HeadHead

Skull FractureSkull Fracture Etiology: Etiology: Blunt trauma or a fall from a heightBlunt trauma or a fall from a height Signs & Symptoms:Signs & Symptoms: Severe headache and nausea; palpation may Severe headache and nausea; palpation may

reflect a defect such as a skull indentation; reflect a defect such as a skull indentation; there may be blood in the middle field, blood there may be blood in the middle field, blood in the ear canal, bleeding through the nose, in the ear canal, bleeding through the nose, ecchymosis around the eyes (raccoon eyes) or ecchymosis around the eyes (raccoon eyes) or ecchymosis behind the ears (battle sign); ecchymosis behind the ears (battle sign); cerebral spinal fluid may appear in the ear cerebral spinal fluid may appear in the ear canal and nosecanal and nose

Treatment:Treatment: Hospitalization and neurosurgeon referralHospitalization and neurosurgeon referral

Cerebral ConcussionsCerebral Concussions(Mild Head Injuries)(Mild Head Injuries)

Etiology: Etiology: Blunt trauma or a fall from a heightBlunt trauma or a fall from a height Signs & Symptoms:Signs & Symptoms: Headache, tinnitus, nausea, irritability, confusion, Headache, tinnitus, nausea, irritability, confusion,

dizziness, loss of consciousness, posttraumatic dizziness, loss of consciousness, posttraumatic (anterograde) amnesia, retrograde amnesia, (anterograde) amnesia, retrograde amnesia, concentration difficulty, blurred vision, concentration difficulty, blurred vision, photophobia, sleep disturbancephotophobia, sleep disturbance

Treatment:Treatment: Athlete is removed from play. May return to play if Athlete is removed from play. May return to play if

asymptomatic for 20 minutes.asymptomatic for 20 minutes.

Head Injury GuidelinesHead Injury Guidelines

GradeGrade 1st Concussion1st Concussion 2nd Concussion2nd Concussion 3rd 3rd ConcussionConcussion

1 (Mild) 1 (Mild) Return to play if Return to play if no symptoms for no symptoms for 20 minutes20 minutes

Return to play in Return to play in 2 wk if no 2 wk if no symptoms for 1 symptoms for 1 wkwk

Terminate Terminate season; may season; may return to play return to play next season if next season if no symptomsno symptoms

2 2 (Moderate) (Moderate)

Return to play if Return to play if no symptoms for no symptoms for 1 wk1 wk

One month One month minimum minimum restriction; Return restriction; Return to play if no to play if no symptoms for 1 symptoms for 1 wk; consider wk; consider terminating terminating seasonseason

Terminate Terminate season; may season; may return to play return to play next season if next season if no symptomsno symptoms

3 (Severe) 3 (Severe) One month One month minimum minimum restriction; Return restriction; Return to play if no to play if no symptoms for 1 symptoms for 1 wk; consider wk; consider terminating terminating seasonseason

Terminate Terminate season; may season; may return to play return to play next season if no next season if no symptomssymptoms

Post-Concussion SyndromePost-Concussion Syndrome

Etiology: Etiology: Poorly understood condition that occurs following Poorly understood condition that occurs following

a concussiona concussion Signs & Symptoms:Signs & Symptoms: Athlete complains of a range of post-concussion Athlete complains of a range of post-concussion

problems, including persistent headache, impaired problems, including persistent headache, impaired memory, lack of concentration, anxiety and memory, lack of concentration, anxiety and irritability, giddiness, fatigue, depression and irritability, giddiness, fatigue, depression and visual disturbances. These symptoms may begin visual disturbances. These symptoms may begin immediately or within several days following the immediately or within several days following the initial trauma and may last for weeks or even initial trauma and may last for weeks or even months before resolving. months before resolving.

Treatment:Treatment: Athlete is removed from play until all symptoms of Athlete is removed from play until all symptoms of

this condition have resolved.this condition have resolved.

Second Impact SyndromeSecond Impact Syndrome

Etiology: Etiology: Rapid swelling and herniation of the brain after a second head Rapid swelling and herniation of the brain after a second head

injury that occur before the symptoms of a previous head injury that occur before the symptoms of a previous head injury have resolved. The second impact may be relatively injury have resolved. The second impact may be relatively minor and, in some cases, may not even involve a blow to the minor and, in some cases, may not even involve a blow to the headhead

Signs & Symptoms:Signs & Symptoms: Often, the athlete does not even lose consciousness and may Often, the athlete does not even lose consciousness and may

look stunned. The athlete may remain standing and be able look stunned. The athlete may remain standing and be able to leave the playing field under his or her own power. to leave the playing field under his or her own power. However, within 15 seconds to several minutes, the athlete’s However, within 15 seconds to several minutes, the athlete’s condition worsens rapidly, with dilated pupils, loss of eye condition worsens rapidly, with dilated pupils, loss of eye movement, loss of consciousness leading to coma, and movement, loss of consciousness leading to coma, and respiratory failure. This is a life-threatening situation!respiratory failure. This is a life-threatening situation!

