1 / 38

Head and Neck Pathologies

Head and Neck Pathologies. Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C. Sports related concussions – 300,000 mild traumatic brain injuries/yr 3-8% of all high school and collegiate football players sustain concussions each year

apu
Download Presentation

Head and Neck Pathologies

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Head and Neck Pathologies Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C

  2. Sports related concussions – 300,000 mild traumatic brain injuries/yr 3-8% of all high school and collegiate football players sustain concussions each year NCAA Injury Surveillance System had reported concussions constitute 12.2 and 4.8% of all injuries occurring in collegiate hockey and soccer Head and Neck Pathologies

  3. Head and Neck Pathologies • Concussions – Mild traumatic Brain Injuries • Immediate (but transient) posttraumatic impairment of brain function • Immediate effect – brain cell loss • Secondary damage (↑ risk of brain cell death) • Diagnosis: • Duration of symptoms (i.e. loss of consciousness) • Neuropsychological findings

  4. Concussion: Cognitive Features State of unawareness (i.e. team opponent) Mental confusion Difficulty concentrating Loss of Consciousness Amnesia Anterograde Retrograde Head and Neck Pathologies

  5. Concussion: Subjective Symptoms Headache Dizziness Nausea Loss of Balance Feeling “dinged” Seeing stars/flashing lights Hearing problems Irritability Double Vision Head and Neck Pathologies

  6. Concussion: Objective Signs Loss of or impaired conscious state Poor coordination/balance Gait unsteadiness Poor concentration Vomiting Vacant stare/glassy eyed appearance Slurred speech Personality changes Head and Neck Pathologies

  7. Response to Trauma: Biochemical Changes with Concussion Excitatory Neurotransmitters are Released Influx of extracellular potassium Altered ionic balance Brain enters state of Hypermetabolism (Hyperglycolysis) Can last up to 7-10 days During this state, Brain needs extra nutrients, sensitive to inadequate blood flow Biochemical changes: Implicated in neuronal loss and Cell Death Potential Mechanism for Lifelong Depression due to Neuronal Death?? Head and Neck Pathologies

  8. Head and Neck Pathologies • Standardized Assessment of Concussion (SAC) • Abbreviated neuropsychological test • Immediate objective data • Presence and severity of neurocognitive impairment • On or off field evaluation • Tests: • Orientation • Immediate Memory Recall • Concentration • Delayed Recall • Glasgow Coma Scale • Severe brain injury • Normal score: 15 • > 11: Excellent prognosis for recovery • < 7: Serious brain dysfunction

  9. Concussion Grading: University of North Carolina

  10. Head and Neck Pathologies • Return to Play Guidelines: Grade 0 Concussion • Remove athlete from contest • Examine immediately: • Abnormal cranial nerve function • Cognition • Coordination • Postconcussive symptoms (both at rest and with exertion) • Return to contest: • Exam is normal and athlete asymptomatic for 20 minutes • If any Sx. develop within 20 minutes, return that day is NOT permitted University of North Carolina Guidelines

  11. Head and Neck Pathologies • Return to Play Guidelines: Grade 1 Concussion • Daily follow-up evaluations • May begin restricted participation when asymptomatic at rest and after exertion tests for the 2 days • Unrestricted participation allowed if asymptomatic for 1 additional day and neuropathological and balance testing normal University of North Carolina Guidelines

  12. Head and Neck Pathologies • Return to Play Guidelines: Grade 2 Concussion • Remove athlete/prohibit return • Examine immediately and at 5-minute intervals for evolving intracranial pathology • Re-examine daily • May return to restricted participation when ATC and physician are assured athlete has been asymptomatic at rest and with exertion testing for 4 days • Unrestricted participation if asymptomatic for additional 2 days and performing restricted activities normally University of North Carolina Guidelines

  13. Head and Neck Pathologies • Return to Play Guidelines: Grade 3 Concussion • Treat athlete on the field as if cervical spine injury has occurred • Immediate re-examination at 5-minute intervals for signs of intracranial pathology • Return based on resolution of symptoms: • If symptoms totally resolve within 1 week, return to restricted participation when athlete has been asymptomatic at rest and exertion for 10 days. If asymptomatic for an additional 3 days of restricted activity, athlete may return to full participation University of North Carolina Guidelines

  14. University of North Carolina Return to Play Progression

  15. Head and Neck Pathologies • Postconcussion Syndrome: • Extended symptoms (cognitive impairment) • Altered neurotransmitter function • Occurs more frequently in women • Symptoms: • ↓ attention span • Trouble concentrating • Impaired memory and irritability • Exercise induced headaches, dizziness, premature fatigue • Balance disruption, ↓ cognitive performance

  16. Head and Neck Pathologies • Second Impact Syndrome: • Athlete who has suffered a head injury sustains a 2nd head injury before the signs/symptoms of the initial injury have subsided • Scenario: Athlete suffering from postconcussion symptoms (headache, visual, motor problems) returns to play prematurely…suffers 2nd injury • SIS: Athlete appears stunned…within seconds to minutes, displays life-threatening symptoms (semicomatose state, rapidly dilating pupils, respiratory failure) • ↑ Intracranial pressure (inability or loss of brain blood supply regulation) • Time frame to brain stem failure is rapid! (2-5 minutes post-impact) → High mortality rate (50%)

  17. Head and Neck Pathologies • Cumulative Injury: Research has shown an ↑ risk of concussion incidence following initial injury • Risk of suffering a 2nd concussion is approximately 4 times that of the chance of initial injury in high school football players • Recent study: Collegiate players with previous history (3 or more) were 3 times as likely to suffer a concussion in comparison to those with no prior history

