Kategoriarkiv: Head

Fracture of the nasal bone

FRACTURE OF THE NASAL BONE

Diagnosis: FRACTURE OF THE NASAL BONE
(Fractura nasi)


Anatomy:
It is only the upper part of the bridge of the nose, close to the cranium, which actually comprises bone (nasal bone). The remainder of the bridge of the nose is made of cartilage (nasal septum).

Cause: Direct blows to the nose can cause a fracture of the nasal bone. A dislocation of the nasal septum can also occur.

Symptoms: Pain and swelling of the bridge of the nose. In the event of fracture the upper part of the nasal bone will be tender when applying pressure. If there is an accompanying head-ache, or a general feeling of being unwell, the possibility of concussion must be considered. Rare cases can cause bleeding in the nasal septum, bringing about swelling and causing the nose to be blocked (requires acute medical treatment).

Acute treatment: Click here.

Examination: All athletes who receive a blow to the head and subsequently complain of uneasiness, visual disturbance or haziness should immediately cease further sport and undergo medical examination. All head injuries must be taken very seriously! If the pain is purely localised to the nose, and there are free airways through both nostrils, a medical examination should be performed if the nose still appears crooked after three days. Urgent medical attention should be sought if the nasal septum swells and blocks one or both nostrils. X-ray examination of the nose is almost never recommended. The patient will be referred to a specialist ear, nose & throat doctor if there are any suspicions of a fracture of the nasal bone.

Treatment: The fracture will be re-placed and fixed if the fracture has caused the nose to be crooked. Fractures of the nasal bone where the nose does not become crooked are treated with rest and relief until the pain abates. Contact sport can usually be resumed after approximately four weeks.

Rehabilitation: Rest and relief until the symptoms have abated. Training can subsequently be cautiously resumed, but should be stopped immediately if concussion symptoms are experienced again (for example head-ache). 
Also read rehabilitation, general.

Bandage: Special facial bandages can be manufactured for use with a fracture of the nasal bone which will allow a speedier resumption of sports activity (article-1) (article-2).

Muscle infiltrations in the neck/shoulder

MUSCLE INFILTRATIONS IN THE NECK/SHOULDER

Diagnosis: MUSCLE INFILTRATIONS IN THE NECK/SHOULDER
(Myalgia)


Anatomy:
Numerous muscles emanate and fasten around the shoulder-neck.

  1. M. semispinalis capitis
  2. Mm. splenii capitis et cervicis
  3. M. levator scapulae
  4. M. rhomboideus minor
  5. M. supraspinatus
  6. M. rhomboideus major
  7. Protuberantia occipitalis externa

DEEP NAPE AND BACK MUSCLES
FROM THE REAR

Cause: All muscles around the shoulder can become tense and tender, and develop tender or sore muscle knots (myalgia). The cause is not known for certain, but it is known that incorrect working positions can trigger myalgia, and that myalgia can arise secondary to pain conditions other places in the neck-shoulder-yoke. The most frequent place for muscle infiltrations is the shoulder blade muscles (M supraspinatus and M infraspinatus, from which the pain can radiate down into the arm) and the large neck-back muscles (M Trapezius, M levator scapulae, M rhomboideus).

Symptoms: Tenderness in the muscles exaggerated when applying pressure on the muscle. There are often emanations to the arm (from muscle infiltrations around the shoulder blade) and to the head (tension head-ache with pressure behind the eyes) in cases of muscle infiltrations on the muscle fastenings in the back of the head.

Acute treatment: Click here.

Examination: Muscle infiltrations do not usually require closer examination, but in case of long-term discomfort, other provoking causes should not be ruled out.

Treatment: If possible the provoking cause must be removed or treated. The treatment of muscle infiltrations is furthermore stretching and increasing weight training (article-1) (article-2) (article-3), (article-4).

Complications: If progress is not smooth, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

Dental injuries

DENTAL INJURIES

Diagnosis: DENTAL INJURIES


Anatomy:
Milk teeth are replaced in childhood, where the permanent teeth appear. The front teeth are usually replaced in the 6-8 year age group.

Cause: Direct blows to the teeth can cause the teeth to fracture, fall out or cause damage to the blood supply to the tooth bringing about permanent damage.

Symptoms: Loose teeth, bleeding from the gums, pain in the tooth.

Examination: Examination by a dentist should be performed in all cases where the tooth is knocked out, loose or crooked. The results of the treatment are directly dependent upon how quickly you can be examined.

Acute treatment: Click here.

Treatment: If the tooth is knocked out you should try to put it in place again or keep it in a moist environment, most favourably in salt water (one teaspoon cooking salt in one litre water) or second best in the mouth under the tongue (not children or unconscious persons) or in a handkerchief made moist with saliva to avoid drying out. You should seek acute dental assistance. The dentist can attempt to replace the tooth so that it can re-attach itself. The chances of good results are reduced for each hour which elapses before reaching the dentist.

Rehabilitation: Normal sports activity can be resumed within a short space of time.
Also read rehabilitation, general.

Special: Preventive mouth guards significantly reduce the risk of dental injury. It is recommended to utilise mouth guards in a wide variety of sports (contact sports). Resumption of contact sports following a dental injury requiring treatment should be delayed until the tooth has attached itself again inorder to avoid possible blows to the tooth in the re-attachment phase (article-1), (article-2).
All dental injuries should be reported to your insurance company.