Treatment:Treatment: Emergency hospitalization. The best treatment is prevention.Emergency hospitalization. The best treatment is prevention.

Cerebral ContusionCerebral Contusion

Etiology: Etiology: Blunt trauma Blunt trauma Signs & Symptoms:Signs & Symptoms: Athlete may experience a loss of Athlete may experience a loss of

consciousness but subsequently becomes consciousness but subsequently becomes very alert and talkative. A neurological exam very alert and talkative. A neurological exam will be normal, however, symptoms such as will be normal, however, symptoms such as headaches, dizziness, and nausea will headaches, dizziness, and nausea will persistpersist

Treatment:Treatment: Hospitalization Hospitalization

Epidural HematomaEpidural Hematoma

Etiology: Etiology: A blow to the head or a skull fracture causing a A blow to the head or a skull fracture causing a

tear of the menigeal arteries which are embedded tear of the menigeal arteries which are embedded in the bony grooves of the skullin the bony grooves of the skull

Signs & Symptoms:Signs & Symptoms: Athlete may experience a loss of consciousness Athlete may experience a loss of consciousness

but subsequently becomes lucid and show few or but subsequently becomes lucid and show few or none of the symptoms of a serious head injury. none of the symptoms of a serious head injury. Gradually symptoms begin to worsen and the Gradually symptoms begin to worsen and the athlete begins to experience severe head pain; athlete begins to experience severe head pain; dizziness, dilation of the pupil (usually on the dizziness, dilation of the pupil (usually on the same side of the injury), and sleeplessness. This same side of the injury), and sleeplessness. This can degrade into a life-threatening situation.can degrade into a life-threatening situation.

Treatment:Treatment: HospitalizationHospitalization

Subdural HematomaSubdural Hematoma

Etiology: Etiology: Occur more frequently than an epidural hematoma; Occur more frequently than an epidural hematoma;

results from acceleration/deceleration forces that results from acceleration/deceleration forces that tear vessels that bridge the dura mater and the tear vessels that bridge the dura mater and the brain. brain.

Signs & Symptoms:Signs & Symptoms: Athlete may loose consciousness; the athlete may Athlete may loose consciousness; the athlete may

experience severe headache; dizziness, dilation of experience severe headache; dizziness, dilation of the pupil (usually on the same side of the injury), the pupil (usually on the same side of the injury), and sleepiness. This can degrade into a life-and sleepiness. This can degrade into a life-threatening situation.threatening situation.

Treatment:Treatment: HospitalizationHospitalization

Malignant Brain Edema Malignant Brain Edema SyndromeSyndrome

Etiology: Etiology: Occurs within minutes to hours after head trauma Occurs within minutes to hours after head trauma

and is caused by an intracerebral clot that results in and is caused by an intracerebral clot that results in diffuse brain swelling with little or no brain injury.diffuse brain swelling with little or no brain injury.

Signs & Symptoms:Signs & Symptoms: Rapid neurologic deterioration from a normal alert Rapid neurologic deterioration from a normal alert

state that progresses to a coma and occasionally state that progresses to a coma and occasionally death.death.

Treatment:Treatment: Emergency hospitalizationEmergency hospitalization

Migraine HeadachesMigraine Headaches

Etiology: Etiology: Athlete has a history of repeated minor blows to Athlete has a history of repeated minor blows to

the head or who has sustained a major cerebral the head or who has sustained a major cerebral injury; the exact cause is unknown, but the injury; the exact cause is unknown, but the condition is believed to be a vascular disordercondition is believed to be a vascular disorder

Signs & Symptoms:Signs & Symptoms: Flashes of light, blindness in half the field of vision Flashes of light, blindness in half the field of vision

(hemianopia), and paresthesia thought to be (hemianopia), and paresthesia thought to be caused by vasoconstriction of intercerebral caused by vasoconstriction of intercerebral vessels. The athlete complains of a severe vessels. The athlete complains of a severe headache that is diffused throughout the head and headache that is diffused throughout the head and often accompanied by nausea and vomiting. There often accompanied by nausea and vomiting. There is evidence of a familial predisposition.is evidence of a familial predisposition.

