1. Head & Neck
Concussion injuries

2. Anatomy of the head & neck - bones
Cranium – protects brain.
Frontal
Parietal (2)
Occipital
Temporal (2)
Facial
Mandible
Maxille (2)
Zygomatic (2)
Nasal

3. Anatomy of the head & neck - bones

4. Anatomy of the head & neck - bones
Cervical Vertebrae

5. Anatomy of the head & neck - Muscles
Location
Function
Sternocleidomastoid
Anterior aspect of the neck
Flex neck; rotate the head
Trapezius
Posterior aspect of the neck
Extends neck; adducts scapula

6. Anatomy of the head & neck – Soft Tissues
Brain
Cerebrum – higher thought processes
Cerebellum – balance and coordinated movement
Brainstem – vital body functions

7. Anatomy of the head & neck – soft tissues
Meninges- layers of tissue that surround brain and spinal cord. Has areas of space between each layer
DURA MATER- outer layer made up of arteries and veins
SUBDRUAL SPACE
ARACHNOID LAYER- spider web of veins
SUBARACHNOID SPACE- contains CSF
PIA MATER- inner layer lines brain and spinal cord
Cerebrospinal Fluid (CSF) - protects, cushions and nourishes the central nervous system.

8. Anatomy of the head & neck – soft tissues

9. Anatomy of the head & neck – soft tissues
Intervertebral Disks
Cartilagenous discs that lie between the vertebrae.
Act as shock absorbers of the spine.

10. Anatomy of the head & neck - Nerves
Cranial nerves
12 pair that branch off of the brain
Spinal Nerves; nerve root pairs that branch off the spinal cord.
Brachial Plexus (C5-T1) – bundle of spinal nerves that innervate the shoulder and arm muscles

11. Common Injuries – Head/Neck
Concussions
Characterized by immediate and transient post-traumatic impairment of neural function
Mechanism of Injury
Result of direct blow to the head from either a fixed or moving object.
Signs of Injury
Headache
Loss of consciousness
Tinnitus
Nausea
Irritability
Confusion
Disorientation
Dizziness
Amnesia
Concentration difficulty
Photophobia
Sleep disturbances
Vision disturbances
Balance disturbances

12. Common Injuries – Head/Neck
Concussions
Assessment:
Neuropsychological Testing
If possible, preseason testing on a computerized system (ImPACT).
If a concussion occurs, retest injured athlete following recommended protocols.
Thorough evaluation of athlete: (Sport Concussion Assessment Tool (SCAT 2 – see additional resources) is a tool that can be used to evaluate a concussed athlete.
Physical Examination – evaluation of athletes physical symptoms as listed previously.

13. Common Injuries – Head/Neck
Concussions
Assessment
Cognitive testing
Immediate memory testing
What month is it?
What time is it?, etc.
Concentration
Months of year backward
100-7, continue backward
Delayed Recall – have athlete remember words, repeat at later time

14. Common Injuries – Head/Neck
Concussions
Assessment
Balance/Coordination testing
Balance Error Scoring System (BESS – see additional resources)
Romberg Test
Finger to Nose

15. Common Injuries – Head/Neck
Treatment:
Careful removal from play
Thorough physical and neurological examination
Refer to physician for follow-up examination

16. Common Injuries – Head/Neck
Return to Play Guidelines:
Depends on the level of play of the athlete involved. It will include some variation of the following :
Progression through Return-To-Play stages on a case by case basis with final clearance by an approved, licensed health care professional:

17. Common Injuries – Head/Neck

18. Common Injuries – Head/Neck
Postconcussion Syndrome
Persistent symptoms following concussion - May begin immediately following injury and may last for weeks to months
Persistent headache
Impaired memory
Lack of concentration
Anxiety
Irritability
Fatigue
Depression
Continued visual disturbances
Treatment – No clear guidelines
Treat symptoms to greatest extent possible
Return athlete to play when all signs and symptoms have fully resolved

19. Common Injuries – Head/Neck
Second Impact Syndrome
Rapid swelling of the brain from additional head trauma; life threatening
Second impact could be minor
Could be caused by blow to chest that accelerates head.
Signs and Symptoms
No initial loss of consciousness
Rapid worsening leading to:
LOC progressing to coma
Dilated pupils
Loss of eye movement
Respiratory failure
Treatment: Immediate transport to medical facility
Prevention
DO NOT LET THIS SITUATION OCCUR!
Careful decision making regarding return to play following initial head trauma