The Thorax and Abdomen

Chapter 21

Pages 516-535

Anatomy of the Thorax

Anatomy of the Thorax: The thorax is known as the

chest, which lies between the base of the neck and the diaphragm

Main function is to protect the heart and lungs

True ribs (1-7) attach to the sternum by costal cartilage

False ribs (8-10) have cartilage that join 7-10 to the sternum

Floating ribs (11&12) do not attach to the sternum

Muscles: intercostal muscles and the diaphragm muscle function in inspiration and expiration.

Anatomy of the Abdomen

Anatomy of the Abdomen: Abdominal muscles

produce trunk flexion and rotation Protect underlying abdominal

viscera Composed of solid organs:

kidneys, spleen, liver, pancreas, and adrenal glands

Composed of hollow organs: stomach, intestines, gallbladder, and urinary bladder

Abdominal Quadrants & Organs

Prevention of Injuries to the Thorax and Abdomen

Wear appropriate protective equipment, especially with collision sports.

Strengthen the muscles of the abdomen. Empty the stomach and bladder prior to

competition.

Injury Assessment: HHistory

What happened to cause this injury?

Was there direct contact? What position were you in? Describe the type of pain? Was the pain immediate or

gradual? Do you feel pain anywhere

else? Have you had any difficulty

breathing? Are certain positions more

comfortable than others? Do you feel

faint/lightheaded/nauseous?

Do you feel any pain in your chest?

Did you hear or feel a pop or crack in your chest?

Have you had any muscle spasms?

Have you noticed any blood in your urine?

Is there any difficulty or pain with urination?

Was the bladder full or empty? How long has it been since

you’ve eaten?

Injury Assessment: OObservation

Is the athlete breathing? Is the athlete having difficulty

breathing deeply or struggling to catch their breath?

Does breathing cause pain? Is the athlete holding the chest

wall? Is there symmetry in movement

of the chest during breathing? If the wind was knocked out,

did normal breathing return rapidly or was there prolonged difficulty?

What is the body position of the athlete?

Is there protrusion of the abdomen?

Does the thorax appear to be symmetrical?

Are the abdominal muscles tight and guarding?

Is the athlete holding/splinting part of the abdomen?

Injury Assessment: PPalpation

Thorax The hands should be placed on either side of the chest

wall to check for symmetry during inspiration/expiration.

This also helps to locate areas that are point tender.

Abdomen Athlete should be laying on their back with arms at the

side and abdominal muscles relaxed. Looking for muscle guarding, rigidity, referred pain.

McBurney’s Point

Recognition and Management of Thoracic Injuries Rib contusions Rib fractures Costal cartilage injury Intercostal muscle strain Injuries to the lungs

Pneumothorax Tension pneumothorax Hemothorax Traumatic asphyxia

Sudden Death Syndrome in Athletes Congenital cardiovascular abnormality

Breast problems

Rib Contusions & Fractures

Rib Contusion MOI:

Blow to ribcage.

S&S: Pain is sharp when

breathing, point tenderness, and pain when the ribcage is compressed.

Treatment: X-ray, RICE, NSAIDS, and

rest.

Rib Fracture S&S:

Severe pain with inspiration and sharp pain with palpation.

Treatment: Similar to contusion. Simple fractures heal within

3-4 weeks.

Costal Cartilage Injury & Intercostal Muscle Injury Costal Cartilage Injury MOI:

Direct or indirect trauma. S&S:

Similar to rib contusion and fracture.

Deformity and crepitus may be present.

Treatment: Similar to rib fracture. Healing 1-2 months.

Intercostal Muscle Injury MOI:

Direct trauma or sudden torsion of the trunk.

S&S: Pain with active motion,

and pain with inspiration/expiration, laughing, coughing, or sneezing.

Treatment: Ice and compression,

immobilization for comfort

Injuries to the Lungs

MOI: Pneumothorax is a condition where the pleural cavity surrounding the

lung becomes filled with air that has entered through an opening in the chest. The lung on the other side collapses.

Tension Pneumothorax occurs when the pleural cavity on one side fills with air and displaces the lung and heart toward the opposite side.

Hemothorax is the presence of blood within the pleural cavity. Traumatic Asphyxia occurs as the result of a violent blow/compression of

the ribcage, causing a cessation of breathing. S&S:

SOB, chest pain on side of injury, coughing up blood, cyanosis, and/or shock.

Treatment: Medical emergency treatment ASAP!

Pictures of Lung Injuries

Sudden Death Syndrome

The most common cause of exercise-induced sudden death is due to a congenital cardiovascular abnormality.

The 3 most common causes: Hypertrophic cardiomyopathy Anomalous origin of the coronary artery Marfan’s Syndrome

Noncardiac causes: Alcohol, cocaine, amphetamines, erythropoietin Cerebral aneurysm or head trauma Obstructive respiratory diseases

S&S: Chest pain, heart palpitations, syncope, nausea, profuse sweating, heart murmurs, SOB,

malaise, and fever. Treatment:

Medical emergency treatment ASAP! Prevention:

PPE

Recognition and Management of Abdominal Injuries Injuries to abdominal wall Hernia

Inguinal hernia in males Femoral hernia in females

Blow to the Solar Plexus Stitch in the side Injury to the spleen

Mono Kidney contusion Liver contusion Appendicitis Injuries to the bladder Scrotal/testicular contusion Gynecological injuries

Hernia

MOI: A hernia is a protrusion of abdominal

viscera through a portion of the abdominal wall.

Types: Inguinal Femoral

S&S: A history of a blow or strain to the

groin area that produced pain and prolonged discomfort, superficial protrusion in the groin area that is increased by coughing, or weakness/pulling sensation in the groin area.

Treatment: Remove from activity until repair is

made.

Blow to the Solar Plexus

MOI: Blow to the middle portion of the abdomen, which

produces a transitory paralysis of the diaphragm.

S&S: Paralysis stops respiration, the athlete is unable to

inhale, and may panic.

Treatment: Calm the athlete, and monitor hyperventilation.

Injury to the Spleen

MOI: Fall/direct blow to the left upper quadrant of the

abdomen. Infectious mononucleosis.

S&S: History of a severe blow to the abdomen, signs of

shock, abdominal rigidity, nausea, vomiting, and/or Kehr’s Sign.

Treatment: Hospitalization, return to participation in 3-4 weeks,

surgery will require a longer resting period.

Kidney Contusion

MOI: Direct trauma.

S&S: Signs of shock, nausea, vomiting, rigidity of back

muscles, hematuria, and/or referred low back pain.

Treatment: Check urine for the presence of blood, referral to

physician, surgery, and 2 weeks of bedrest.

Liver Contusion

Appendicitis

MOI: Acute or chronic onset, inflammation of the appendix,

bacterial infection a major concern.

S&S: Mild-to-severe pain in the right lower abdomen,

nausea, vomiting, fever, cramps, abdominal rigidity, and point tenderness at McBurney’s Point.

Treatment: Medical emergency treatment ASAP!

Scrotal/Testicular Contusion

MOI: Direct trauma.

S&S: Hemorrhage, fluid effusion, and muscle spasm.

Treatment: Place the athlete on his side and instruct him to flex

thighs to chest, apply an ice bag after pain decreases. If pain does not resolve within 15-20 minutes, refer to a

physician.

Visual Aids Courtesy of the Following Websites:

http://www.highlands.edu/subwebs/shenderson/API/lab_manual/body_quads.jpg

http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19589.jpg

http://connection.lww.com/products/smeltzer9e/images/figurelarge21-12b.gif

http://www.laparoscopic-surgeon.co.uk/images/typesofhernia.jpg