  18. Head and Neck Pathologies • Epidural Hematoma: • Arterial bleeding between the dura mater and the skull • Onset of symptoms → within hours • MOI: blow to the head • Size of hematoma ↑, condition deteriorates • Progression of symptoms: • Patient has signs of concussion • Period of very lucid consciousness (may eliminate suspicion of serious concussion) • Patient becomes disoriented, confused, drowsy • Patient complaints of headache that ↑ in intensity with time • Signs and symptoms of cranial nerve disruption • Onset of coma • Left untreated, death or permanent brain damage occurs

  19. Head and Neck Pathologies

  20. Head and Neck Pathologies • Subdural Hematoma: • Hematoma between the brain and dura mater • Usually involves venous bleeding • Slow accumulation of blood (low BP) • Symptoms may occur hours, days, or even weeks after initial trauma • Simple subdural hematoma: • No direct cerebral damage • Complex subdural hematoma: • Contusions of brain’s surface with associated swelling

  21. Head and Neck Pathologies

  22. Head and Neck Pathologies • Skull Fractures: • History: • Onset: Acute • Pain characteristics: Pain over impact site, possible headache • MOI: Blunt trauma to head • Inspection: • Bleeding • Ecchymosis under eyes and over mastoid process • Rounded contour of skull may be lost • Palpation: • Crepitus • Do not palpate over obvious deformity • Neurological Tests: • Cranial nerve assessment, sensory and motor testing • Comments: • Rule out cervical fracture/dislocation • No object should be inserted into site of skull laceration • A cerebral concussion may be associated with injury • Immediate referral

  23. Head and Neck Pathologies Depressed Skull Fracture Linear Parietal Skull Fracture

  24. Head and Neck Pathologies • Cervical Spinal Cord Trauma: • 1976: NCAA and NFHSA outlawed spearing in football • Present: Estimated that spearing still occurs in 19% of football plays • Spinal cord function: Inhibition • Impingement or laceration secondary to bony displacement • Compression secondary to hemorrhage, edema, and ischemia of the cord • Trauma to spinal cord above C4: ↑ probability of death secondary to dysfunction of brain stem or phrenic nerve

  25. Head and Neck Pathologies • Cervical Fracture or Dislocation: • Dislocation: • ↑ threat to spinal cord • Lower cervical vertebrae (C4-C6) • MOI: Neck forced into flexion and rotation • History: • Onset: Acute • Chief complaints: • Pain in cervical spine • Numbness, weakness, parasthesia radiating into extremities • Cervical muscle spasm • Chest pain • Loss of bladder or bowel control

  26. Head and Neck Pathologies • Cervical Fracture or Dislocation: • History: • MOI: • Most fractures: axial load • Most dislocations: hyperflexion or hyperextension and rotation • Predisposing Conditions: • ↑ risk of cervical fracture if normal lordoctic curve of cervical spine is ↓ • Inspection: • Malalignment of cervical spine • Head may be abnormally tilted and rotated • Unilateral dislocation → head tilts towards site of dislocation; muscles on opposite side are in spasm; muscles on side of dislocation are flaccid • Swelling

  27. Head and Neck Pathologies • Cervical Fracture or Dislocation: • Functional Tests: • ROM testing should not be performed if numbness, weakness, or parasthesia radiating into extremities or bowel/bladder signs present • Neurological Tests: • Upper and lower quarter screen • Special Tests: • Not applicable if fracture/dislocation suspected • Comments: • Immediate transportation (EMS activation)

  28. Head and Neck Pathologies Dislocation: Result - Quadriplegia Fracture of C4-C5 segment

  29. Head and Neck Pathologies Spinal repair involving four types of spinal reconstruction.  Several of the vertebral disks have been replaced with bone graft material.  A plate and screws have been  used to lock the vertebral bodies of C5, C6 and C7 tightly against the graft. From a posterior approach, lateral mass  screws at C4, C5 and C6 prevent rotation and lateral bending.  A thin titanium cable  and cable clamp has also been used to lash a strut of bone onto the spinous processes of C4 to C7 to resist flexion forward.

  30. Head and Neck Pathologies • Transient Quadriplegia: • Body-wide state of decreased or absent sensory and motor function • MOI: Blow to head (cervical spine forced into hyperextension, hyperflexion or axial load force) • Result: Neuropraxia of cervical spinal cord • Predispositions: • Spinal stenosis (C3-C4 ) • Congenital fusion of cervical canal or other abnormalities • Cervical instability • Pavlov ratio 0.80 or less (ratio between diameter of spinal canal and diameter of vertebral body)

  31. Transient Quadriplegia: Predisposing Conditions: (continued) Spear Tackler’s Spine: Pavlov ratio of <0.8 Straight or kyphotic alignment of the neck on a neutral lateral radiograph Posttraumatic radiographic abnormality Documentation of the patient's use of the spear-tackling technique Spear tackler's spine = contraindication for return to play Head and Neck Pathologies

  32. Transient Quadriplegia: Signs and Symptoms: Initially, resemble those of catastrophic cervical injury Sensory dysfunction, burning, pain, numbness, parasthesia in upper and lower extremities Motor dysfunction (weakness to paralysis) Symptoms clear: 15 minutes to 2 days Diagnosis: X-rays, CT, MRI, electromyelograms Head and Neck Pathologies

More Related