Dr. Martin's notes

Tuesday April 11, 2017

The term head injury may be used to describe damage to the scalp, skull, or brain. Head injuries can occur in any sport and in various ways. However, most head injuries are caused by the application of some type of sudden force to the head, usually by a direct blow. Trauma of this type may be caused by the athlete colliding with another athlete or an object such as a goalpost, wall, bleacher, or the floor/ground. It may also occur if the athlete is struck by some sort of athletic equipment, such as a baseball bat, golf club, or hockey stick. In addition, the head may be injured by a blow from a projectile such as a baseball, golf ball, discus, or hockey puck.

The head can be divided into two anatomical groups: the face and cranium. The face includes the eyes, ears, nose, jaw, and mouth. The cranium (skull) contains the brain and spinal cord attachments

The sports that cause most of these injuries are basketball, baseball, and racquet sports. Any sport involving a projectile is considered hazardous to the eyes. The most common eye injury occurs in basketball, usually due to a finger or elbow penetrating the eye. However, baseball, racquetball, hockey, and other sports are also frequently related to eye injuries. These injuries range from corneal abrasions and bruises, to fractured eye sockets and facial bones, to eye hemorrhages and retinal detachments, to blindness from a direct hit that crushes the eyeball.

Injuries to the eye and orbit are not very common in competitive athletics. If an eye injury is not treated properly, the result could be a loss of visual acuity or permanent loss of sight in the affected eye. Proper treatment of eye injuries is paramount.

Specks in the Eyes
It is not uncommon for dirt and other debris to find its way to the eyes. Because the eyes are very sensitive, any foreign object on the eye will create pain. A scratch or cut caused by dirt or some other foreign object can cause a corneal abrasion, a scratch or small cut of the cornea of the eye.

Corneal abrasions can be caused by sand, dust, dirt, wood shavings, or metal filings that get in the eye. The cornea can also be scratched by a fingernail, a tree branch, or a contact lens. Rubbing the eyes very hard can also cause a corneal abrasion.
Objects in the eye should be washed out of the eye by splashing clean water into it. It is important to avoid rubbing the eye because of the risk of further injury. An athlete can return to competition or practice as soon as the object has been removed from the eye and the athlete no longer complains of pain or irritation.

Blows (Contusions) to the Eye
The eye is located in a deep socket called the orbit. This is nature's way of protecting one of the most important organs of the body. A black eye is often a minor injury, but it can also appear when there is significant eye injury or head trauma.
Blows to the eye are not uncommon and can occur during almost any sport or activity. Common mechanisms of this injury include contact of the orbit with elbows in basketball, baseballs hit or thrown, and other athletes

The athlete should apply a cold compress immediately for 15 minutes, and again each hour as needed. This will help to reduce pain and swelling. Discoloration or blackening of the eye could indicate that internal damage has occurred. If this bruising occurs, the athlete should consult a physician immediately.

Cuts, Punctures/ and Abrasions of the Eye or Eyelid
Wounds that penetrate the eye can cause infection and blindness. These injuries are considered medical emergencies. Penetrating wounds to the eye can occur from any object, including fingers accidentally stuck in the eye. The athlete should receive emergency medical care and promptly be transported to the nearest medical facility.

Orbital Blow-out Fracture
An orbital blow-out fracture consists of a fracture of the bones of the eye socket. An orbital blow-out fracture is almost always secondary to a blunt blow from a relatively large object, such as a fist, elbow, or baseball bat. Most athletes will have pain and tenderness around the eye, swelling, and double vision- Pain upon attempted eye movement is also common. Immediate treatment is to bandage both eyes and apply an ice compress for 15 to 20 minutes. The athlete will need to see an ophthalmologist immediately for evaluation and treatment.

Conjunctivitis, commonly known as pink eye, is an infection of the conjunctiva (the outermost layer of the eye that covers the sclera). The three most common types of conjunctivitis are viral, allergic, and bacterial. Each requires different treatment. With the exception of the allergic type, conjunctivitis is typically contagious.

The first symptom of conjunctivitis is discomfort in the eye, followed by redness and inflammation of the conjunctiva, the tissue covering the eye and inner surface of the eyelids. There is some pain associated with conjunctivitis, but the athlete will complain of discomfort that is not relieved by rubbing or a sensation of something that feels like sand in the eye. Conjunctivitis requires medical attention. The appropriate treatment depends on the cause of the problem. Because conjunctivitis is contagious, the athlete will need to be cleared by a doctor for return to athletics.

Cauliflower Ear
Cauliflower ear is caused by destruction of the underlying cartilage of the outer ear (pinna). Blood collects between the ear cartilage and the skin. There is a thickening of the entire outer ear, which may be so extensive that the normal shape becomes completely distorted and unrecognizable. To treat the hematoma (the blood clot), the athlete's doctor may drain it through an incision in the ear and apply a compressive dressing to sandwich the two sides of the skin against the cartilage.