Treatment:Treatment: MedicationMedication

Scalp InjuriesScalp Injuries

Etiology: Etiology: Blunt or penetrating traumaBlunt or penetrating trauma Signs & Symptoms:Signs & Symptoms: Possible bleeding, pain, and point Possible bleeding, pain, and point

tendernesstenderness Treatment:Treatment: Pressure with a sterile gauze, cleanse the Pressure with a sterile gauze, cleanse the

wound thoroughly, then dress. Possible wound thoroughly, then dress. Possible physician referral.physician referral.

Mandible FractureMandible Fracture

Etiology: Etiology: Direct blowDirect blow Signs & Symptoms:Signs & Symptoms: Deformity, loss of normal occlusion of the Deformity, loss of normal occlusion of the

teeth, bleeding around the teeth, lower lip teeth, bleeding around the teeth, lower lip anesthesiaanesthesia

Treatment:Treatment: Immobilize the jaw with an elastic Immobilize the jaw with an elastic

bandage, physician referralbandage, physician referral

Mandible DislocationMandible Dislocation

Etiology: Etiology: Side blow to an open mouthSide blow to an open mouth Signs & Symptoms:Signs & Symptoms: Locked in an open position, jaw movement Locked in an open position, jaw movement

almost impossible, overriding malocclusion almost impossible, overriding malocclusion of the teethof the teeth

Treatment:Treatment: Immobilize the jaw with an elastic bandage Immobilize the jaw with an elastic bandage

and ice, physician referral, soft diet, and and ice, physician referral, soft diet, and NSAIDsNSAIDs

Temporomandibular Joint Temporomandibular Joint DysfunctionDysfunction

Etiology: Etiology: Forward translation of the jaw Forward translation of the jaw Signs & Symptoms:Signs & Symptoms: Headache, earache, vertigo, inflammation, Headache, earache, vertigo, inflammation,

neck painneck pain Treatment:Treatment: Strengthening exercises for hypermobility; Strengthening exercises for hypermobility;

mobilization exercises for hypomobility; mobilization exercises for hypomobility; custom-fitted mouthpiececustom-fitted mouthpiece

Zygomatic Complex Zygomatic Complex (Cheekbone) Fracture(Cheekbone) Fracture

Etiology: Etiology: Direct blowDirect blow Signs & Symptoms:Signs & Symptoms: Deformity, nosebleed, seeing double Deformity, nosebleed, seeing double

(diplopia), numbness(diplopia), numbness Treatment:Treatment: RICE, physician referralRICE, physician referral

Maxillary FractureMaxillary Fracture

Etiology: Etiology: Direct blowDirect blow Signs & Symptoms:Signs & Symptoms: Pain while chewing, malocclusion, Pain while chewing, malocclusion,

nosebleed, double vision (diplopia), nosebleed, double vision (diplopia), numbness in the lip and cheeknumbness in the lip and cheek

Treatment:Treatment: RICE, immobilize, physician referralRICE, immobilize, physician referral

Facial LacerationFacial Laceration

Etiology: Etiology: Direct impact with a sharp object or by an Direct impact with a sharp object or by an

indirect compressive forceindirect compressive force Signs & Symptoms:Signs & Symptoms: Pain, substantial bleeding, obvious tearing, Pain, substantial bleeding, obvious tearing, Treatment:Treatment: Pressure with a sterile bandage, dress the Pressure with a sterile bandage, dress the

wound, possible physician referralwound, possible physician referral

Tooth FractureTooth Fracture Etiology: Etiology: Any type of impactAny type of impact Signs & Symptoms:Signs & Symptoms: Possible bleeding, broken toothPossible bleeding, broken tooth Treatment:Treatment: May not require immediate treatment, if May not require immediate treatment, if

the tooth is not sensitive, the athlete can the tooth is not sensitive, the athlete can play. Place tooth in a plastic bag and refer play. Place tooth in a plastic bag and refer to a dentist. Must play with a mouth guard.to a dentist. Must play with a mouth guard.

Tooth Subluxation,Tooth Subluxation,Luxation, AvulsionLuxation, Avulsion

Etiology: Etiology: Any type of impactAny type of impact Signs & Symptoms:Signs & Symptoms: Tooth is loosened or dislodged; little or no Tooth is loosened or dislodged; little or no

pain; pain; Treatment:Treatment: May not require immediate treatment, if the May not require immediate treatment, if the

tooth is not sensitive, the athlete can play. tooth is not sensitive, the athlete can play. Place tooth in a plastic bag and refer to a Place tooth in a plastic bag and refer to a dentist. Must play with a mouth guard.dentist. Must play with a mouth guard.

