Liberty Union High School District / Overview



1Nervous System/Head & NeckNeurology – Study of nerves and their diseasesFunctions of the Nervous System: Communication system of the bodyReceives impulsesSorts impulses and directs them to the appropriate places in the bodyControls body functions & actions – we have within us the mechanism for:CreativityImaginationCalculationPredictionAbstract reasoning and control of violenceMaintains homeostasis Helps the body adapt to an ever changing environmentInjuries to the head & spine regions in high school athletics are of great concern, because this is where most athletic fatalities or permanent paralysis occur. Keep in mind that in head and spine injuries, the damage to the brain and/or nervous system is of far more importance than damage to the skull or vertebrae. Immediate care and follow-up treatment of head and spine injuries is very delicate, because of the risk involved in future impairment. For this reason, the physician must be responsible for all emergency care and follow-up procedures.2Components of the Nervous SystemCNS – Central Nervous SystemMade up of the brain and spinal cord, which are continuous through the foramen magnum of the skull. The brain is located in the cranial cavity, the spinal cord in the vertebral canal of the spineBrain – Center of consciousness - 3 Parts:Cerebellum – Posterior portion of the brainFunctions:Controls coordination of skeletal muscleBalance, postureSkilled movements below the level of consciousnessCerebrum – Occupies most of the cranium, divided into right & left halvesFunctions:Controls memory & conscious thoughtHighest mental & behavioral activities occur at this levelSpeech, motor, & sensory functionsMedulla Oblongata – (Brain Stem) Continuous with the spinal cordFunctions:Controls heart rateRespirationTemperatureSpinal Cord Oval and less than ? inch in diameter. Continuous with brain & ends between 1st & 2nd lumbar vertebrae. Total length is about 18’. It is surrounded by the meninges, cerebrospinal fluid, adipose tissue, & blood vessels. It is the main channel in relaying information to the brain from the body and to the body from the brain.Functions:Serves as a reflex centerReciprocal Innervation – when a muscle on one side of the joint flexes the muscle on the opposite side of the joint is inhibited – allowing for smooth movements.Conduction highway – sensory information is sent to the brain and motor information is sent sway from the brain to muscleReflexes – fast, predictable, automatic responses to changes in the environment that help protect the body. A reflex arc is the functional unit of the nervous system. Reflexes may also be used as a diagnostic tool to determine nervous system disorders3Components of a Reflex Arc:Receptor – sensitive to a variety of environmental changes or stimuli (heat, pain, light, sound, pressure, tension & chemicals)Afferent (sensory) neuron – carries impulse from receptor to the CNSNerve center or synapse (intern uncial neuron) that make different responses possibleEfferent (motor) neuron – carries impulse toward a muscle or gland to provide a responseEffector – responding structure or the adjustment in the bodyTypes of Reflexes:Stretch Reflex – results in the contraction of a muscle when it is stretched suddenlyEx: Patellar tendon reflex results from muscle spindles which are sensitive to length (stretch) in the muscle. The muscle spindles cause the muscle to contract when it is stretched suddenlyGolgi Tendon Organs – are located in tendons and protect them from excessive tension. They cause the muscle to relax when a tendon is stretched & they help maintain balanceWithdrawal Reflex – sudden contraction and removal of a body segment as a result of a painful stimulusEx: Hot Stove Reflex*Nerve roots emanate from the ventral & dorsal portions of the spinal cord and continue to form the spinal nervesiii. Meninges – The three membranes around the brain & spinal cord which serve to protect and cushion these structures. They are named from the outside inward:4Dura Mater – Dense, fibrous, inelastic sheathEpidural Space – Lies just beneath the skullA layer of fat with vital arteries and veins which separate the dura mater from the bony walls of the cranium and spinal columnEpidural hematomas occur hereContains middle meningeal arterySubdural Space – Lies just beneath the Dura Mater. Subdural hematomas occur hereArachnoid Layer – Extremely delicate sheath, lines the dura mater and attaches directly to the spinal cord by many silk-like tissue strands. Cerebral veins cross in this layer. Looks like a spider web due to the veins bridging and