Chapter 8 - Head Injuries

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Chapter 8 - Head Injuries

• Greatest danger to our physical well-being due to
  head structures controlling life sustaining
  processes

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Head Anatomy

• Skull
• 29 bones
• 8 cranial
• 14 facial
• 7 ear
• Hyoid

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Head Anatomy

• Brain
• Cerebrum
• two hemispheres
• Frontal
• parietal
• temporal
• occipital
• Meninges
• Dura matter
• Arachoid Sub arachoid space (CSF)
• Pia

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Head Anatomy

• Brain stem (relays sensory and motor information
  and life supporting reflex center, cranial
  nerves)
• Midbrain
• Pons
• Medulla oblongata
• Cerebellum
• Subconscious movements
• Equilibrium posture
• Motor error detectors
• Movement patterns
• Emotional pleasure anger

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Head Injuries

• Causes
• Sudden forces to head
• Direct
• Indirect (inertial)
• acceleration deceleration mechanism
• Head Motion
• translation
• rotation

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Head Injuries

• Mechanical Properties
• Skull stiff yet compressible
• Brain compliant
• Internal stresses
• Strain exceeds capacity to withstand load
• Close vs. Open
• Primary and Secondary
• Severity internal damage to neural structures
• Boxing CTBE or dementia pugilistica

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Chapter 8 - Trunk Anatomy Injuries

• Largest segment of the body (40-50 body mass).

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Trunk Anatomy

• Bone Axial Skeleton
• Ribs
• Sternum
• Vertebrae

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Trunk Injuries

• Vertebral fractures
• Major Health concern
• Proximity to spinal
• Potential to cause severe neural damage,
  including death
• Axial compressive loads
• T11-L3 minimal curvature, transition zone

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Trunk Injuries

• Three Column model
• Burst fracture compression force causing
  vertebrae to shatter from within
• High loading rates intrusion
• Disk degeneration
• Healthy more intrusion
• Old less intrusion

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Trunk Injuries

• Spinal Deformities
• abnormal distributions patterns or pathological
  tissue adaptations
• Associated with cardiopulmonary dysfunction
• Scoliosis Lateral

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Trunk Injuries

• Kyphosis
• Sagittal plane hunchback
• Common in women
• Osteoporosis
• Prevention exercise
• Scheuermanns kyphosis changes in endplates of
  growing vertebrae

• Lordosis abnormal extension (swayback)
• Lumbar area
• tilting lumbar area
• luumbosacral angle above 30 deg

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Trunk Injuries

• Spondylolysis
• defect of the vertebrae lamina (pars articularis)
• Spondylosthesis
• translation or slippage between adjacent segments

• Five types
• Dysplastics
• Isthmic
• degenerative
• Traumatic
• Pathological
• Young athletes
• Isthmic repeated loading of pars region,
  fractures

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Trunk Injuries

• Spondylolisthesis
• older L4-L5 degeneration due to arthritis
• Young L1-S5, end plate lesions

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Trunk Injuries

• Loads of the spinal column
• comples
• compression
• torsional - shearing
• tensile - excessive spinal motion
• Lumbar region highest forces

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Trunk Injuries

• Disks
• viscoelastic
• annulus fibrosus
• fibrocartilage
• criss-crossed orientation
• nucleus pulposus
• 70-90 water
• mucoprotein fibers
• intrinsic pressure
• High tensile stress (Poissons)
• cartilaginous end plate

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Trunk Injuries

• Loading during exercise
• Sit-up versus curls

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Trunk Injuries

• Lifting
• Weight belts
• IAP

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Trunk Injuries

• Bulging disks
• nucleus pulposus is displaced from its normal
  position
• Rotation stress

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Trunk Injuries
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Trunk Injuries

• Mechanism
• Compressive loads
• Hyperflexion with lateral bending
• nerve root disturbance
• posterolateral displacement
• Low Back Pain
• 85 undiagnosed