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Shoulder acromioclavicular (AC) separation glenohumeral dislocation Elbow olecrannon bursitis

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Shoulder acromioclavicular (AC) separation glenohumeral dislocation Elbow olecrannon bursitis - PowerPoint PPT Presentation

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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

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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)



Upper Extremity

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



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 ligamentsprain

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 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



Signs: altered mental status, poor coordination, seizure, slow to answer, poor concentration, nausea, vomiting, vacant stare, slurred speech, personality changes, inappropriate emotions, abnormal behavior



  • repeated concussions cause cumulative damage increased severity with each incident
  • initial concussion  chance of a 2ndconcussion 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 andcognitive 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