Nasal Fracture andNasal Fracture andChondral SeparationChondral Separation

Etiology: Etiology: Direct blow from the side or straight frontal Direct blow from the side or straight frontal

forceforce Signs & Symptoms:Signs & Symptoms: Profuse hemorrhage, swelling, deformity, Profuse hemorrhage, swelling, deformity,

palpation will reveal abnormal mobility and palpation will reveal abnormal mobility and crepituscrepitus

Treatment:Treatment: Ice and compression, x-ray referral, Ice and compression, x-ray referral,

protectionprotection

Nosebleed (Epistaxis)Nosebleed (Epistaxis)

Etiology: Etiology: Direct blow Direct blow Signs & Symptoms:Signs & Symptoms: Profuse bleeding, possible nasal painProfuse bleeding, possible nasal pain Treatment:Treatment: Ice and compression, possible doctor Ice and compression, possible doctor

referralreferral

Auricular Hematoma Auricular Hematoma (Cauliflower Ear)(Cauliflower Ear)

Etiology: Etiology: Compression or shearing injuryCompression or shearing injury Signs & Symptoms:Signs & Symptoms: Hemorrhage and fluid accumulationHemorrhage and fluid accumulation Treatment:Treatment: Apply some friction reducing agent Apply some friction reducing agent

(petroleum jelly), the athlete must wear (petroleum jelly), the athlete must wear head gear. If the ear is “hot”, apply icehead gear. If the ear is “hot”, apply ice

Rupture of the Rupture of the Tympanic MembraneTympanic Membrane

Etiology: Etiology: Fall or slap to the unprotected earFall or slap to the unprotected ear Signs & Symptoms:Signs & Symptoms: Loud pop followed by pain in the ear; nausea, Loud pop followed by pain in the ear; nausea,

vomiting, and dizziness; loss of hearing and a vomiting, and dizziness; loss of hearing and a visible tearing of the membranevisible tearing of the membrane

Treatment:Treatment: Small to moderate tears usually heel spontaneously Small to moderate tears usually heel spontaneously

in one to two weeks. Infection can occur and must in one to two weeks. Infection can occur and must be continually monitored. Possible physician referralbe continually monitored. Possible physician referral

Orbital Hematoma (Black Orbital Hematoma (Black Eye)Eye)

Etiology: Etiology: Direct blowDirect blow Signs & Symptoms:Signs & Symptoms: Ecchymosis and painEcchymosis and pain Treatment:Treatment: Ice and compression, athlete should not Ice and compression, athlete should not

blow their nose due to the possible blow their nose due to the possible increase in eye hemorrhageincrease in eye hemorrhage

Orbital FracturesOrbital Fractures

Etiology: Etiology: Direct blow from the side or straight frontal Direct blow from the side or straight frontal

forceforce Signs & Symptoms:Signs & Symptoms: Diplopia, restricted eye movement, Diplopia, restricted eye movement,

downward displacement of the eye, pain, downward displacement of the eye, pain, swelling, hemorrhage, numbnessswelling, hemorrhage, numbness

Treatment:Treatment: Physician referral, antibiotics, possible Physician referral, antibiotics, possible

surgerysurgery

Foreign Body in the Eye Foreign Body in the Eye

Etiology: Etiology: Any circumstance where there are particles Any circumstance where there are particles

and no eye protectionand no eye protection Signs & Symptoms:Signs & Symptoms: Pain and disabilityPain and disability Treatment:Treatment: Flush with waterFlush with water

Corneal AbrasionsCorneal Abrasions

Etiology: Etiology: Abrading force, usually from a foreign body Abrading force, usually from a foreign body

in the eyein the eye Signs & Symptoms:Signs & Symptoms: Pain, watering of the eye, photophobia, Pain, watering of the eye, photophobia,

eyelid spasmeyelid spasm Treatment:Treatment: Cover eye with a patch, physician referralCover eye with a patch, physician referral

Heart ContusionHeart Contusion

Etiology: Etiology: When the heart is compressed between the When the heart is compressed between the

sternum and the spine by a strong outside sternum and the spine by a strong outside forceforce

Signs & Symptoms:Signs & Symptoms: Severe shock, heart pain, certain Severe shock, heart pain, certain

arrhythmias, decreased cardiac outputarrhythmias, decreased cardiac output Treatment:Treatment: Medical emergency, must be transported to Medical emergency, must be transported to

the hospital as quickly as possible, may the hospital as quickly as possible, may need to begin CPR, treat for shockneed to begin CPR, treat for shock