crossingSubarachnoid Space – Lies just beneath the arachnoid layerContains Cerebrospinal fluid, cerebral veins, and major arteriesCerebrospinal fluid completely surrounds the brain, suspending it and acting as a cushion, helping to diminish the forces that might injure the brainPia Mater – A very thin & delicate, highly vascularized membrane that adheres closely to the brain and spinal cordiv Cerebrospinal Fluid – Completely surrounds and suspends the brain. Function:Cushion brainDiminish transmission of shock or force to the brain v. CirculationInternal Carotid Arteries – Lie anterior to the cervical spine and supply blood to the brainVertebral Arteries – Lie posterior and on either side of the cervical vertebrae – supply blood to the spinal cord and spinal nerves5PNS – Peripheral Nervous System – Consists of Spinal and Cranial nerves. The cranial nerves (12) start on the inferior side of the brain & supply chiefly the head & neck. The spinal nerves (31) come from the spinal cord by anterior and posterior roots, supplying the remainder of the body.Spinal Nerves: (31 Pairs) Arising from the spinal cord and connect the CNS to the rest of the body. A nerve root is that portion of the nerve that connects it to the spinal cord and is the most proximal segment of the peripheral nervous system. Branch off the spinal cord and are named to correspond to the regions of the vertebral column through which they pass.8 Cervical12 Thoracic5 Lumbar5 Sacral1 CoccygealNerve Plexus – A network of nerves with varying number of fibersBrachial Plexus – feeds the shoulder and arm. Lumbar Plexus – feeds the back and abdominal area. Sacral Plexus – feeds the lower extremitiesCranial Nerves (12 Pairs) – Can be used to help diagnose injury to the brain. If any of the tests below are positive, the athlete should be referred to physician immediatelyNerve NameFunctionTest IOlfactory(S) SmellIdentify familiar odorsIIOptic(S) Visual AcuityVisual FieldReadApproach athlete from the sideIIIOculomotor(M) Pupillary ReactionShine light in athlete’s eye and watch pupil reactionIVTrochlear(M) Eye MovementsHave athlete follow your finger up & down and side to sideVTrigeminal(B) Facial SensationChewingTouch athlete’s face with their eyes closedHave athlete keep mouth open against resistanceVIAbducens(M) Eye MovementsCheck lateral eye movementVIIFacial(B) TasteFacial ExpressionsHave athlete smile, frown, etc. Identify tastesVIIIVestibulocochlear(S) HearingBalanceIdentify sounds in both earsAthlete performs balance activitiesIXGlossopharyngeal(B) SwallowingTasteTongue SensationsHave athlete say “ah”, swallow, or test gag reflexXVagus(B) SpeechSwallowingHave athlete speakSwallowXIAccessory(M) Head MovementsApply resistance as athlete moves their headXIIHypoglossal(M) Tongue MovementHave athlete stick out their tongue, move it around, etc.6Autonomic Nervous System – Self-governing, spontaneous, involuntary. Consists of 2 division:Sympathetic – Speeds body functionParasympathetic – Slows body functionNeck AnatomyStructures in the neck include larynx, trachea, muscles, nerves, and blood vessels. It is adequate to support the head, which weighs about 14 pounds. The neck is a very fragile region of the body, in which injuries can occur. The neck is seldom injured in daily activities, including sports. However, those injuries that do occur to the neck have the potential to cause paralysis and even death. This is because the vertebrae, like the other bones, can be fractured. Without protection of the vertebrae in their correct alignment, permanent spinal cord damage can occur. The spinal cord transmits impulses that control all voluntary and involuntary movements of the body.Bones Cervical spine is by far the most flexible, allowing flexion, extension, and rotation of the neck and head7 vertebraeC1 – AtlasC2 – Axis Vertebral Foramen allows passage of the spinal cordMain function of the Cervical spine is to protect the spinal cord and provide structure and motion in the neckThoracic spine is important for muscle and rib attachment. They form a protective cavity for the circulatory & respiratory systems12 vertebraeLumbar spine supports the major weight of the body and hold the body erect5 vertebraeSacral spine is fused. The sacrum is joined to the pelvis by a non-movable joint known as the sacroiliac joint5 vertebraeCoccyx is the tail bone3-5 fused vertebraeMusclesSternocleidomastoid – Connects the clavicle and sternum to the mastoid process of the skull. This muscle rotates the head to the opposite sideTrapezius – Extends the neck and head & rotates the head to the same side7Head InjuriesAny athlete sustaining a head injury should be monitored a minimum of 24 hours and carefully evaluated on a regular basis for at least one week.