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Head and neck injuries in soccer. Impact of minor trauma.

Head injuries have been shown to account for between 4 and 22% of soccer injuries. Clinical and neuropsychological investigations of patients with minor head trauma have revealed organic brain damage. 69 active football (soccer) players and 37 former players of the Norwegian national team were included in a neurological and electroencephalographic (EEG) study to investigate the incidence of head injuries mainly caused by heading the ball. 3% of the active and 30% of the former players complained of permanent problems such as headache, dizziness, irritability, impaired memory and neck pain. 35% of the active and 32% of former players had from slightly abnormal to abnormal EEG compared with 13 and 11% of matched controls, respectively. There were fewer definitely abnormal EEG changes among typical 'headers' (10%) than among 'nonheaders' (27%). The former players were also subjected to cerebral computed tomography (CT), a neuropsychological examination and a radiological examination of the cervical spine. One-third of the players were found to have central cerebral atrophy and 81% to have from mild to severe (mostly mild to moderate) neuropsychological impairment. The radiological examination of the cervical spine revealed a significantly higher incidence and degree of degenerative changes than in a matched control group.

Adolescent↗

Neck injury after repeated flexions due to parachuting.

A 37-yr-old, previously healthy officer developed a severe pain in the right shoulder and parethesia in the right I-III fingers during a high-altitude low-opening parachute jump. The pain started after a sudden neck flexion while he was checking the developing canopy, well before landing. Electroneuromyography revealed damage to the right C7 nerve root. Cervical radiography showed severe spondylosis and discus degeneration in the CV-VII region; magnetic resonance image demonstrated posterior disk protrusions in this area. Military aviators flying high-performance aircraft often have similar problems in the cervical spine; they have been attributed to effects of high + Gz forces in association with twisted head positions. Parachutists appear to face similar risks. Selection of the optimal head position during the parachute opening and use of light helmets should be emphasized.

Adult↗

Management of radiation-induced head and neck injury.

Toxicity from H&N cancer irradiation is complex and multifactorial. The nature and severity of the side effect profile for a given patient result from the interplay of patient-related, tumor-related, and treatment-factors. Among the side effects studied, skin toxicity and mucositis represent the most common acute effects of irradiation. Supportive care is essential to prevent superimposed infection and other complications that might lead to treatment breaks or, in extreme cases, discontinuation of therapy. Technological advances with conformal radiotherapy techniques have allowed for increasing salivary gland sparing. Further protection may be achieved with existing and future medical therapies. Swallowing dysfunction following chemoradiation for laryngeal cancer is significant and may persist for 1-2 years. Efforts should be made to ensure proper patient education and reassurance in this regard.

Bone Diseases↗

Biomechanical assessment of soft tissue neck injuries in cases with long sick leave times.

A database was established by collecting 919 cases of claimed cervical spine disorders (CSDs) sustained in automotive accidents. All cases had a sick leave time of more than 4 weeks. Data was obtained from a major Swiss accident insurer. An assessment scheme was developed that took into account technical, medical, and biomechanical aspects. All cases were evaluated according to this scheme. The overall biomechanical assessment, that stated the extent to which the symptoms claimed could be explained by the impact, was found to be significantly influenced by the patient's history of CSD in terms of preexisting damage or preexisting symptoms. In 52% of the assessed cases, the CSD claimed could be explained with a combination of neck loading and also by considering the patient's medical history. Performing a solely technical analysis of the collision circumstances or a purely medical evaluation based on a Quebec Task Force (QTF) grade alone are insufficient to assess the accident-related explicability of claimed CSD. Biomechanically relevant individual factors have to be considered.

Accidents, Traffic↗