Principles of Research

1
Upper Extremity

• Shoulder
• acromioclavicular (AC) separation
• glenohumeral dislocation
• Elbow
• olecrannon bursitis

2
Upper Extremity

• Wrist
• distal radius fracture
• scaphoid (navicular) fracture
• ECU (tendon) subluxation/dislocation
• DRUJ (ligament)
• sprain

3
Upper Extremity

• Hand
• ulnar collateral (thumb ligament) sprain
• phalanx (finger)
• fracture

4
Lower Extremity

• Abdomen/Groin/Hip
• athletic pubalgia
• adductor (groin) strain
• iliopsoas/rectus
• (hip flexor) strain

5
Lower Extremity

• Knee
• MCL sprain
• ACL sprain
• quadriceps contusion

6
Lower Extremity

• Ankle
• malleolar bursitis
• distal fibula fracture
• syndesmosis/lateral ligament sprain

7
Lower Extremity

• Foot
• contusion/fracture
• calcaneal bursitis

8
Catastrophic Injuries

• Traumatic Brain Injury
• (Concussion)

• Cervical Spine Fracture/Dislocation
• ( spinal cord injury)

• Eye Injuries

9
Catastrophic Injuries

• Upper Airway
• (larynx, hyoid, soft tissues)
• Commotio Cordis
• (chest blow)
• Subarachnoid Hemorrhage
• (neck blow)
• Spleen Rupture
• Neck Laceration

10
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 short-lived
impairment of neurologic function that resolves
spontaneously.
11
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
12
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
13
Concussion

• repeated concussions cause cumulative damage ?
  increased severity with each incident

• initial concussion ? chance of a 2nd concussion
  is 4x greater

14
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?

15
Complex Concussion

• Specific features, persistent symptoms or
  recurrence with exertion
• prolonged loss of consciousness (gt1 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)

16
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

17
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!
18
Concussion Management

• physical and cognitive rest
• monitoring of
• symptoms
• neurocognitive function
• postural stability
• neuropsychological testing (?)
• graded exertion protocol

19
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