Swimmer's Ear
Swimmer's ear is an infection of the skin covering the outer ear canal. Acute swimmer's ear is commonly a bacterial infection caused by the streptococcus, staphylococcus, or pseudomonas types of bacteria. Swimmer's ear is usually caused by excessive water exposure. The first sign of infection is that the ear feels full, and it may itch. The ear canal will swell and ear drainage will follow. At this stage the ear will be very pa infill, especially with movement of the outside portion of the ear. The ear canal may swell shut and the side of the face can become swollen. The glands of the neck may enlarge, and it can become difficult to open the jaw. The ear should be kept dry. While showering or swimming, the athlete should wear an earplug (that is designed to keep water out).

Foreign Bodies in the Ear
Foreign bodies in the ear may cause the following symptoms: mild to severe ear pain, drainage from the ear, fever, nausea and vomiting, coughing, tearing from the eye, dizziness, and a foul odor from the ear caused by infection.
Treatment will depend on the depth and type of foreign body in the ear. Some foreign bodies will fall out of the ear naturally without having to be removed. Gentle flushing of the ear canal with warm water can remove other objects

Tympanic (Eardrum) Rupture
The eardrum is delicate and easily perforated (torn). Most often it is ruptured by an infection of the middle ear (otitis media), but other types of trauma may also cause tears or ruptures. The person may have severe ear pain that gets better or goes away when the eardrum ruptures and relieves the pressure. A ruptured eardrum usually drains suddenly. The drainage often looka like pus and smells bad. The athlete should be taken to a doctor immediately for evaluation and treatment.

The human nose serves as an air passage between the nostrils and the throat, and as the organ for the sense of smell. The nose warms, moistens, and filters the air that enters the nostrils and travels down to the lungs. Injuries to the nose are often caused by impact and blunt trauma.

Epistaxis is the medical term for nosebleed. Epistaxis usually refers to major nosebleeds that are difficult to stop or recurrent nosebleeds. Nosebleeds are most common in the winter months when the humidity is low; certain types of heating may further dry the air indoors.

In athletics, nosebleeds are common, especially in wrestling. Wrestling requires close physical contact that frequently results in forceful contact with the nose.

There is no way for the certified athletic trainer to stop this type of bleeding. The athlete must rely on the natural clotting mechanism to stop the bleeding. Blood flowing from the nostrils is an anterior nosebleed and can normally be managed conservatively.

The first step in treating epistaxis is to stop the bleeding. If an athlete gets a nosebleed, the athlete should sit down and lean slightly forward so that the blood will drain out of the nose instead of down the back of the throat. Keeping the head above the heart will make the nose bleed less. If the athlete leans back, he or she may swallow the blood, This can cause nausea, vomiting, and diarrhea.

Mouth and Jaw
The mouth and jaw are complex structures that are vulnerable to athletic injury. The jaw is made up of the maxilla and the mandible. The maxilla is a fixed bone that does not move. The mandible, in contrast, moves forward, backward, and sideways. This allows the teeth to bite and chew. The mandible and maxilla are attached to the skull at the temporomandibular Joint (TMJ).

Possible injuries to the jaw and month include fractures, TMJ dislocation and dysfunction, and damage to the teeth and soft tissues of the mouth. Generally, these injuries fall into three categories:

1. Soft-tissue injuries, such as cuts or lacerations to the lips, the tongue, the inside of the mouth, or the face.
2. Dental injuries, which are injuries t'? the teeth. Examples of dental injuries include fractured teeth, teeth that are partially or totally knocked out, and injuries to tooth-related structures (such as the braces a younger person might wear).
3. Jaw-related or bone-related injuries in which some bruising or fracturing of the jaw bones occurs. This includes alveolar fracture, which is a break in the bone that houses the teeth, and upper-jaw or lower-jaw fractures. Bruises or contusions to the bone in the lower jaw may also occur.

Jaw Fractures
A broken jaw is a fracture of the mandible (bone of the lower jaw). Jaw fractures are the third most common type of facial fractures, after fractures of the nose and cheek. Fractures of the mandible are normally a result of a direct blow to the jaw.
Symptoms may include severe pain at the fracture site, swelling, blood at the base of the teeth near the fracture site, deformity, tenderness, and sometimes numbness. Treatment includes immobilization of the athlete, application of ice, and treatment for shock. The athlete should be transported to a physician immediately.

Temporomandibular Joint Injury
The temporomandibular joint (TMJ) allows the opening and closing of the mouth. The TMJ is affected by the resulting action of the joint on the other side of the jaw, the muscles of the jaw and tongue, and the relationship of the teeth as they meet. As these all work together, a change in one part will cause a change in the function of the other parts.
TMJ pain can be the result of direct trauma to the jaw or face, malocclusion (teeth not coming together), muscle imbalance, postural imbalance, or all of these.

A TMJ dislocation will result in inability to close the mouth, severe pain, deformity, and swelling. There may be tenderness, swelling, and bruising at the injury site. Treatment includes application of ice and referral to a physician. Athletes may have to wear a dental appliance to support the TMJ. Wearing of a mouthpiece may be required for future participation. A doctor's clearance is required prior to return to athletics.