Eye injuries

EYE INJURIES

Diagnosis: EYE INJURIES
(Contusio oculi)


Anatomy:
The eye is protected by the eyelid. An eye nerve runs from the back of each eye to the brain. The visual centre of the brain is located in the rear part of the brain.

Cause: Visual disturbance following a blow to the eye can be due to an injury to the eyeball, optic nerve or the brain.

Symptoms: Visual disturbance in the form of double vision, blurred vision, loss of visual field, newly arisen spots in front of the eyes, pain, bleeding on the outer part of the eyeball (both in the white (conjunctiva) and the anterior chamber of the eye at the pupil (hyphaema)), change in the shape of the pupil as well as stinging and irritation sensations in the eye (article-1),(article-2).

Acute treatment: Click here.

Examination: In all cases where the visual disturbance does not slowly disappear, with bleeding in the anterior chamber (hyphaema), and with loss of visual field, medical examination should be performed (possibly by specialist eye doctor) at the earliest opportunity.

Treatment: Treatment usually consists of rest and relief. Some serious eye injuries can require medicinal (rarely surgical) treatment.

Rehabilitation: Normal sports activity can usually be resumed as soon as the symptoms have disappeared.
Also read rehabilitation, general.

Prevention: More widespread use of helmets in different sports will unquestionably reduce the number of eye injuries.

Concussion of the brain

CONCUSSION OF THE BRAIN

 

Diagnosis: CONCUSSION OF THE BRAIN
(Commotio cerebri)


Anatomy:
The brain is surrounded by the membrane of the brain (meninx) and protected by the cranial bones.

Cause: With a violent blow or shaking of the head, the brain can collide against the cranial bones with such a force that bleeding can occur, or fluids can seep, on to or in to the surface of the brain.

Symptoms: Headache, general uneasiness, nausea, visual disturbance, drowsiness, increasing remoteness, unconsciousness, convulsions and in worst case, death (article). In the rare cases where a fatality occurs in sport due to a blow to the head, it is often caused by incurring two head injuries in the same match.

Examination: All athletes who receive a blow to the head and subsequently complain of uneasiness, visual disturbance or haziness should immediately cease further sport and undergo medical examination. 
All head injuries must be taken very seriously! (article)

Treatment: Rest and relief until the symptoms have abated (article). It is naturally highly inappropriate, and can be extremely hazardous, to take head ache pills in order to continue sports activity.

Rehabilitation: Rest and relief until the symptoms have abated. Training can subsequently be cautiously resumed, but should be stopped immediately if symptoms are experienced again (for example head ache).
Also read rehabilitation, general.

Special: More widespread use of helmets in different sports will unquestionably reduce the number of concussions and after effects thereof. It is imperative that athletes with head injuries which have brought about groggy moments are removed from the sports activity and not permitted to resume until the symptoms have gone during the following days (article 1), (article 2).

Slipped disc in the nape of the neck

SLIPPED DISC IN THE NAPE OF THE NECK

Diagnosis: SLIPPED DISC IN THE NAPE OF THE NECK
(Prolabsus disci intervertebralis cervicalis)


Anatomy:
The neck is constructed of box-like vertebrae which are held in place partly with the help of the shape of the bones, and partly by ligaments and muscles. Cartilage discs (disci) are located between the vertebrae which act as shock absorbers. The discs lie close to the spinal canal from where nerves depart to the arms.

  1. Vertebra prominens
  2. Vertebra coccygea I
  3. Promontorium
  4. L I
  5. Th I
  6. Axis

THE BACK SEEN FROM THE SIDE

Cause: If the neck is subjected to a load which exceeds its capabilities, a crack in one of the discs may occur so that the liquid content in the centre of the disc (nucleus pulposus) can be squeezed out and apply pressure on a nerve root.

Symptoms: Pain and stiffness in the neck, radiating to one of the arms. There can be sensory interference and reduction in arm strength. Symptoms are often aggravated by coughing.

Examination: If a slipped disc is suspected medical attention should be sought at once so that special examinations can be performed (extent of sensory interference, reduction of muscle strength, reflexes, foramen compression test) to establish the diagnosis and which treatment should be initiated. In some cases it is necessary to supplement with an MRI scan if the treatment does not progress smoothly.

Treatment: If examination reveals signs of a slipped disc without alarming symptoms (substantial deterioration of muscle strength/paralysis), treatment will primarily be directed at altering the imbalance between the load the neck is subjected to, opposed to the level the neck is trained to manage. It is therefore recommended that you are instructed (possibly by a physiotherapist) in the appropriate way to put a strain on the neck, and which loads and movements should be avoided (“ergotherapeutic guidance”). A few days’ rest and relief may be needed to subdue the pain, after which steadily increasing training should be started with neck and throat muscle exercises. If painkillers are required, paracetamol can be recommended, possibly combined with rheumatic medicine (NSAID). By far the majority of slipped discs can be managed through correct training. In cases where the above treatment does not produce progress in the condition, an MRI scan will be considered with a view to possible operation. Operation is therefore first considered if the rehabilitation programme does not succeed (article), and if the MRI scan can detect a prolapse which can explain the symptoms. In cases with alarming symptoms (substantial deterioration of muscle strength/paralysis) acute hospitalisation is recommended for evaluation of the need for acute surgery.

Special: Training should be performed on a “lifelong” basis to reduce the risk of relapse after a successful rehabilitation. Smoking causes increased risk of pain by reducing the flow of blood to the cartilage discs (disci), implying that daily small injuries do not heal so well. Stopping smoking is therefore an important part of the treatment.