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Neck
Orthopedic Assessment III
Head, Spine, and Trunk
with Lab
PET 5609C
Clinical Anatomy
Clinical Anatomy
Clinical Anatomy
Brain: Cerebrum
Largest section of brain (most
anterior and superior region of CNS)
Formed by 2 hemispheres:
Frontal lobe
Parietal lobe
Temporal lobe
Occipital lobe
Clinical Anatomy
Clinical Anatomy
Brain: Cerebrum
Functions:
Temperature
Touch
Pain
Pressure
Proprioception
Visual
Auditory
Olfactory and taste
Spatial
relationships
Behavior
Memory
Association
Communication:
Special senses:
Cognition:
Motor function
Sensory
information:
Functions (cont.)
Right hemisphere
controls left side
of body
Left hemisphere
controls right side
of body
Clinical Anatomy
Brain: Cerebellum
Clinical Anatomy
Clinical Anatomy
Brain:
Diencephalon
Processing center
for conscious and
unconscious
brain input
Parts:
Thalamus
Hypothalamus
Epithalamus
Clinical Anatomy
Brain: Thalamus
Functions:
Translates
information
(inputs) for
cerebral cortex
Processes and
relays sensory
information
Helps regulate
states/levels of
sleep and
consciousness
Hypothalamic
Regulation
Neurosecratory
Neuron
Vasopressin
(ADH)
Water Retention
Neurosecratory
Neuron
Oxytocin
Milk ejection
(mammary gland)
Hypothalamic
Regulation
Anterior Pituitary
Effect
Involved Thyroxin
from Thyroid
Gland
Corticotropin
Releasing Hormone
Growth-Hormone
Releasing Hormone
GH
Whole body
growth
Gonadotropin
Releasing Hormone
FSH, LH
Reproductive
function
Prolactin Releasing
Hormones
Prolactin
Milk production
Skin pigments
Clinical Anatomy
Clinical Anatomy
Brain: Hypothalamus
Clinical Anatomy
Medulla Oblongata
Pons
Functions:
Cranial nerves
Clinical Anatomy
Brain: Meninges
Pia mater:
Dura Mater:
Outermost layer
Arachnoid Mater:
Middle layer
Subdural space area between dura mater and
arachnoid mater
Subarachnoid space beneath the arachnoid
Clinical Anatomy
Clinical Anatomy
Cerebrospinal Fluid:
Clinical Anatomy
Brain blood
demand:
20% of bodys O2
uptake at rest
1 Celsius, brains
demand 7%
0
Supplying vessels:
Vertebral arteries
Carotid arteries:
Internal
External
Circle of Willis
Clinical Evaluation
Key Points:
All unconscious athletes must be
managed as if a fracture or dislocation
of the cervical spine exists until the
presence of these injuries can be
definitively ruled out
Ideally, 2 responders are available to
evaluate:
Palpation
Sensory and motor tests
Clinical Evaluation
Clinical Evaluation
Initial Evaluation:
Level of Consciousness:
Communicate with athlete (verbal)
Unresponsive athlete:
Clinical Evaluation
Initial Evaluation:
Primary Survey:
Secondary Survey:
Bleeding
Possible fractures,
dislocations
Clinical Evaluation
History:
Location of
symptoms:
Brain
Amnesia
Confusion and
Disorientation
Cervical pain
or muscle
spasm:
Area
Pain
Numbness
Burning
Irritability and
Uncoordination
Dizziness
Headache
Ocular
Head pain:
Headaches
Ears
Tinnitus
Dizziness
Stomach
Nausea
Vomiting
Clinical Evaluation
Mechanism of Injury:
Head
Coup Injury:
Contrecoup Injury:
Clinical Evaluation
Clinical Evaluation
Clinical Evaluation
Mechanism of
Injury: Head
Repeated
subconcussive
forces:
Repeated trauma:
Boxing
Heading in soccer
Rotational or
shear forces:
Twisting
Acceleration and
deceleration
Clinical Evaluation
Catastrophic injuries
Clinical Evaluation
Clinical Evaluation
Clinical Evaluation
History:
Loss of consciousness:
History of concussion:
Seeing stars
Blacking out
Complaints of weakness:
Fatigue
Muscular weakness:
More serious:
Trauma to brain, spinal cord, spinal nerve roots
Clinical Evaluation
Position of head:
Cervical vertebrae:
Mastoid process:
Clinical Evaluation
Inspection: Eyes
General:
Nystagmus:
Pupil size:
Clinical Evaluation
Inspection:
Nose and Ears
Ears:
Nose:
Bleeding and/or
cerebrospinal
fluid
Skull fracture
Bleeding
Nose fracture or
skull fracture
Nose/eyes:
Raccoon eyes
skull or nasal
fracture
Clinical Evaluation
Palpation: Bony
Structures
Spinous Processes:
Transverse Processes
Skull:
Palpation: Soft
Tissue
Musculature:
Trapezius
SCM
Throat
Clinical Evaluation
Patient position:
Examiner position:
Positive test:
At patients side
Procedure:
Lying or seated
Implications:
Clinical Evaluation
Retrograde amnsesia:
Anterograde amnesia:
Inability to recall events after injury
Fading memory progressive
deterioration of cerebral function
ATHLETE
POSITION:
EXAMINER
POSITION:
PROCEDURE:
Who am I?
