Chapter 27: The Thorax and Abdomen

Chapter 27: The Thorax and Abdomen
© 2011 McGraw-Hill Higher Education. All rights reserved.

Assessment of the Thorax Abdomen
Injuries to this region can produce life-threatening situations Athletic trainer’s evaluation should focus on signs and symptoms that indicate potentially life-threatening conditions Continually monitor breathing, circulation and any indication of internal bleeding or shock © 2011 McGraw-Hill Higher Education. All rights reserved.

History What happened to cause this injury? Was there direct contact or a direct blow? What position were you in? What type of pain, was it immediate or gradual, location(s)? Difficulty breathing? What positions are most comfortable? Do you feel faint, light-headed or nauseous? Chest pain? © 2011 McGraw-Hill Higher Education. All rights reserved.

Hear or feel snap, crack or pop in your chest? Muscle spasms? Blood or pain during urination? Was the bladder full or empty? How long has it been since you last ate? Is there a personal or family history of any heart, abdominal problems or other diseases involving the abdomen and thorax? © 2011 McGraw-Hill Higher Education. All rights reserved.

Observations Is the patient breathing? Are they having difficulty breathing? Does breathing cause pain? Is the patient holding their chest wall? Is there symmetry of the chest during breathing? If the patient’s wind was knocked out, is normal breathing returning? How rapidly? Body position Thorax injury - leaning towards side that is injured and splinting area w/ hand Abdominal injury - lie on side w/ knees pulled to chest Male external genitalia injury - lying on side holding scrotum © 2011 McGraw-Hill Higher Education. All rights reserved.

Check for areas of discoloration, swelling or deformities Around umbilicus = intra-abdominal bleed Flanks = swelling outside the abdomen Protrusion or swelling in any portion of abdomen (internal bleeding) Does the thorax appear to be symmetrical? Are the abdominal muscles tight and guarding? Is the athlete holding or splinting a particular part? Blood - Bright red = lung injury Vomiting bright red and frothy = injury to esophagus and stomach although blood may be swallowed from mouth and nose © 2011 McGraw-Hill Higher Education. All rights reserved.

Cyanosis - respiratory difficulty Pale, cool, clammy skin indicates low BP Monitor vital signs (pulse, respiration, BP) Rapid weak pulse or drop in BP is an indication of a serious internal injury (involves blood loss) Palpation Thorax Check for symmetry of chest wall movement and search for areas of tenderness Palpate along ribs and intercostal spaces as well as costochondral junctions AP pressure to rib cage to assess for fracture Transverse pressure assesses costochondral junction Semi-reclining position is useful if athlete is having difficulty breathing © 2011 McGraw-Hill Higher Education. All rights reserved.

Abdomen Patient should have arms at side, knees and hips flexed to relax abdomen Four abdominopelvic quadrants (move clockwise starting from upper right quadrant) Feel for guarding and tenderness, rigidity (internal bleeding) Rebound tenderness Assess each organ (if possible) Auscultation Heart Sounds “Lubbdupp” (may hear 3rd sound in children) Listen for murmur (abnormal period due to valve insufficiency) Listening at a variety of points © 2011 McGraw-Hill Higher Education. All rights reserved.

Breath sounds Should be consistent Abnormal patterns Cheyne-Stokes breathing (rate changes over 1-3 minutes) Biot’s breathing - normal rate followed by cessation Apneustic breathing - pauses in respiratory cycle at full inspiration Wheeze, crackles, stridor, stertor, rales, & ronchi Perform over apex, centrally and at base of each lung, both anteriorly and posteriorly Bowel sounds Liquid-like gurgling due to peristalsis Diminished = paralytic ileus or peritonitis High pitched sounds = intestinal obstruction © 2011 McGraw-Hill Higher Education. All rights reserved.

Recognition and Management of Specific Injuries
Rib Contusion Etiology Blow to the rib cage can bruise ribs, musculature or result in fracture Signs and Symptoms Painful breathing (particularly if muscles are involved) Point tenderness; pain with rib compression Management RICE and NSAID’s Rest and decrease in activity © 2011 McGraw-Hill Higher Education. All rights reserved.

