Week 10: Injuries to the Head, Face and Neck Flashcards
Injuries to Anterior Neck/Throat
-MOI: blunt force to anterior neck/throat by stick, puck, ball, opponent
-Common in field hockey, hockey, lacrosse
-S&S: pressure, difficulty swallowing “feels thick”, difficulty breathing, panicky
-Risk of larynx fracture
-Trent McCleary (former Montreal Canadiens player)in 2000 suffered a career-ending puck strike to the throat
Major Bleeds
-MOI: Skate, stick, contact with boards → Laceration of carotid artery, jugular vein, subclavian vein
-Hockey, figure skating
-Acute management: pressure++, rapid call to EMS, treat for shock
-Requires vascular surgical team to repair damaged vessels
-Prevention: neck guards
Facial Injuries (6)
- Eye-Poke Injuries
- Fractures
- Auricular hematomas
- Lacerations
- TMJ conditions
- Dental injuries
Eye-Poke Injuries
-Most commonly results in:
a) Subconjunctival hemorrhage - bright red bleeding/spot on white of eye from broken blood vessel
b) Corneal abrasion – scratch on surface of eye
-S&S: mild discomfort, irritation
-Acute management: cold compress, refer for eye exam
-Any vision changes, shadows, floaters, pressure, pain should be referred urgently due to risk of more serious conditions (retinal tears/detachment, deeper damage to the eye and/or vessels)
Facial Fractures
-MOI: Direct trauma via opponent (head-to-head, fist), puck, ball
-Common in ice hockey, football (mandible), rugby, baseball
-Unilateral zygomatic-maxillary-orbital, isolated mandibular, & nasal fractures most common
-S&S: TOP fracture site, racoon eyes, swelling, divots, deformities
-Acute management: PIER if tolerated, refer
Auricular Hematoma
-MOI: blunt trauma, repetitive friction
-Resulting contusion to ear
-S&S: pain, swelling, bruising
-Blood accumulates between connective tissue & cartilage of the ear – results in pressure++
-Can lead to necrosis of the cartilage from bl supply being cut off
-If not drained, the cartilage can become deformed resulting in “cauliflower ear” aka wrestler’s ear
-Common in wrestling, rugby, judo, boxing
-Acute management: PIER, add pressure by: packing ear with folded gauze to prevent fluid accumulation, magnets? (use with caution)
Lacerations
-MOI: blunt trauma, sharp object (including teeth!)
-Tend to open up
-Lots of bleeding = requires firm pressure
-Can affect any area, including tongue and lips
-Lacerations of the face → refer for stitches
-Acute care: pressure, Steri-Strips
Temporomandibular Joint (TMJ) Conditions
Hinge joint
-MOI: direct trauma to mandible, cumulative repeat impacts
-Most common in contact sports
-Can result in:
-Dislocations
-Sprains
-Articular disc injuries
-Muscle tension/strains
-Clicking/altered joint mechanics
-Headaches
Dental Injuries
-MOI: Direct blow
-Common sports related dental injuries:
1) Tooth (crown) fractures
2) Tooth intrusion – tooth gets forced into the bone
3) Tooth extrusion – tooth gets forced out of the bone
4) Tooth avulsion – complete removal from socket i.e. tooth knocked out
-Acute management: ensure broken teeth removed from mouth (choking hazard), rule out concussion & C-spine, refer to dentist, ER (for severe cases), rolled gauze to control bleeding, on-field Dr. can supply numbing agent
-Prevention: mouthguards
Headaches
-Types seen in sport:
1) Dehydration – approx. 90% of headaches are due to dehydration
2) Cervicogenic
-Muscle tension: referred pain patterns (see image below)
-Joint dysfunction
3) Concussion
*traps are common to be tense (bracing) and suboccipital muscles behind eyes (guard)
Concussions: aka Mild Traumatic Brain Injuries (mTBI)
-MOI: Direct blow or indirect (land on bum, whiplash mechanism)
-Used to be thought of as a structural injury to the brain
-Physical damage needs to be ruled out – but concussions are now known to be a functional injury
-A transient change of neurological function
-Cause: Stretch & shearing of axons
-Concussion = stretch, ion exchange, depolarization of action potentials→ results in an electrical storm
Signs of Concussion (What you can “see”)
-Vomiting
-Disorientation or confusion
-Memory loss
-Loss of consciousness (but only in <10% of concussions)
Symptoms of Concussion (What athletes describe)
-Headache, pressure, migraines
-Cognitive changes: focus and thought processing, difficulty following instructions/directions
-Vestibular system: dizziness, motion sensitivity, balance & coordination
-Nausea: due to vestibular dysfunction or migraines
-Fatigue
-Fogginess, detached from self
-Mood changes: anxiety, depression, irritability
-C-spine injuries often get missed – can contribute to symptoms and NB to rule out
*rehab tailored towards which systems are affected
Assessing a Concussion
-Includes: Interviews, physical exams, testing
-Two common assessment tools:
1. SCAT6 – Sport Concussion Assessment Tool
-Standardized tool for evaluating concussions
-Sideline and/or clinical
-Designed for Health Care Professionals; athletes ≥ 13 yrs old
-Takes 10-15 min to be done correctly
- ImPACT® Testing (Immediate Post-concussion Assessment and Cognitive Testing)
-Computerized objective tool – clinical only
-Requires a baseline test
-Measures memory, attention span, visual & verbal problem solving
Components of Concussion Assessment SCAT6
Immediate assessment/neuro scan – on-field or 1st identified:
1. Observable signs – athlete position/behaviour/MOI
2. Glasgow Coma Scale (LOC) – eye/verbal/motor responses
3. Cervical Spine Assessment – pain at rest, TOP, AROM, limbs
4. Coordination & Ocular/Motor Screen (Visual, Vestibular) – finger to nose, follow finger
5. Memory Assessment Maddocks Questions (Cognitive) – questions re venue, game, past games
Off-Field Assessment:
1. Athlete Background (head history)
2. Symptom Evaluation
3. Cognitive Screening
a) Orientation
b) Immediate Memory
c) Concentration
4. Coordination & Balance Examination
5. Delayed Recall
6. Decision – Summary of Scores with decision
