Head Injuries

The head, containing the most important human organ, the brain, is the nerve center of the body and is built upon the skeletal structure of the skull and the cervical spine. These bones both protect the brain, and move the head upward, downward, and rotationally.

The anatomy of the skull consists of the cranium, representing the container in which the brain and related organs are protected, and the mandible, or jaw bone. The skull is also comprised of a series of more delicate bones that forms the structural aspects of the ear. The cranium is a further series of distinct bones, including the bones in support of the ears and the orbits, or eye sockets. The mandible is connected to the rest of the skull by the temporalmandibular joint (TMJ), a powerful hinge mechanism. Given the frequency with which the head comes into contact with other objects, or otherwise sustains significant forces in the course of athletic competition, fractures and other forms of damage to these bony structures are relatively common.

A concussion is a distinct form of injury to the brain that results from a blow to the head and skull. A concussion may arise without a fracture or any other bone damage taking place. A concussion is not a life-threatening injury, but it may have serious consequences both in the short term as well as regarding the future health of the recipient, especially if there are subsequent concussions received. In medical language, a concussion is one of a number of forms of the injury known as a closed head injury.

A concussion may arise if the head, and ultimately the brain, receives a significant blow resulting in trauma. In sports where the head is exposed to such physical actions as tackling, a fall to the ground as in skiing, or a collision with an opponent in auto racing or hockey, concussions are most common. When the blow causes the recipient to feel faint, to lose consciousness for a brief period, or to otherwise not retain complete physical control, the concussion is generally classed as mild. When the blow causes a prolonged loss of consciousness and a resulting period in which the athlete has difficulty with mental functions such as memory, balance, and coordination, the concussion is termed severe. The additional symptoms of a concussion are persistent headache, nausea, and a loss of short-term memory.

In sports such as ice hockey and American football, blows to the underside of the chin are common. These may lead to concussions, as the TMJ is driven upward and backward by the mandible. A protective mouth guard has been proven an effective form of protection from the consequences of these blows, as the mouth guard tends to prevent the lower jaw from being forced back into the skull.

Medical attention should be immediately sought for any person for whom a concussion is a suspected event. There is a culture in many contact sports that a speedy return to the playing field is a badge of honor; because concussion has the potential to pose a cumulative risk if the brain receives another trauma, the injured person should undergo a thorough physical evaluation.

The assessment of the present concussion should occur within the context of the following factors:

• the history of the injury, with particular emphasis upon the exact contact that led to the concussion, and the length of any period of unconsciousness
• the medical history, including any prior concussions as well as current medications
• a complete physical examination, including a determination of the existence of a companion injury to the cervical spine (neck), which might have happened if the injured person was attempting to deliver a blow such as a rugby or football tackle, or bleeding from the ears or nose, indicative of internal injury
• a head x-ray or CT scan

Most concussion treatments will involve a combination of ice applied to the point of impact to reduce swelling, along with an acetaminophen-type pain reliever, and rest. In cases of a single concussion incident, most athletes make a complete recovery after a period of rest and no exposure to contact to the head; a condition known as a post-concussion syndrome will arise in approximately 10% of single concussion cases, in which the symptoms of dizziness and troubles with memory persist. The most significant concern regarding concussions is their cumulative effect; it is not uncommon for the combined impact of two or more concussions to result in a dangerous condition, marked by bouts of significant memory loss and physical coordination problems. Boxers, ice hockey players, and American football players are vulnerable to these repeated occurrences, and numerous athletes in these sports have been forced to early retirement from competition due to concussion.

see also Football (American); Musculoskeletal injuries; Neck injuries; Nervous system.