Rib Fractures Etiology Caused by a direct blow or the result of a violent muscular contraction Can be caused by violent coughing and sneezing A flail chest is one where 3+ consecutive ribs are fractured Signs and Symptoms History is critically important Pain with inspiration, point tenderness and possible deformity with palpation Management Refer for X-rays Support and rest; brace Figure 27-19 © 2011 McGraw-Hill Higher Education. All rights reserved.

Costochondral Separation Etiology Result of a direct blow to the anterolateral aspect of the rib cage Signs and Symptoms Localized pain in region of costochondral junctions Pain with movement; difficulty with breathing Point tenderness and possible deformity Management Rest and immobilization Healing may take 1-2 months © 2011 McGraw-Hill Higher Education. All rights reserved.

Rib Tip Syndrome Etiology Involves ribs 8-10 Fibrous tissue connecting ribs damaged resulting in impingement of ribs on intercostal nerve Signs and Symptoms Localize pain in upper abdomen Pain with lateral flexion and extension away from injury May present with popping or clicking Pain reproduced by pulling inferior rib anteriorly; positive sign = clicking Management Bracing & compression wrap Manipulation/mobilization Inject with corticosteroids or local anesthetic © 2011 McGraw-Hill Higher Education. All rights reserved.

Sternum Fractures Etiology Result of high impact blow to the chest May also cause contusion to underlying cardiac muscle Signs and Symptoms Point tenderness over the sternum Pain with deep inspiration and forceful expiration Signs of shock, or weak rapid pulse may indicate more severe injuries Management X-ray and monitor patient for signs of trauma to the heart © 2011 McGraw-Hill Higher Education. All rights reserved.

Muscle Injuries Etiology Muscles are subject to contusions and strains Occur most often from direct blows or sudden torsion of the trunk Signs and Symptoms Pain occurs on active motions; pain with inspiration and expiration, coughing, sneezing and laughing Management Immediate pressure and application of cold for approximately one hour After hemorrhaging is controlled, immobilize the injury to make the patient comfortable © 2011 McGraw-Hill Higher Education. All rights reserved.

Breast Injury Etiology Constant uncontrolled movement (particularly in large breasted women) Stretching of Cooper’s ligament Runner’s and cyclist’s nipple Management Females should wear well-designed bra that has minimum elasticity and allows for little movement Special plastic cup-type brassieres may be required in sports with high levels of physical contact Use of an adhesive bandage can be used to prevent runner’s nipple Wearing a windbreaker can prevent cyclist nipple © 2011 McGraw-Hill Higher Education. All rights reserved.

Breast Cancer Etiology Should be of great concern to all women Most common cause of cancer in females Risk factor – age, gender, family history Hormonal influences can put individuals at higher risk Began menstruation prior to age 11; reached menopause after age 55 More commonly seen in women with high dietary fat intake Sign & Symptoms Early on – no symptoms and pain free Lump identified on breast, in arm pit, or on mammogram Breast discharge, nipple inversion, redness or puckering skin overlying breast © 2011 McGraw-Hill Higher Education. All rights reserved.

Management Females over 20 years old should perform breast self-examinations every month and receive a clinical evaluation every 3 years Not all lumps are malignant, but should be examined by a physician If malignancy is identified surgery is primary treatment Additional treatments are based on stage and type of cancer © 2011 McGraw-Hill Higher Education. All rights reserved.

Lung Injuries Etiology Pneumothorax - pleural cavity becomes filled with air, negatively pressurizing the cavity, causing a lung to collapse Will produce pain, difficulty with breathing and anoxia Tension Pneumothorax Pleural sac on one side fills with air displacing lung and heart, compressing the opposite lung May cause shortness of breath, chest pain, absence of breath sounds, cyanosis, distention of neck veins, deviated trachea Hemothorax Blood in pleural cavity causes tearing or puncturing of the lungs or pleural tissue Painful breathing, dyspnea, coughing up frothy blood and signs of shock © 2011 McGraw-Hill Higher Education. All rights reserved.

