1. Anatomy & Injuries to the Abdomen & Thorax
Sports Medicine
Spain park High School

2. Anatomy Abdominal cavity Borders Diaphragm superiorly
Pelvis inferiorly
Spine posteriorly
Abdominal wall anteriorly

3. Anatomy Divided into 4 quadrants
Line runs through navel at midline of body UL UR LL LR

4. Anatomy--Quadrants UL Stomach Part of liver & Pancreas Left kidney
Spleen
Parts of large & small intestine

5. Anatomy--Quadrants UR Liver Part of pancreas Right kidney Gall bladder
Parts of large & small intestine

6. Anatomy--Quadrants LL Parts of Lg & Sm intestines Part of bladder
Uterus-females
Left ovary-females
Prostate- males
Ureter-male

7. Anatomy--Quadrants LR Parts of Lg & Sm intestines Appendix
Part of bladder
Uterus-female
Right ovary-female
Prostate-male
Ureter-male

10. Anatomy Organs are part of: Urinary system Digestive system
Kidneys, bladder
Digestive system
Stomach, liver, pancreas, gall bladder, large & small intestine, spleen
Reproductive system
Uterus, ovaries, prostate, seminal vesicles

11. Anatomy Solid organs Hollow organs More often & easily injured
Can cause rapid death due to large blood supply—internal bleeding
Spleen, liver, kidney, pancreas
Hollow organs
Injuries are rare because tubes are hollow—assist in transporting substances from one organ to another

12. Digestive organs Digestion begins in mouth Stomach Liver Gall bladder
Secretes gastric juices that assist in breaking down food before entering small intestine
Liver
Detoxifies chemicals that the body perceives as poisonous, stores vitamins, produces bile, assists with food metabolism
Gall bladder
Storage tank for bile, which passes into sm intestine where it assists in metabolism of fat

13. Digestive Organs Pancreas Small intestine Large intestine
Produces insulin and enzymes for digestion
Small intestine
Completes digestion, absorbed the products into circulatory system. Peristalsis (sequential contraction/relaxation of intestinal muscle) pushes the food through the intestines to the large intestine. At this point all material that has not been absorbed is considered waste.
Large intestine
All materials not absorbed into the system in sm intestine is passed into large intestine as waste. Water is absorbed leaving solid waste for excretion

14. Digestive organs Appendix Spleen Part of large intestine
No known function
Spleen
Produces & destroys red blood cells
Storage site for blood
Aids in destruction of harmful microorganisms

15. Urinary system Kidneys Bladder
Responsible for maintaining acid-base in body, which if changed causes body system to shut down eventually resulting in death
Filter blood and remove waste products of metabolism to maintain stable acid-base relationship
If blood supply is inadequate, can cause hypertension from chemical constriction of body’s blood vessels
Bladder
Holding tank for liquid waste in body

16. Reproductive system Females Males Ovaries Uterus seminal vesicles
Produces eggs and estrogen (stimulates development of & maintains feminine characteristics)
Uterus
Fertilized eggs develop here
Males
seminal vesicles
Prostate gland
Responsible for adding fluid & nutrients to seminal fluid

17. Anatomy Pelvis Abdominal muscles
Provides bony base and protection for internal organs
Wider in females to accommodate childbirth
Abdominal muscles
Provides protection for organs
Rectus abdominus gives “washboard” affect; attaches to pelvis & lower ribs & sternum—trunk flexion
Obliques (external & internal) attaches to lateral aspect of lower ribs & runs diagonally to pelvis—flexion and rotation
Transverse abdominus—holds internal organs in cavity

18. Pelvis

19. Muscles

21. Anatomy of thorax Part of body between neck & abdomen
Contains heart & lungs

22. Anatomy Throat Carotid arteries Jugular veins
One on each side of trachea
Carry oxygenated blood to brain
Jugular veins
One on each side of trachea
Carry unoxygenated blood away from brain

23. Anatomy Larynx Trachea Esophagus Modified upper part of trachea
Contains vocal chords
Trachea
Made up of circular rings of cartilage
Main trunk of system of tubes by which air passes to & from lungs for exchange of CO2 and O2
Esophagus
Passageway for food going from the mouth to the stomach
Sits in front of the cervical vertebrae and behind the trachea & larynx

24. Anatomy of thorax Bony structures Thoracic vertebrae posterior
12 ribs on each side
Sternum anterior
Protects organs of thorax

25. Anatomy Heart Divided into 4 chambers Size of fist
Pumps blood to all parts of body
Divided into 4 chambers
Right & left atrium
Upper chambers
Right & left ventricle
Lower chambers
Larger with thicker walls