*Serious head injury almost always presents a life-threatening situation – it is important to get the athlete to a hospital within a 30 min. period.**When treating an unconscious athlete, head and neck injuries are ALWAYS assumedCauses: Direct blow (ground, elbow, helmet, other equipment) or when the head is forcefully and quickly moved, such as in a whiplash-type injuryConcussion – A traumatic injury to the soft tissue of the brain Immediate and transient impairment of neural function, or bruising of the brain. Because of the fluid suspension of the brain, a blow to the head can effect an injury to the brain either at the point of contact or on the opposite side. A player does not have to lose consciousness to suffer a concussion.Symptoms (player may have one or more of the following):DizzinessNauseaVomitingBlurred VisionUnequal pupils or inappropriate pupil response to lightDisorientation, confusion, loss of balance, eyes not tracking properlyAmnesiaRetrograde Amnesia: Loss of memory for events that occurred before the injuryAnterograde Amnesia: Loss of memory for events that occurred after the injuryGrading Concussion Severity:Cantu Grading System (2001):Grade I – No LOC, post-concussion symptoms clear in 30 min or lessGrade II – LOC lasting less than 1 minute & PTA, post-concussion lasting longer 30 min but less than 24 hoursGrade III – LOC lasting more than 1 minute, PTA lasting longer than 24 hours, post-concussion symptoms lasting longer than 7 daysThe use of grading systems have been abandoned in favor of a symptom-based, “multi-faceted approach to concussion management that emphasizes the use of objective assessment tools aimed at capturing the spectrum of clinical signs & symptoms, cognitive dysfunction, and physical deficits, and a symptom-limited, graduated exercise protocol leading to return to play.8Treatment:When the brain is traumatized, as in a concussion, the body’s response will be the same as with other tissue injuries and there may be an internal hemorrhage present. Unlike other areas of the body, the brain has very little room to swell and bleeding cannot be controlled with ice. Memory questions should be asked to determine the level of amnesia, if any, and then asked again every 5 minutes or so. Questions such as the day, time, score, location, and how the injury occurred should be used to determine the athlete’s level of awareness.Taking the athlete through a thorough assessment process is vital in determining if the athlete does, in fact, have a concussion and the level of severity and impairment. If the athlete is suspected of having a concussion, the athlete MAY NOT return to competition that day. Also, according to CIF guidelines, the athlete that has been removed from competition due to concussion MUST get cleared by a physician and has a minimum one week sit out period before return to play is allowed.Treatment of concussions depends on the severity and scope of the athlete’s signs and symptoms. For all cases, the athlete MUST be released to a parent or trusted adult. In more mild cases, where symptoms clear relatively quickly, the athlete can be released to parents with take home instructions. These instructions include signs and symptoms to look for, when to take the athlete to the physician, and precautions to take. The athlete may go to sleep, however they should be woken up several times during the night in order to assess their mental status. In severe cases, athlete may be released to a parent with instructions to go directly to a physician for further observation and care. In cases where there is a loss of consciousness, the athlete should be treated as if they have a neck injury, and EMS should be activated.The first 24 hours post-concussion are critical. If proper care is not given, it can extend the amount of time an athlete suffers from symptoms. Likewise, if there is an internal bleed, those symptoms will be present within the first 24 hours. No pain meds should be given during this time period as they may mask worsening symptoms. Athlete should rest as much as possible, and avoid “screen time”. The athlete may also experience an increase in symptoms upon returning to school and learning activities. If these symptoms are present, the athlete should not be cleared to play. The athlete MUST be 100% symptom free prior to RTP.In all cases, prolonged LOC and anterograde amnesia are considered red flags for concussion and factors that may modify concussion management.Signs demanding emergency action