Traumatic Asphyxia Result of a violent blow or compression of rib cage Causes cessation of breathing Signs include purple discoloration of the trunk and head, conjunctivas of the eye Condition requires immediate mouth to mouth resuscitation Management Each of these conditions are medical emergencies and require immediate attention Transport patient to hospital immediately © 2011 McGraw-Hill Higher Education. All rights reserved.

Hyperventilation Etiology Rapid rate of ventilation due to anxiety induced stress or asthma Develop a decreased amount of carbon dioxide relative to oxygen Signs and Symptoms Patient has difficulty getting air in and seems to struggle with breathing Panic state with gasping and wheezing Management Decrease rate of carbon dioxide loss Slow respiration rate and alter respiration techniques Breath into a bag Normal respiration should return within 1-2 minutes, initial cause must be determined © 2011 McGraw-Hill Higher Education. All rights reserved.

Sudden Cardiac Death Syndrome in Athletes Etiology Hypertrophic cardiomyopathy- thickening of cardiac muscle w/ no increase in chamber size Anomalous origin of coronary arteries Marfan’s syndrome- abnormality in connective tissue results in weakening of aorta and cardiac vessels Series of additional cardiac causes Coronary artery & peripheral artery disease Right ventricular dysplasia; cardiac conduction abnormalities; aortic stenosis Wolf-Parkinson-White syndrome Non-cardiac causes include drugs and alcohol, intracranial bleeding, obstructive respiratory disease © 2011 McGraw-Hill Higher Education. All rights reserved.

Signs and Symptoms Most do not exhibit any signs prior to death May exhibit chest pain, heart palpitations, syncope, nausea, profuse sweating, shortness of breath, malaise and/or fever Management/Prevention Counseling and screening are critical in early identification and prevention of sudden death Screening questions should address the following History of heart murmurs Chest pain during activity Periods of fainting during exercise Family history Thickening of heart or history of Marfan’s syndrome Cardiac screening - electrocardiograms and echocardiograms © 2011 McGraw-Hill Higher Education. All rights reserved.

Heart Murmur Etiology Abnormal periodic sounds heard during auscultation Functional murmur = no organic heart dysfunction Forceful blood flow (high cardiac output) through healthy valves Abnormal murmur = blood flow through damaged valve Mitral valve prolapse – can lead to infective endocarditis or aortic regurgitation Mitral valve or aortic stenosis – narrowing due to scarring from infections (rheumatic fever); if untreated could result in heart failure Aortic sclerosis – scarring and thickening of aortic valve due to arthrosclerosis; tends not to be dangerous © 2011 McGraw-Hill Higher Education. All rights reserved.

Heart Murmur Signs and Symptoms Abnormal or unusual sounds (clicking, whooshing, swishing) Abnormal murmurs could result in symptoms of other heart problems Management Different types require different management Mitral valve prolapse and innocent murmurs don’t require additional management Others will require medication to reduce chance of infection, prevent clots, control irregular beats, control heart beat/fluttering, relax dilated vessels Surgery may be required to fix valve issues or repair congenital defects © 2011 McGraw-Hill Higher Education. All rights reserved.

Athletic Heart Syndrome Etiology Structural and functional heart changes due to greater than one hour on most days Results in increased left ventricle mass, diastolic capacity dimension, wall thickness Maximum cardiac output increases = low resting heart rate & longer diastolic filling time Systolic and diastolic function remain normal Signs and Symptoms Typically asymptomatic May exhibit bradycardia, systolic murmur, extra heart sounds with ECG abnormalities being common Management If serious cardiac conditions are ruled out – no treatment necessary © 2011 McGraw-Hill Higher Education. All rights reserved.

