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The potential for catastrophic head or cervical spine injuries and their life-ending or altering consequences necessitates development of a clear plan for evaluation and management. Fortunately, the overall rate of injury to these body areas is relatively low.1 However, when it does occur, the outcomes can be fatal or result in long-term physical and/or mental deficits.2

Most often the result of direct contact with another player, head injuries occur more frequently in college athletics than in high school and tend to be more frequent in women's than in men's sports.3 Sports in which blows to the head are commonplace—football, baseball, and ice hockey—have rules mandating the use of protective headgear. The use of helmets has greatly reduced the number and severity of head injuries in football, but various styles and brands have differing levels of effectiveness.3–6

Regular inspection of helmets is needed to ensure proper maintenance and continued protection. Athletes must be knowledgeable about the risks associated with participation in sports and be instructed in the proper techniques necessary to avoid serious head and cervical spine injuries.

This chapter focuses on the immediate and follow-up evaluation and management of athletes with head and cervical spine injuries. A well-organized procedure for the emergency management of head and cervical spine trauma is crucial to this process and must be rehearsed regularly by the medical staff to ensure appropriate care. Chapter 14 describes the anatomy of the cervical spine, examination of noncatastrophic cervical spine conditions, and injury to the brachial plexus.

Clinical Anatomy

With the exception the foramen magnum, a small opening on the skull's base through which the brainstem and spinal cord pass, the brain is almost fully encased in bone (Fig. 20-1). In adults, the cranial bones are rigidly fused by cranial sutures, making the skull a single structure. In infants and children, the sutures are more pliable because they are continually being remodeled during growth.


Lateral view of the bones of the skull.

The skull's design allows for maximum protection of the brain. The density of the bone reduces the amount of physical shock transmitted inwardly. The rounded shape of the skull also has protective qualities. When an object strikes a rounded object, it tends to be deflected quickly. Consider, for example, two scenarios: dropping a brick on a tabletop and dropping a brick on a basketball. When the brick hits the tabletop, it stays there, transmitting its force into the table. When a brick is dropped onto a basketball, although some of the force is transmitted into the ball, the remaining force is dissipated as the brick deflects off the round surface. Suspended within cerebrospinal fluid, the brain floats within the cranium. The fluid suspension decreases the mechanical ...

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