Transcript Principles of Research

Upper Extremity
 Shoulder
 acromioclavicular
(AC) separation
 glenohumeral
dislocation
 Elbow
 olecrannon bursitis
Upper Extremity
 Wrist
 distal radius fracture
 scaphoid (navicular)
fracture
 ECU (tendon)
subluxation/dislocation
 DRUJ (ligament)
sprain
Upper Extremity
 Hand
 ulnar collateral (thumb
ligament) sprain
 phalanx (finger)
fracture
Lower Extremity
 Abdomen/Groin/Hip
 athletic pubalgia
 adductor (groin) strain
 iliopsoas/rectus
(hip flexor) strain
Lower Extremity
 Knee
 MCL sprain
 ACL sprain
 quadriceps contusion
Lower Extremity
 Ankle
 malleolar bursitis
 distal fibula fracture
 syndesmosis/lateral
ligament sprain
Lower Extremity
• Foot
 contusion/fracture
 calcaneal bursitis
Catastrophic Injuries
• Traumatic Brain Injury
(Concussion)
• Cervical Spine
Fracture/Dislocation
(± spinal cord injury)
• Eye Injuries
Catastrophic Injuries
• Upper Airway
(larynx, hyoid, soft tissues)
• Commotio Cordis
(chest blow)
• Subarachnoid Hemorrhage
(neck blow)
• Spleen Rupture
• Neck Laceration
Concussion
Concussion may be caused by a direct
blow to the head, face, neck or
elsewhere on the body that results in
an impulsive force transmitted to the
head causing a rapid onset of shortlived impairment of neurologic
function that resolves spontaneously.
Concussion
Symptoms: unaware of situation,
confusion, amnesia, loss of
consciousness, headache dizziness,
nausea, loss of balance, flashing lights,
ear ringing, double vision, sleepiness,
feeling dazed
Concussion
Signs: altered mental status, poor
coordination, seizure, slow to answer,
poor concentration, nausea, vomiting,
vacant stare, slurred speech, personality
changes, inappropriate emotions,
abnormal behavior
Concussion
• repeated concussions cause
cumulative damage  increased
severity with each incident
• initial concussion  chance of a 2nd
concussion is 4x greater
Simple Concussion
Progressively resolves without
complication over 7-10 days:
• all concussions mandate evaluation by physician
• limit training & competition while symptomatic
• able to resume sport without further problems
• managed by certified athletic trainers working
under medical supervision
• formal neuropsychological testing unnecessary?
Complex Concussion
Specific features, persistent symptoms or
recurrence with exertion:
• prolonged loss of consciousness (>1 minute)
• multiple concussions over time
• repeated concussions with less impact force
• neuropsychological testing helpful
• multidisciplinary management
(experienced sports medicine physician, sports
neurologist or neurosurgeon, neuropsychologist)
Concussion Management
A player with ANY symptoms or signs:
• should not be allowed to return to play
in the current game or practice
• should not be left alone- regular
monitoring for deterioration is essential
• should be medically evaluated following
the injury
Concussion Management
Return to play must follow a medically
supervised stepwise process:
• monitored by a medical doctor
• player should never return to play while
symptomatic
“When in doubt, sit them out!”
Concussion Management
• physical and cognitive rest
• monitoring of:
– symptoms
– neurocognitive function
– postural stability
– neuropsychological testing (?)
• graded exertion protocol
Concussion Management
Return to Play Protocol
1. No activity, complete rest
2. Light aerobic activity (walking, stationary cycling)
3. Sports specific training- skating.
4. Non-contact training drills
5. Full-contact training after medical clearance
6. Return to competition
* Proceed to the next level only if asymptomatic
* Any symptoms or signs: drop back to the previous level
& attempt progression again after 24 hours