Commotio Cordis Etiology Syndrome resulting in cardiac arrest due to traumatic blunt impact to chest Unfortunate timing relative to re-polarization phase of cardiac cycle Young athletes are at risk Signs and Symptoms Ventricular fibrillation Management Resuscitation of victim is seldom successful Early defibrillation with AED and resuscitation is critical © 2011 McGraw-Hill Higher Education. All rights reserved.

Heart Contusion Etiology Result of compression between sternum and spine Most severe consequence would involve an aortic rupture Signs and Symptoms Severe shock and heart pain Heart may exhibit arrhythmias causing a decrease in cardiac output, followed by death if medical attention is not administered Management Immediate referral to an emergency room Prepare to administer CPR and treat for shock © 2011 McGraw-Hill Higher Education. All rights reserved.

Injuries and Conditions of the Abdomen

Kidney Contusion Etiology Result of an external force (force and angle dependent) Susceptible to injury due to normal distention of blood Signs and Symptoms May display signs of shock, nausea, vomiting, rigidity of back muscles and hematuria (blood in urine) Referred pain (costovertebral angle posteriorly radiating forward around the trunk) Management 24 hour observation and gradual increase of fluid intake Surgery required if hemorrhage fails to stop Bed rest and close observation after activity resumes © 2011 McGraw-Hill Higher Education. All rights reserved.

Management Monitor status of urine (hematuria) - refer if necessary 24 hour hospitalization and observation with a gradual increase in fluid intake Surgery may be required if hemorrhaging continues 2 weeks of rest and close surveillance following initial return to activity is necessary © 2011 McGraw-Hill Higher Education. All rights reserved.

Kidney Stones Etiology Unknown cause May be small (grain of sand), large (marble-size), smooth, or jagged May remain in kidney causing blockage and pressure in renal system If breaks free and travels through urinary tract it is very painful Signs and Symptoms Sudden painful, severe and sharp pain initially Referred pain in low back, flank, and groin Nausea and vomiting Cool, clammy, pale and sweaty skin Burning with frequent urination (possible blood in urine © 2011 McGraw-Hill Higher Education. All rights reserved.

Management Fluids – especially water OTC for pain In 80-85% of cases smaller stones move through ureter and drops into bladder, coming out in urine Larger stones may require procedure to break up or be surgically removed © 2011 McGraw-Hill Higher Education. All rights reserved.

Contusion of Ureters, Bladder and Urethra Etiology Blunt force to the lower abdomen may avulse ureter or contuse/rupture bladder Hematuria is often associated with contusion of bladder during running (runner’s bladder) Injury to the urethra (more common in males) may produce severe perineal pain and swelling Signs and Symptoms Pain, discomfort of lower abdominal region, abdominal rigidity, nausea, vomiting, shock, bleeding from the urethra, increased quantity of bloody urine, Inability to urinate will present in case of ruptured bladder © 2011 McGraw-Hill Higher Education. All rights reserved.

Contusion of Ureters, Bladder and Urethra Signs and Symptoms (continued) Referred pain to low back and trunk as well as upper thigh region anteriorly and suprapubically Prevention Check periodically for blood in urine Empty bladder prior to practice or competition Wear protective equipment © 2011 McGraw-Hill Higher Education. All rights reserved.

Cystitis and Urinary Tract Infections Etiology Inflammation of the bladder associated with a urinary tract infection (bacteria-related) Occurs due to incorrectly wiping following bowel movement, rough sexual intercourse or activities that push bacteria into bladder Occurs most often in sexually active females ages 20-50; rarely occurs in men with normal urinary tracts Signs & Symptoms Strong or persistent urge to urinate Burning sensation with urination; passing small amounts of urine, blood in urine, passing cloudy or strong smelling urine Pressure in lower abdomen or low grade fever © 2011 McGraw-Hill Higher Education. All rights reserved.

Management Oral antibiotics Symptoms usually subside within a few days Fluids are critical Water Cranberry juice due to potential infection fighting properties Practicing sanitary bowel and bladder habits Washing genitals before intercourse and emptying bladder after Immediately removing contraceptive diaphragms after intercourse © 2011 McGraw-Hill Higher Education. All rights reserved.