with head injuries:Increasing headache, nausea, vomitingDecrease in level of consciousnessIncreased disorientationIncreasing blood pressureDecreasing pulseInequality of pupils – this would be from brain stem pressure, most likely seen in the unconscious athlete9Intracranial Pressure – Brain injury as a result of external trauma can be classified into three primary categories of intracranial hemorrhaging: epidural, subdural, & intracerebralHematoma (Subdural & Epidural):Definition – Bleeding or pooling of blood between the layers (meninges) of the brain/skull. Can be a life-threatening situation.Signs & symptoms: same as severe concussion – hard to distinguishEpidural Hematoma – may have a “lucid” period lasting a few minutes to a few hours where they seem ok and then rapidly decline. Caused by an arterial bleed in the epidural space. Bleeding is fast and hard to controlSubdural Hematoma – Bleeding in subdural space caused by Cerebral veins. Symptoms may not appear for many hours after injury. Bleeding is venous, so it is slow and easier to controlIntracerebral Edema: Similar to a hematoma, but it is swelling of the brain tissue due to trauma. Cause, signs & symptoms, and treatment are the same for all of these conditions.Cause: Direct blow or impact to the headSigns and symptoms: Same as severe concussionTreatment: Hospitalization with possibility of surgical interventionTraumatic Seizures:Definition – Seizure caused by a blow to the head. Indicates a possibility of a brain injuryCause: Direct impact to the headTreatment: Maintain airway, try to prevent further injury to the athlete, do NOT restrain athlete during seizure. Once seizure has passed, stabilize head & neck and activate EMS. Skull Fractures:S & S: Deformity on palpation, bleeding or clear fluid leaking from the ears, nose, or mouth. May also experience concussion symptoms. An important danger with skull fractures is the possibility of bacteria entering through a laceration site into the intracranial cavity.10Treatment: Call 911, stabilize head & neck until EMS arrives, monitor vital signsLacerationsCommon sites: Eyebrow, forehead, chin, nose, scalpCause: Usually direct trauma with an object (ball, elbow, racket, etc.)S & S: Pain, bleeding, tendernessTreatment: Direct pressure with gauze, butterfly, or steri-strip, ice. Depending on thickness & location, athlete may need to see physician for stitches. Lacerations of the face should be sutured within 4 hours of the injury. Don’t forget to look for other head & neck injuriesInjuries to the eye: Black Eye:Definition – Contusion to soft tissues around the eyeCause: Direct TraumaS & S: Pain, swelling, discoloration, possibly bleeding into the white of the eye, deformity – indicating possible fractureTreatment: Ice, rest, see physician if fracture is suspectedCorneal Abrasion:Definition – Scratching the cornea layer of the eyeCause: Dirt, sand, glass, or other material caught in the eye, fingernail of another playerS & S: Pain, burning, redness of the eye, decreased vision, blurred vision, sensitivity to lightTreatment: Remove any small irritating particle with clean cotton, cover eye with gauze. See physician, do not rub eye, remove contact lensesDetached Retina:Definition – Retina separates from its attachments to the eyeCause: Usually a blow to the head or eyeS & S: Athlete describes seeing a curtain fall in front of the eye or multiple lights that flashed on and off, or mentions the appearance of “floaters”Treatment: Athlete should immediately be referred to an ophthalmologist11Fractures:Nose FractureDefinition – Fracture of the nasal bone or tear of the cartilageCause: Direct impact to the noseS & S: Pain, grating feeling in nose, crooked or deformed nose, profuse bleeding, swelling, discoloration, trouble breathing, “raccoon eyes”Treatment: Ice, Refer to physician for X-Rays and setting if necessary Jaw FractureDefinition – Fracture of the mandible or maxillaCause: Direct impactS & S: Tenderness & swelling over fracture site, inability to bite down, malocclusion (teeth do not align properly)Treatment: Ice, Refer to physician for X-RaysBloody Nose:Cause: Direct impact to nose, head injury, dry nasal passage, high blood pressureS & S: Bleeding from nasal passageTreatment: Athlete should sit up with head forward and apply direct pressure to nostril. Put ice on bridge of nose if bleeding won’t stop. Athlete should not blow their nose for at least an hour following bleedTeeth InjuriesCauses: Most often a direct impact to the toothPrevention: Mouth guards should be worn in both practice and game situations for all contact sports. Use of mouth guards has not