26. Heart Pumps blood to lungs and throughout body
Right atrium fills w/ blood from vein
Carries waste products and CO2
Right ventricle receives blood from atrium (through tricuspid valve)
Pulmonary arteries carry UNOXYGENATED blood to lungs

27. Heart Blood is mixed with O2 in the lungs
OXYGENATED blood is carried back to heart by the pulmonary veins
Goes into the left atrium
Flows to the left ventricle through the bicuspid valve
Is pumped to the rest of the body through the aorta

28. Heart Main branches (arteries) off the aorta
Ascending and descending aortas
Carotid
Subclavian
Axillary
Brachial
Radial & ulnar
Common iliac
Femoral
Anterior & Posterior Tibial

34. Run parallel with the arteries
Veins
Run parallel with the arteries
Superior vena cava
Inferior vena cava
Two extra in arm
Cephalic
basilic
Two extra in leg
Greater saphenous
Lesser saphenous

37. Lungs Function: Right has 3 lobes Left has 2 lobes
to exchange O2 and CO2
To dissipate heat from the body

38. Trachea divides into two bronchi
Bronchi are filled with cilia
Hair like projections that help remove foreign substances like dust & pollen
Bronchi divide into bronchioles
Bronchioles end in alveoli
Alveoli are air containing cells of the lungs
O2 and CO2 are exchanged here
Coughing & sneezing help keep trachea and bronchi clear & remove phlegm and allergy-causing agents from lungs

39. Respiration rate
Lung function & breathing rate controlled by CO2 receptors
If there is too much CO2, inhalation occurs to bring in more O2
Exercise increases cell metabolism
Causes cells to need more O2 and eliminate more CO2

40. Breaths become deeper & more forceful
Respiration Rate
With exercise lungs’ ability to exchange air more efficiently increases
Breaths become deeper & more forceful
Return to normal breathing quicker

41. Pleura Thin lubricated tissue Lines each half of thorax
Folded back over the surface of the lung on same side
Allow for smooth movement of lungs as they encounter the wall of ribs during inhalation & exhalation

43. Lungs

44. Lungs

45. Muscular Anatomy Intercostal muscles sit between ribs
Internal and external intercostals
Aid in inhalation and exhalation

46. Intercostal muscles

47. Intercostals

48. Abdominal & Thoracic Injuries
Injuries are rare
Solid organs most often injured
Life threatening

49. Abdominal Strains Rectus abdominus most often injured
Potentially can be incapacitating
Mxn:
sudden twisting of trunk or reaching overhead
S/S:
pain with movements of the trunk, POT over affected muscle, tightness of muscles
TX:
ice, compression, gentle stretching, no exercise until ROM is pain free

50. Abdominal contusions
Not common but most likely to occur in collision sports
Mxn:
direct blow to abdomen, compressive force to abdominal wall
S/S:
pain, tightness, hematoma formation under the fascial tissue surrounding muscle
Tx:
ice, compression, look for signs of internal injury, no activity until pain free

51. Hernia
Protrusion of abdominal viscera through a portion of abdominal wall
Those resulting from sports occur in groin area
Inguinal hernias occur most often in men ( more than 75%)
Femoral hernias occur most often in women

52. Hernias Inguinal Femoral
Results from abnormal enlargement of opening in inguinal canal through which vessels and nerves of male reproductive system pass
Femoral
Arises in canal that transports vessels & nerves that go the thigh and lower limb

53. Hernias
When intra-abdominal tension is produced in these areas, muscles produce a contraction around canal openings.
If muscles fail to react abdominal contents may be pushed through opening

54. Hernias
Mxn:
improperly lifting a heavy object, increased abdominal pressure, blow to groin area, weakness of abdominal wall
S/S:
pain and prolonged discomfort in groin area, protrusion in the groin area that is present when standing (or when coughing) but goes away when lying down, feeling of weakness or pulling sensation in groin area
Tx:
surgical repair

55. hernias Complications: Strangulated hernia:
If hernia is not treated, the bulge can get stuck in abdominal wall or inguinal canal.
The blood supply to the tissue will be cut off and eventually die.
If the intestine is involved, a bowel obstruction will result and prevents the passage of waste material from the body causing pain and illness

56. Hernias

57. Hernias

58. Hernias

59. Hernias

60. Blow to Solar Plexus Commonly known as “getting the wind knocked out”
Mxn: blow to the middle of the abdomen or solar plexus
S/S: transitory paralysis of diaphragm, inability to breath (inhale) or trouble breathing for a brief period of time, cyanosis, short term panic
Tx: calm athlete, loosen belt/clothing around abdomen, bend knees, , control breathing-short inspirations, long expirations