Sudden Death SyndromeSudden Death Syndromein Athletesin Athletes

Etiology: Etiology: Usually a caused by some congenital cardiovascular Usually a caused by some congenital cardiovascular

abnormality, the three most prevalent being abnormality, the three most prevalent being hypertrophic cardiomyopathy, anomalous origin of hypertrophic cardiomyopathy, anomalous origin of the coronary artery, and Marfan’s syndromethe coronary artery, and Marfan’s syndrome

Signs & Symptoms:Signs & Symptoms: Chest pain or discomfort during exertion, heart Chest pain or discomfort during exertion, heart

palpitations or flutters, syncope, nausea, profuse palpitations or flutters, syncope, nausea, profuse sweating, heart murmurs, shortness of breath, sweating, heart murmurs, shortness of breath, malaise, and fevermalaise, and fever

Treatment:Treatment: Prevention through counseling, screening, and early Prevention through counseling, screening, and early

identification of preventable causes of sudden death.identification of preventable causes of sudden death. Medical emergency, must be transported to the Medical emergency, must be transported to the

hospital as quickly as possible, may need to begin hospital as quickly as possible, may need to begin CPRCPR

Head EvaluationHead Evaluation HOPSHOPS

– HistoryHistory– ObservationObservation– PalpationPalpation– Special testsSpecial tests

Head EvaluationHead Evaluation Neuralogic examNeuralogic exam

– Cerebral Function - Questions that assess general affect:Cerebral Function - Questions that assess general affect: What’s your name?What’s your name? What happen?What happen?

– Cerebral Function - Questions that assess level of Cerebral Function - Questions that assess level of consciousness:consciousness:

Where are you?Where are you? What time (day) is it?What time (day) is it? What’s the score?What’s the score?

– Cerebral Function - Questions that assess intellectual Cerebral Function - Questions that assess intellectual performance:performance:

Count backward from 100 by 7’s.Count backward from 100 by 7’s. Months backward.Months backward.

– Cerebral Function - Questions that assess emotional status:Cerebral Function - Questions that assess emotional status: Are they being erratic?Are they being erratic?

Head EvaluationHead Evaluation Neuralogic examNeuralogic exam

– Cerebral Function - Questions that assess thought content:Cerebral Function - Questions that assess thought content: Memorize three words.Memorize three words.

– Cerebral Function - Questions that assess sensory Cerebral Function - Questions that assess sensory interpretation:interpretation:

Blurred vision?Blurred vision? Hearing problems.Hearing problems.

– Cerebral Function - Questions that assess language skills:Cerebral Function - Questions that assess language skills: Slurred speech.Slurred speech. Speech impared?Speech impared?

– Reflex testingReflex testing– Sensory (dermatome) testingSensory (dermatome) testing– Pupil response:Pupil response:

PEARL (Pupils equal and reactive to light)PEARL (Pupils equal and reactive to light)

Head EvaluationHead Evaluation Cranial Nerve FunctionCranial Nerve Function Sense of smell (I. Olfactory)Sense of smell (I. Olfactory) Eye tracking (II. Optic, III. Oculomotor, IV. Trochlear, VI. Abducens)Eye tracking (II. Optic, III. Oculomotor, IV. Trochlear, VI. Abducens) Imitations of facial expressions (V. Trigeminal, VII. Facial)Imitations of facial expressions (V. Trigeminal, VII. Facial) Biting down (V. Trigeminal)Biting down (V. Trigeminal) Balance (VIII. Vestibulocochlear)Balance (VIII. Vestibulocochlear) Hearing (VIII. Vestibulocochlear)Hearing (VIII. Vestibulocochlear) Swallowing (IX. Glossopharyngeal, X. Vagus, XI. Accessory, XII. Swallowing (IX. Glossopharyngeal, X. Vagus, XI. Accessory, XII.

Hypoglossal)Hypoglossal) Strength of shoulder shrugs (XI. Accessory)Strength of shoulder shrugs (XI. Accessory) Speak (XII. Hypoglossal, X. Vagus)Speak (XII. Hypoglossal, X. Vagus) Tongue protrusions (XII. Hypoglossal)Tongue protrusions (XII. Hypoglossal)

Head EvaluationHead EvaluationCerebellar FunctionCerebellar Function Finger to noseFinger to nose Finger to examiner’s fingerFinger to examiner’s finger Drawing alphabet in the air with the footDrawing alphabet in the air with the foot Heel-toe walkingHeel-toe walking Rhomberg’s Balance Test – eyes shut with one foot in the airRhomberg’s Balance Test – eyes shut with one foot in the air