What quarter is it?
IMPLICATIONS:
Retrograde amnesia:
Not remembering events from the day before is more
significant that not
remembering more recent events
The same set of questions should be repeated to determine
whether memory
is returning, deteriorating, or staying the same
Further deterioration of memory or acutely profound
EXAMINER
POSITION:
EVALUATION:
POSITIVE TEST:
IMPLICATIONS:
COMMENT:
Clinical Evaluation
Behavior:
Analytical Skills:
Information Processing:
Clinical Evaluation
Romberg Test
Tandem Walking
Balance Error Scoring System
Clinical Evaluation
Romberg Test:
Patient Position:
ATC Position:
Positive Test:
Procedure:
Patient unsteadiness
Implications:
Cerebellar dysfunction
Clinical Evaluation
Tandem Walking:
Patient Position:
ATC Position:
Positive Test:
Evaluation:
Implications:
Clinical Evaluation
Patient Position:
Patient barefoot or wearing socks (no
tape); hands on iliac crest; eyes closed
Phase 1:
Phase 2:
Phase 3:
Clinical Evaluation
ATC Position:
Procedure:
Clinical Evaluation
Positive Test:
Clinical Evaluation
Standardized Assessment of
Concussion (SAC)
Clinical Evaluation
Neuropsychological Testing:
Clinical Evaluation
Vital Signs:
Respirations:
Pulse:
Blood pressure
Pulse pressure:
Normal: 40 mm HG
Pulse pressure > 50 mm HG may indicate
increased intracranial bleeding
Clinical Evaluation
Cranial Nerve
Assessment:
Ganglia of sensory
component outside
CNS
Ganglia of motor
component within CNS
intracranial pressure
impairs motor component
Cranial
Nerve
Function
Test
(I) Olfactory
(II) Optic
Transmits visual
information to
brain
Check athletes
vision
(III)
Occulomotor
Innervates
superior, medial,
and inferior rectus
muscles and
inferior oblique
Ask athlete to
elevate the eyelid,
elevate, depress,
and adduct the eye
Ask athlete to
elevate the eyes
(V)
Trigeminal
Check sensation of
face, ask athlete to
elevate, depress,
protrude, retrude,
Receives sensation
from the face,
innervates
muscles of
Cranial
Nerve
Function
Test
(VII) Facial
Motor innervation
to muscles of facial
expression,
receives special
sense of taste from
anterior 2/3 of the
tongue, provides
secremotor
innervation to
salivary glands and
lacrimal gland
Check athletes
ability to taste along
anterior portion of
tongue; elevate,
abduct, depress
eyebrows, open/close
eyes, dilate and
constrict nostrils,
open and close
mouth, protrude lips
(VIII)
Vestibulocochle
ar
Senses sound,
rotation, and
gravity (essential
for balance and
movement)
Romberg Test,
athletes ability to
hear
(IX)
Glossopharyng
Cranial
Nerve
Function
Test
(X) Vagus
Supplies innervation to
most laryngeal and
pharyngeal muscles,
provides parasympathetic
fibers to thoracic and
abdominal viscera,
receives special sense of
taste from epiglottis
Assess
athletes
ability to
breathe
(XI)
Accessory
Ask athlete to
shrug
shoulders
(XII)
Motor innervation to
Hypoglossal intrinsic muscles of the
tongue
Ask athlete to
stick out
their tongue