61. Blow to solar plexus
Complications: fear of not being able to breath may cause athlete to hyperventilate
Increased rate of ventilations that results in increases levels of O2 which can cause dizziness, lump in throat, pounding of heart, fainting, tingling/numbness in hands, face, feet
Care for hyperventilation:
Have athlete breath into a paper bag to increase levels of CO2 to restore normal breathing
If athlete does pass out, normal breathing should be restored

62. Stitch in Side
Name given to an idiopathic condition that occurs in some athletes
Causes:
Constipation
Intestinal gas
Overeating
Diaphragmatic spasm as result of poor conditioning
Lace of visceral support because of weak abdominal muscles
Distended spleen
Breathing techniques that lead to lack of O2 in diaphragm
Ischemia of either the diaphragm or intercostal muscles

63. Stitch in Side
S/S:
Cramp like pain in side at either right or left costal border during hard physical activity
Tx:
Relax the spasm
Stretch arm on affected side above the head and side bend to the same side
Flex the trunk over the thighs
Ice
If pain/spasm persists seek medical evaluation

64. Spleen injury Mxn: Direct blow to upper left quadrant
Falling on UL quadrant
Infectious mononucleosis causes enlarged spleen putting athlete at risk
If spleen is enlarged due to mono, may resume activity after 3 weeks if the spleen is no longer enlarged or painful and there is no fever

65. Spleen injury S/S: History of injury
Signs of shock-dizziness, thirst, pale, sweating, rapid pulse/respirations
Abdominal rigidity
Nausea
Vomiting
Kehr’s sign
Reflex (referred) pain that comes on about 30 minutes after injury where pain radiates to the left shoulder and 1/3 the way down the left arm
Referred pain—pain felt in one part of the body other than its actual origin

66. Spleen injury
Can hemorrhage profusely into abdominal cavity causing athlete to die of internal bleeding days or weeks after injury
Tx:
Call 911, monitor athlete, conservative, non-operative treatment with about 1 week of hospitalization
At 3 weeks can engage in light conditioning
Return to full activity at 4 weeks
If surgical repair is needed athlete will return to activity at 3 months
If surgical removal is necessary, return to activity at 6 months

67. Spleen injury

68. Kidney Contusion Mxn: blow to the back S/S: signs of shock nausea
vomiting
rigidity of muscles of back
hematuria (blood in urine)
referred pain radiates forward around the trunk into the lower abdominal region

69. Kidney Contusion
Tx:
Have athlete urinate 2-3 times to determine if there is blood in urine
Call 911 if necessary
Treat for shock
Immediate physician referral there is hematuria
24 hour hospitalization for observation
Gradual increase in fluid intake
If hemorrhage fails to stop, surgical intervention
Usually takes 2 weeks bed rest prior to return to activity

70. Kidney contusion
Kidney contusion Kidney Laceration

71. Liver Contusion/laceration
Mxn:
hard blow to right side of abdomen
S/S:
hemorrhage
signs of shock
referred pain
just below the right scapula
right shoulder
substernal area
anterior left side of chest (occasionally)

72. Liver contusion/laceration
Tx:
Call 911
Treat for shock
Monitor athlete
Immediate surgical intervention

73. Appendicitis Mxn: inflammation of appendix Chronic or acute
Caused by fecal obstruction
Initially appendix is red & swollen
Can become gangrenous, rupture into bowels & cause peritonitis

74. Appendicitis S/S: Mild to sever pain in lower abdomen Nausea Vomiting
Low grade fever
Cramps in lower right side
Abdominal rigidity
Referred pain is at McBurney’s point (between the ASIS and the umbilicus)

75. Appendicitis Tx: Monitor athlete Refer when necessary
Surgical removal of inflamed appendix
Not an emergency unless there is a bowel obstruction
An obstructed bowel, with an acute rupture is life-threatening
Highest incidence in males between ages of 15 & 25.

