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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pelvis

Muscles

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lungs

Lungs

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

Intercostal muscles

Intercostals

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

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

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

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

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

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

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

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

Hernias

Hernias

Hernias

Hernias

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

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

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

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

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

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

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

Spleen injury

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

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

Kidney contusion Kidney contusion Kidney Laceration

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)

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

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

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)

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.

Appendicitis

Appendicitis Inflamed appendix perforated appendix

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

Bladder injuries Tx: Monitor athlete Physician referral if necessary

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

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 15-20 minutes

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

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

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

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

Rib Fractures

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

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

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

Costal cartilage injury

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

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

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

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

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

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

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

Pneumothorax

Pneumothorax

Tension pneumothorax

Hemothorax

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

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

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

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

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

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

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