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