76. Appendicitis

77. Appendicitis
Inflamed appendix perforated appendix

78. Injuries to Bladder Mxn: S/S:
blunt force to lower abdominal region if the bladder is distended by urine
Hematuria associated with contusion of bladder during running
Known as runner’s bladder
S/S:
blood in urine
Referred pain to lower trunk, upper thigh anteriorly
With rupture, athlete will be unable to urinate

79. Bladder injuries
Tx:
Monitor athlete
Physician referral if necessary

80. Testicular/Scrotal contusion
Due to considerable sensitivity & vulnerability, contusions to the scrotum & testicles cause extreme pain, nausea and disability
Important for males to wear proper protection to prevent incidence of contusions
Mxn:
direct blow to the genitalia

81. Testicular/Scrotal contusion
S/S:
hemorrhage
fluid effusion
muscle spasm
Vomiting is severe
Tx:
place athlete on his side
flex thighs to chest
ice to scrotum as pain diminishes
Immediate medical referral for increasing or unresolved pain after minutes

82. Rib Contusion Mxn: S/S: Tx: blow to rib cage sharp pain with breathing
POT over contused area
pain with compression of rib cage
Tx:
RICE
NSAIDS
cessation of activity until pain subsides
self limiting

83. Rib Fractures Most common in collision sports
Ribs 5-9 most commonly fractured
Possibility of cause damage to or puncturing a lung
Mxn:
direct impact
compression of rib cage

84. Rib Fractures S/S: severe pain during inspiration
POT over fracture site
Crepitus
Pain with movement of trunk

85. Rib Fractures Tx: Refer for x-ray ice Support Rest
Heal within 3-4 weeks
Rib brace may offer some stabilization and comfort

86. Rib Fractures

87. Costal Cartilage Injury
More common than rib fractures
Mxn:
direct blow to thorax
Indirectly from sudden twist of fall on a ball compressing the rib cage

88. Costal cartilage injury
S/S:
similar to rib fracture except pain is localized in the junction of the rib cartilage and the rib
Sharp pain during sudden movements
Difficulty in breathing deeply
POT with swelling
Rib deformity
Ribs make crackling noise (crepitus) as it moves in and out of place

89. Costal cartilage injury
Tx:
Ice
Rest
Immobilization with rib brace
1-2 months healing time

90. Costal cartilage injury

91. Intercostal Muscle Strain
Mxn:
Direct blow
Sudden torsion of trunk
S/S:
Pain w/ active motion
Pain w/ inspiration/expiration, laughing, coughing, sneezing
Tx:
Ice
Compression
Immobilization for comfort

92. Lung Injuries Injures to lungs are rare but can be life threatening
Pneumothorax
Tension Pneumothorax
Hemothorax
Traumatic asphyxia

93. Pneumothorax
Condition in which pleural cavity surround lung becomes filled w/ air that has entered through an opening in the chest
As pleural cavity fills with air, lung on that side collapses

94. Tension pneumothorax
Occurs when the pleural cavity on one side fills with air & displaces the lung and the heart toward the opposite side, this compressing the opposite lung

95. Hemothorax
Presence of blood within the pleural cavity or pleural tissue involving the blood vessels in the area

96. Traumatic asphyxia
Occurs as the result of a violent blow to or compression of the rib cage causing a cessation of breathing.
Demands immediate mouth-to-mouth resuscitation & immediate medical attention

97. Lung injuries S/S: Tx: Difficulty breathing Shortness of breath
Chest pain on side of injury
Coughing up blood
Cyanosis
shock
Tx:
Call 911
Monitor athlete
Treat for shock

98. Pneumothorax

99. Pneumothorax

100. Tension pneumothorax

101. Hemothorax

102. Sudden Death Syndrome Athletes 35 years and younger
Most common cause of death is congenital cardiovascular abnormality
3 prevalent causes:
Hypertrophic cardiomyopathy (HCM)
Anomalous origin of the coronary artery
Marfan’s syndrome

103. Hypertrophic Cardiomyopathy
Condition in which there is thickened cardiac muscle with no evidence or chamber enlargement or extensive myocardial scarring

104. Anomalous origin of coronary artery
One of the two coronary vessels originates at a different site than normal
This compromises or obstructs the artery because of its unusual course

105. Marfan’s syndrome
Abnormality of connective tissue resulting weakening of the aorta and cardiac valves which can lead to a rupture of either a valve or of the aorta itself

106. Coronary artery disease (CAD)
One other potential cause of sudden cardiac death
Results from atherosclerosis which causes a narrowing of the coronary arteries due to hypercholesterolemia in the young athlete

107. Sudden death S/S: chest pain or discomfort during exertion
Heart palpitations or flutters
Syncope
Nausea
Profuse sweating
Heart murmurs
Shortness of breath
General malaise
Fever

108. Sudden death Tx: Life-threatening Call 911 Be prepared to perform CPR
Have AED ready to use
Early detection/screening/identification could prevent sudden death from occuring