 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 Upper 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 Foot  contusion/fracture  calcaneal bursitis Lower Extremity

Catastrophic Injuries Traumatic Brain Injury Traumatic Brain Injury (Concussion) (Concussion) Cervical Spine Fracture/Dislocation Cervical Spine Fracture/Dislocation (± spinal cord injury) (± spinal cord injury) Eye Injuries Eye Injuries

Catastrophic Injuries Upper Airway Upper Airway (larynx, hyoid, soft tissues) (larynx, hyoid, soft tissues) Commotio Cordis Commotio Cordis (chest blow) Subarachnoid Hemorrhage Subarachnoid Hemorrhage (neck blow) Spleen Rupture Spleen Rupture Neck Laceration 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 short- lived impairment of neurologic function that resolves spontaneously.

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

Concussion repeated concussions cause cumulative damage  increased severity with each incident repeated concussions cause cumulative damage  increased severity with each incident initial concussion  chance of a 2 nd concussion is 4 x greater initial concussion  chance of a 2 nd concussion is 4 x greater

Progressively resolves without complication over 7-10 days: all concussions mandate evaluation by physician all concussions mandate evaluation by physician limit training & competition while symptomatic limit training & competition while symptomatic able to resume sport without further problems able to resume sport without further problems managed by certified athletic trainers working under medical supervision managed by certified athletic trainers working under medical supervision formal neuropsychological testing unnecessary? formal neuropsychological testing unnecessary? Simple Concussion

Specific features, persistent symptoms or recurrence with exertion: prolonged loss of consciousness (>1 minute) prolonged loss of consciousness (>1 minute) multiple concussions over time multiple concussions over time repeated concussions with less impact force repeated concussions with less impact force neuropsychological testing helpful neuropsychological testing helpful multidisciplinary management multidisciplinary management (experienced sports medicine physician, sports neurologist or neurosurgeon, neuropsychologist) Complex Concussion

A player with ANY symptoms or signs: Concussion Management should not be allowed to return to play in the current game or practice 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 not be left alone- regular monitoring for deterioration is essential should be medically evaluated following the injury should be medically evaluated following the injury

Return to play must follow a medically supervised stepwise process: Concussion Management monitored by a medical doctor monitored by a medical doctor player should never return to play while symptomatic player should never return to play while symptomatic “When in doubt, sit them out!”

Concussion Management physical and cognitive rest physical and cognitive rest monitoring of: monitoring of: – symptoms – neurocognitive function – postural stability – neuropsychological testing (?) graded exertion protocol 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