deformity

Spondylolysis Spondylolisthesis

Why does this translated vertebrae not cause significant neurological trauma?

CAUDA EQUINA

Spinal Cord ends at L2, where cauda equina begins.

DISC HERNIATION

L4/L5 OR L5/S1MECH: LIFTING WITH ROTATION, AXIAL

LOADING, VALSALVA MANEUVER

Postero-lateral herniation

HEAD INJURIEShttp://www.youtube.com/watch?v=pyAmP8CowSk&feature=related

FACTS

Head injuries are the leading cause of death in sports

TYPES OF HEAD INJURIES MOI

Coup injury Stationary skull being hit by a traveling object Trauma to the side of the brain that was struck

Contrecoup Moving skull suddenly stopped Trauma to the side of the brain that was struck as well

as the opposite side Repeated sub-concussive forces

Boxing, heading a soccer ball Cumulative neurological damage

Rotational or shear forces Sudden twisting, acceleration or deceleration force Cerebral concussion symptoms Rupture of the vertebral artery

MILD TRAUMATIC BRAIN INJURY (MTBI)- CONCUSSION

Neurological disruption Temporary Loss of Function Sx

Headache Dizziness Concentration deficits LOC

Heals over time FUNCTIONAL problem with nerve conduction

COMPLICATIONS OF CONCUSSIONS

Post-concussion syndrome Extended duration of cognitive impairments

following a concussion Decreased attention span Impaired memory Irritability Headaches Fatigue dizziness

COMPLICATIONS OF CONCUSSIONS CONT. Second Impact Syndrome

Consequence of returning an athlete to competition too soon following a concussion Second trauma is often a minor blow Increases cerebral congestion Loss of autoregulation of brain’s blood supply

vasodilation Increased intracranial pressure

Rapid onset of symptoms Following initial concussion symptoms, athlete

may collapse into a comatose state **High morbidity rate**

HEAD TRAUMA

Intracranial hematomaRupture of blood vessels supplying the brainEpidural hematoma

Arterial bleeding between the dura mater and the skull

Rapid bleeding and onset of symptoms within hours

Symptoms progress as bleed continuesSubdural hematoma

Venous bleeding between brain and dura mater Slow bleeding and onset of symptoms may not

occur for hours, days, weeks This type of bleed is responsible for most post concussion deaths… WHY?

SUBDURAL HEMATOMA

ZYGOMATIC (COMPLEX) FRACTURE

Etiology MOI = direct blow

Signs and Symptoms Deformity, or bony discrepancy Nosebleed Diplopia Numbness in cheek

FACIAL LACERATIONS

MOI: Direct blow S&S: LOTS of blood

NASAL INJURIES

Fractures and Chondral separations MOI: Direct Blow S&S: Profuse Bleeding, Deformity, Swelling

Care for nosebleed?

FACIAL INJURIES (CONT)

Auricular Hematoma Cauliflower Ear

Orbital Hematoma Orbital Fracture

Blow-out Fracture S&S: Diplopia, downward displacement of the

eye, inability to look up Corneal Abrasion Hyphema

Blood in anterior chamber MAJOR

EVALUATION OF HEAD INJURIES IN CONSCIOUS ATHLETE An athlete goes down on the field, and

you suspect a head/neck injuryStabilize headALWAYS SUSPECT A NECK INJURY WITH

A HEAD INJURY!!!Take a thorough history

Location of symptoms Cervical pain Head pain

Flexion mechanisms are most likely to cause catastrophic injury (spearing) In flexed position, the curve is straightened, and the

ability for the c-spine to dissipate forces is lost LOC History of concussion Complaints of weakness/fatigue

EVALUATION OF HEAD INJURIES IN CONSCIOUS ATHLETE Inspection

Do you remove the helmet in football/hockey? Inspect

Cervical vertebrae Mastoid process

Battle’s sign – swelling/bleeding over mastoid process may indicate a skull fracture

Racoon eyes – skull or nasal fracture Skull and scalp Nystagmus

Cyclical eye movement indicates pressure on motor nerves or disruption of inner ear

Battle Sign

Raccoon Eyes

EVALUATION OF HEAD INJURIES IN CONSCIOUS ATHLETE Inspection (cont’d)

Pupil size PEARL

Pupils equal and reactive to light May indicate pressure on cranial N III (oculomotor)

Racoon eyes Bruising around orbit may indicate a skull or nasal fracture

Nose and ears Leakage of blood and cerebral spinal flluid

General Vacant Stare Delayed verbal and motor response Inability to focus attention Disorientation

Slurred Speech Heightened emotions

ON FIELD MANAGEMENT OF HEAD AND NECK INJURIES Equipment considerations

In general, do not remove the helmet during pre-hospital care when Athlete is breathing

With the helmet on rescuers can still Access an airway with the facemask removed Place a cervical collar on Adequately secure head to spine board Take x-rays

ON FIELD MANAGEMENT OF HEAD AND NECK INJURIES Equipment considerations (cont’d)

When do you remove the helmet and shoulder pads? Improperly fitting helmet Unable to remove facemask Unable to access airway

Considerations Defibrillation intubation

EVALUATION OF HEAD/NECK INJURIES IN UNCONSCIOUS ATHLETE Airway Breathing Log roll into supine position Remove facemask Jaw thrust maneuver to open airway Rescue breathing/CPR

http://www.csmfoundation.org/Educational_Materials.html

RETURN TO PLAY CRITERIA

Complete resolution of Neurological symptoms Motor weakness Paresthesia Numbness Cognitive function

Standardized Testing