Course

Head and Neck

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12 Lessons

Across all sports, special attention must be given to head and neck injuries. This is because in rare cases, these injuries are potentially serious and can lead to a prolonged course of treatment or have catastrophic consequences. Football is generally not considered to be a high-risk sport. In international championships (1998 to 2012), approximately 13% of all injuries were classified as head and neck injuries. 1 Of these, between 1 and 5% of all injuries were diagnosed as concussion.

This key documents to refer to when considering how to assess and treat a sport-related concussion are the 5th Consensus statement on concussion in sport and the SCAT5 .

Across all sports, special attention must be given to head and neck injuries. This is because in rare cases, these injuries are potentially serious and can lead to a prolonged course of treatment or have catastrophic consequences. Football is generally not considered to be a high-risk sport. In international championships (1998 to 2012), approximately 13% of all injuries were classified as head and neck injuries. 1 Of these, between 1 and 5% of all injuries were diagnosed as concussion.

One of the main challenges for a team doctor faced with a player who has sustained a head injury is the difficulty of estimating the severity of the injury on the pitch or on the touchline. 2 One of the reasons for this difficulty is because a brain injury can be dynamic (its course can change unexpectedly and acutely). Likewise, a single objective diagnostic test or clinical marker for a direct early diagnosis of a concussion (or other brain injuries) does not yet exist. As a result of the inherent vagueness in the early assessment of head injuries, a standardised diagnostic and therapeutic approach, aimed at identifying occasional serious injuries, is essential. 3 This standardised approach is also advocated for injuries to the cervical spine.

The short- and long-term consequences of playing football, including the impact of heading and head injuries on the brain structure and function, have been debated widely. FIFA has conducted different projects on the acute effects of heading and head injuries and has supported a number of other studies which investigate the incidence, prevention, on-pitch and touchline assessment and appropriate management of concussion. These studies have also investigated the role of baseline testing and concussion modifiers like coexisting cervical spine dysfunction or peripheral vestibular impairment. Moreover, the long-term health status of former elite football players is currently being investigated as part of a large multicentre study.

In this module, we will review the current consensus on the acute management of head and neck injuries, including concussion, in football. The subsequent clinic-based assessment, treatment and return to play is considered in a separate “Concussion” module.

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Learning outcomes

After studying this topic, you should be able to:

  • have an awareness of the most common or serious head and neck injuries;
  • be familiar with the pathogenesis and definition of concussion;
  • understand the principles discussed in the current Consensus Statement on Concussion in Sport including the Sport Concussion Assessment Tool (SCAT);
  • be aware of the head injury assessment process including on-pitch assessment and the immediate removal criteria
  • be able to assess a player who has sustained a cervical spine injury with special reference to the on-pitch assessment and the immediate removal criteria;
  • be able to appropriately manage a footballer after a head impact event or cervical spine injury in the acute setting;
  • be able to distinguish between head and neck injuries which are likely to resolve spontaneously and those which require emergency referral, further assessment and treatment;
  • be aware of the return-to-play protocol following concussion injuries.

Tasks

  • Review the text and media content provided
  • Read the suggested articles
  • Complete the case-based assessment task

References

  1. Junge A, Dvorak J. Injury surveillance in the world football tournaments 1998-2012. Br J Sports Med. 2013;47(12):782-788.
  2. McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th international conference on concussion in sport, Zurich, November 2012. J Athl Train. 2013;48(4):554-575.
  3. Feddermann-Demont N, Straumann D, Dvorak J. Return-to-play management after concussion in football: recommendations for team physicians. J Sports Sci. 2014;32(13):1217-1228.
  4. Levy ML, Kasasbeh AS, Baird LC, Amene C, Skeen J, Marshall L. Concussions in soccer: A current understanding. World Neurosurg. 2012;78(5):535-544.
  5. Nilsson M, Hagglund M, Ekstrand J, Walden M. Head and neck injuries in professional soccer. Clin J Sport Med. 2013;23(4):255-260.
  6. Holm L, Cassidy JD, Carroll LJ, Borg J, Neurotrauma Task Force on Mild Traumatic Brain Injury of the WHO Collaborating Centre. Summary of the WHO collaborating centre for neurotrauma task force on mild traumatic brain injury. J Rehabil Med. 2005;37(3):137-141.
  7. Lincoln AE, Caswell SV, Almquist JL, Dunn RE, Norris JB, Hinton RY. Trends in concussion incidence in high school sports: a prospective 11-year study. Am J Sports Med. 2011;39(5):958-963.
  8. Faude O, Rossler R, Junge A, et al. Head injuries in children’s football – results from two prospective cohort studies in four European countries. Scand J Med Sci Sports. 2017.
  9. Fuller CW, Junge A, Dvorak J. A six-year prospective study of the incidence and causes of head and neck injuries in international football. Br J Sports Med. 2005;39 Suppl 1:i3-9.
  10. Feddermann-Demant N, Dvorak J, Straumann D. Head injuries and concussion: screening, diagnosis and management. http://football.org.il/SiteCollectionDocuments/FTP/leer/רפואי/FDEP%203_Head%20Injury%20and%20Concussion%20Chapter.pdf. Updated 2016. Accessed January 31, 2017.
  11. Leddy JJ, Baker JG, Merchant A, et al. Brain or strain? Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury. Clin J Sport Med. 2015;25(3):237-242.
  12. Wartenberg KEM, Stephan A. Trauma. In: Brust JCM, ed. Neurology: Current diagnosis & treatment. Lange; 2012:177-187.
  13. Galetta KM, Brandes LE, Maki K, et al. The King-Devick Test and sports-related concussion: study of a rapid visual screening tool in a collegiate cohort. J Neurol Sci. 2011;309(1-2):34-39.
  14. Galetta KM, Barrett J, Allen M, et al. The King-Devick Test as a determinant of head trauma and concussion in boxers and MMA fighters. Neurology. 2011;76(17):1456-1462.
  15. Ventura RE, Balcer LJ, Galetta SL. The neuro-ophthalmology of head trauma. Lancet Neurol. 2014;13(10):1006-1016.
  16. Galetta KM, Morganroth J, Moehringer N, et al. Adding vision to concussion testing: a prospective study of sideline testing in youth and collegiate athletes. J Neuroophthalmol. 2015;35(3):235-241.
  17. Ventura RE, Jancuska JM, Balcer LJ, Galetta SL. Diagnostic tests for concussion: is vision part of the puzzle? J Neuroophthalmol. 2015;35(1):73-81.
  18. Vos PE, Alekseenko Y, Battistin L, et al. Mild traumatic brain injury. Eur J Neurol. 2012;19(2):191-198.