1 Injuries to the Thorax and Abdomen PE 236 Juan Cuevas, ATC

2 Anatomy Review Thoracic cage has 12 pairs of ribs. The first ___ pairs connect directly to sternum. Pairs 8 through 10 connect via common costal cartilage. Pairs 11 and 12 are “______________” Major thoracic joints include: Intervertebral. ____________________ Sternocostal. ____________________

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5 Anatomy Review (continued) Muscles of the trunk (posterior view) ______________. Rhomboids. Latissimus dorsi and others.

6 Anatomy Review (continued) Internal thoracic organs and major blood vessels of the region are: ________ & pericardium. Lungs & ________. Thoracic aorta. Pulmonary artery & veins. ___________. Trachea & esophagus.

7 Anatomy Review Abdominal quadrants _______ RLQ LLQ

8 Anatomy Review (continued) Abdominal Organs and Structures RUQ contains: _______, gallbladder, and right kidney. RLQ contains: _____________ and ascending colon. LUQ contains: Stomach, __________, left kidney, and pancreas. LLQ contains: Descending colon.

9 Common Sports Injuries Fractures can occur to ribs, sternum, clavicle, or thoracic vertebrae. Injuries must be treated immediately to avoid ______________ or __________________. Injuries must be treated immediately to avoid ______________ or __________________. Joint dislocations and subluxations of thoracic skeletal joints can occur. _________________separations involve disunion of sternum and ribs.

10 Common Sports Injuries (continued) Signs and symptoms of rib ____________ include: Extreme localized pain that is aggravated by sneezing, ________, and forced inhalation. Extreme localized pain that is aggravated by sneezing, ________, and forced inhalation. Athlete grasps chest wall at point of injury. Athlete grasps chest wall at point of injury. Mild swelling at site; there may be bony __________. Mild swelling at site; there may be bony __________. Breathing difficulties; rapid _______ breathing. Breathing difficulties; rapid _______ breathing. First Aid Monitor vital signs and watch for respiratory distress. Monitor vital signs and watch for respiratory distress. Transport to medical facility. Transport to medical facility.

11 Common Sports Injuries (continued) Signs and symptoms of subluxations and dislocations include: History of snap or _________ sensations. History of snap or _________ sensations. Pain and tenderness over costochondral junction. Pain and tenderness over costochondral junction. Palpable ________ may be felt, and swelling in the localized area. Palpable ________ may be felt, and swelling in the localized area. Maximum or near-maximum inhalation may be very difficult. Maximum or near-maximum inhalation may be very difficult. First Aid Apply ice and light compression immediately. Apply ice and light compression immediately. Treat for ______ and transport to medical facility. Treat for ______ and transport to medical facility.

12 Heart Injuries Heart Injuries While rare, contusions to the chest wall can bruise the heart, resulting in death. While rare, contusions to the chest wall can bruise the heart, resulting in death. __________________ can occur. Use of ______ device is the most practical way to save the lives of people experiencing commotio cordis. Use of ______ device is the most practical way to save the lives of people experiencing commotio cordis.

13 Sudden ________ Syndrome in Athletes Cause of Condition Cause of Condition _____________ cardiomyopathy- thickening of cardiac muscle w/ no increase in chamber _______ ___________ syndrome- abnormality in connective tissue results in weakening of _______ and cardiac vessels Series of additional cardiac causes Non-cardiac causes include drugs and alcohol, intracranial _________, obstructive respiratory disease Signs of Condition Signs of Condition Most _______ exhibit any signs prior to death May exhibit chest pain, heart palpitations, __________, nausea, profuse sweating, shortness of breath, malaise and/or fever

14 Care Care ___________ medical attention is necessary – life threatening condition ______________ ______________ Counseling and screening are critical in early identification and prevention of sudden death Screening questions should address the following History of ______________ History of ______________ Chest pain during _______________ Chest pain during _______________ Periods of _____________ during exercise Periods of _____________ during exercise Family history Family history Thickening of _________-or history of Marfan’s syndrome Thickening of _________-or history of Marfan’s syndrome Cardiac screening - electrocardiograms and echocardiograms may be needed to determine existing pathology

15 Lung Injuries Pulmonary contusions may occur as complication of _____ fracture, contusion, or other type of lung injury. Pulmonary contusions may occur as complication of _____ fracture, contusion, or other type of lung injury. Fractured rib can puncture pleural sac, causing _____________. Fractured rib can puncture pleural sac, causing _____________. Spontaneous pneumothorax can occur _________ trauma (reported in weight lifters and runners). _____________ occurs when fractured rib punctures lung. _____________ occurs when fractured rib punctures lung. This condition can be ______________.