only dramatically reduced the incidence of dental injuries, but has shown to lessen incidence of concussionsFractured Tooth:S & S: Deformity, possible pain and sensitivity to heat/cold, pressure if chipped down to the dentin or pulp. Treatment: Apply pressure to bleeding areas, send athlete to dentist w/in 24 hours12Dislocated Tooth:S & S: Swelling of gums, tooth dislodged from gum, painTreatment: Reimplant tooth immediately. If this is not possible, place tooth in milk or wet gauze. Transport immediately to dentistLoose Tooth:Treatment: If tooth moves 2mm or more, push tooth back in and send immediately to dentist. A displaced tooth under 2mm will usually heal itself.Ear Injuries: Cauliflower EarDefinition – Hematomoa of the PinnaCause: Occurs in contact sports such as boxing, rugby, and wrestling. Caused by direct blows to the ear while not wearing ear protection. A hemorrhage in the ear with pressure or infection destroys the underlying cartilageS & S: Swelling, discoloration of the pinna following a blow to the earTreatment: Ice and moderate compression. A physician should be seen to drain the bloodRuptured Eardrum:Cause: Direct trauma to the ear which causes a sudden violent increase in the pressure within the external auditory canalS & S: Intense pain, followed by hearing loss and in some cases, severe dizziness and nausea. A small amount of bleeding from the external auditory canal may be present.Treatment: See physicianOtitis Externa “Swimmers Ear”:Definition – Bacterial or fungal infection involving the lining of the external auditory canalCause: Occurs frequently in those who neglect to adequately dry the canalS & S: Itching or painful ear that may or may not be dischargingTreatment: See physician. Eardrops are necessary for healingHead Injury Prevention:Appropriate and intelligent coaching – Proper hitting techniqueGood quality equipment – Helmets, mouthpieces, etc.Safe playing environment – Poles padded, etc.13Other diseases which may effect the nervous system:Cerbral PalsyDefinition – Developmental defects of motor areas of the brain or trauma at birth. Results in muscle paralysis and most of the time developmental delaysCerebrovascular Accident (Stroke)Definition – A block in an artery which feeds part of the brain or rupture of the blood vessel. Symptoms: Slurred speech, loss or blurred viosn, paralysis of a lim or half of the body, coma, and death. Think F.A.S.T (Face drooping, Arm weakness, Slurred speech, Time to call 911)Parkinson’s DiseaseDefinition – Progressive disorde of the CNS caused by too little dopamine.Symptoms: Muscle tremors, muscle rigidity, slow and difficult movement. Walking and speech are affectedMultiple Sclerosis (MS)Definition – Progressive destruction of the myelin sheaths of neurons of the CNS. Causes “short circuits” in nerve transmission. No known cause or treatment. Symptoms: Progressive loss of functionNeck InjuriesFootball provides the greatest potential for serious cervical spine injuries, as the head is often used in blocking and tackling techniques. Diving and gymnastics also provide mechanisms for devastating neck injuries. Most paralyzing or fatal injuries occur when an athlete’s neck is presented with an axial load or forced into hyperflexion Paralysis:Definition – Inability to voluntarily move a muscle or limbCause: Damage to the spinal cord or a motor nerve. Damage to a sensory nerve will result in a lack of sensation in the area which that nerve innervates. Types:Paraplegia – Paralysis of both lower extremitiesQuadriplegia – Paralysis of both upper and lower extremitiesVertebral Fractures/Dislocations:Cause:Blow to the head forcing the beyond its normal ROM, resulting in compression, forced hyperextension, flexion, lateral flexion, rotation, or a combination of these movementsS & S: Midline tendernessDeformity over midline in cervical regionInability to move neckNumbness or tingling in extremitiesWeakness or paralysis in extremitiesPainDecreased sensaion14Treatment:Stabilize the head and neckMonitor airway, breathing, circulation; Use jaw thrust method for opening airwayCall 911, transport on spine boardIf athlete is wearing a helmet, do not remove equipmentAny head injury severe enough to render an athlete unconscious must be handled as if there is also associated cervical spine involvement. The mechanism of injury is any force that flexes, extends, whiplashes, or rotates the neck beyond its normal range of motion:MOI for Cervical Fractures:1 Axial Load2 Flexion3 Hyperextension 4 Lateral Flexion5 Whiplash 6 Rotation & Hyperextension ................
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