16 Lung Injuries (continued) Signs and symptoms include: Severe _______ in chest, sometimes radiating to thoracic spine. Severe _______ in chest, sometimes radiating to thoracic spine. Breathing problems (___________). Breathing problems (___________). May have nonproductive _______ and tachycardia. May have nonproductive _______ and tachycardia.

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18 Lung Injuries (continued) First Aid Treat for ________. Treat for ________. Monitor ____________. Monitor ____________. Transport to medical facility immediately. Transport to medical facility immediately.

19 Internal Injuries to the Thorax and Abdomen Liver, Kidneys, Spleen and Bladder Injuries Although fairly safe, the liver is susceptible to ________________. Although fairly safe, the liver is susceptible to ________________. Diseases such as ____________ make liver more vulnerable. Heavy consumption of ________ and/or use of steroids damages the liver.

20 Internal Injuries to the Thorax and Abdomen (continued) Kidneys are susceptible to blunt trauma directed at the ______________. Kidneys are susceptible to blunt trauma directed at the ______________. Kidneys may also be injured as a result of heat stroke Kidneys may also be injured as a result of heat stroke Be alert for ________________. Refer athlete to a physician. Refer athlete to a physician.

21 Injury of the ___________ Cause of Injury Cause of Injury Result of a direct blow to _________ Infectious mononucleosis (causing an enlarged spleen) Signs of Injury Signs of Injury Indications of a ruptured spleen involve history of a direct blow, signs of _______, abdominal rigidity, nausea, vomiting Be alert for _____________ sign. Be alert for _____________ sign. Referred pain in upper left shoulder Decreased peripheral circulation. Check nail beds and ________ Check nail beds and ________ Ability to splint self may produce delayed hemorrhaging - easily disrupted resulting in internal bleeding

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23 Care Care Conservative treatment involves 1 wk of hospitalization and a gradual return to _______ Surgery will result in three months of recovery while removal of spleen will result in a ___ month removal from activity In cases of mononucleosis athlete may resume training in ________ if spleen not enlarged and if there is no fever

24 Injuries to the Bladder Cause of Injury Cause of Injury Blunt force to the ____________ may cause injury to urinary bladder if distended with urine _________ is often associated with contusion of bladder during running (runner’s bladder) Signs of Injury Signs of Injury Pain, discomfort of lower abdominal region, abdominal rigidity, nausea, vomiting, shock, bleeding from the _______, increased quantity of bloody urine Athlete should be instructed to monitor ______ Inability to urinate will present in case of ruptured bladder

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26 Scrotal/Testicular Contusion Cause of Injury Cause of Injury Result of blunt trauma and______ to the vulnerable and sensitive scrotum Signs and Symptoms Signs and Symptoms Hemorrhaging, fluid effusion, _____________, severe pain (disabling) May cause nauseating, disabling and painful condition Care Care Place athlete on side with knees to chest Apply ________ as pain subsides If pain persist after minutes referral will be necessary

27 __________ Cause of Injury Cause of Injury Protrusion of abdominal viscera through portion of abdominal ______ (congenital or acquired) Inguinal vs. ____________ hernias Complications and strangulated hernias Signs of Injury Signs of Injury Acquired hernia occur when ______________ is further aggravated by a direct blow or strain History of direct blow to groin area, pain and prolonged discomfort, superficial protrusion with pain increasing with coughing & reported pulling sensation in ________ area History of direct blow to groin area, pain and prolonged discomfort, superficial protrusion with pain increasing with coughing & reported pulling sensation in ________ area

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29 Abdominal Hernia __________ of the abdominal viscera through a portion of the abdominal ________ __________ of the abdominal viscera through a portion of the abdominal ________ _____________ Hernia Protrusion of the spermatic cord through the inguinal ________- Protrusion of the spermatic cord through the inguinal ________- Signs and Symptoms Previous history of a blow or strain to the groin/lower abdomen region that produces pain and prolonged _____________ Previous history of a blow or strain to the groin/lower abdomen region that produces pain and prolonged _____________ Protrusion is increased by ___________ Protrusion is increased by ___________ Reported feeling of weakness and pulling sensation in the groin/lower abdomen region. Reported feeling of weakness and pulling sensation in the groin/lower abdomen region.

30 Care Care Most physicians prefer athlete to refrain from hard physical activity until ___________ repaired Mechanical devices are not suitable for athletics due to friction and irritation they produce While exercise is thought to be beneficial with regards to strengthening, that is not the case

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32 Hernias (cont’) First Aid/ Treatment Refer to MD Refer to MD Surgery!!! Surgery!!!

33 Internal Injuries Always rule out internal injuries whenever there is a blow to the ribs or abdomen. Internal injuries “sneak up” due to no immediate warning signs. Always re-evaluate minutes after injury. ***When in doubt…REFER!!!