Urethritis Etiology Inflammation of the urethra caused by gonorrhea, chlamydia, herpes virus, or bacterial infection Chemical irritation due to soap, lotions, spermicides Signs & Symptoms Pain on urination, urethral discharge, urge to urinate more often Itching, tenderness or swelling in penis; pain with intercourse; ulcers on genitals; blood in urine or semen If it spreads to other organs there may be back or abdominal pain, fever, nausea or swollen joints Management Treated with antibiotic therapy; fluids, NSAID’s for pain © 2011 McGraw-Hill Higher Education. All rights reserved.

Conditions of the Digestive System

Gastrointestinal Bleeding Etiology Distance running, gastritis, iron-deficiency anemia, ingestion of aspirin or NSAID’s, stress, bowel irritation, colitis Signs and symptoms Blood in stool Abdominal pain, watery stool (w/pus) dehydration, intermittent fever (if colitis is involved) Management Refer to physician if bleeding is occurring © 2011 McGraw-Hill Higher Education. All rights reserved.

Liver Contusion Etiology Blunt trauma - right side of rib cage More susceptible if enlarged due to illness (hepatitis) Signs and Symptoms Hemorrhaging and shock may present May require immediate surgery Presents with referred pain in right scapula, shoulder and sub-sternal area and occasionally in left anterior side of chest Management Referral to a physician for diagnosis and treatment © 2011 McGraw-Hill Higher Education. All rights reserved.

Pancreatitis Etiology Inflammation of pancreas (acute or chronic) due to obstruction of pancreatic duct Acute conditions may lead to necrosis, suppuration, gangrene and hemorrhage Chronic cases may develop scar tissue, causing malfunction -- may develop due to chronic alcoholism Signs and Symptoms Acute epigastric pain causing vomiting, belching, constipation and potentially shock Tenderness and rigidity during palpation Chronic cases may result in jaundice, diarrhea and mild to moderate pain that radiates into the back © 2011 McGraw-Hill Higher Education. All rights reserved.

Pancreatitis (continued) Management In acute cases, re-hydration is necessary along with pain reduction, treatment of shock, reduction of pancreatic activity through medication Surgery if the duct is blocked Chronic cases require large doses of analgesics, pancreatic enzymes and modified diet © 2011 McGraw-Hill Higher Education. All rights reserved.

Indigestion (Dyspepsia) Etiology Some patients develop food idiosyncrasies which cause them distress after eating Reactions before competition Emotional stress, esophageal and stomach spasms, or inflammation of mucous linings in stomach and esophagus Signs and Symptoms Increased HCl secretion, nausea, and flatulence Management Elimination of irritating foods, development of regular eating habits, avoidance of anxieties that cause gastric distress If problems persist or athlete appears high strung and nervous -- follow-up with a physician is needed © 2011 McGraw-Hill Higher Education. All rights reserved.

Vomiting Etiology Result of some irritation, most often in the stomach Stimulates vomiting center of the brain, causing a series of forceful diaphragm and abdominal contractions to compress stomach Management Antinausea medications should be administered Fluids to prevent dehydration (by mouth or intravenously depending on the situation) © 2011 McGraw-Hill Higher Education. All rights reserved.

Food Poisoning (Gastroenteritis) Etiology Ranges from mild to severe Caused by infectious microorganisms that contaminate food particularly during warm weather and periods of improper refrigeration Signs and Symptoms Nausea, vomiting, cramps, diarrhea and anorexia Usually subsides within 3-6 hours (staph. infection) Salmonella infection may last hours or more © 2011 McGraw-Hill Higher Education. All rights reserved.

Food Poisoning (Gastroenteritis) Management Rapid replacement of fluids lost Bed rest in all but mild cases Nothing should be given by mouth if vomiting and nausea persist Re-introduce easy food first © 2011 McGraw-Hill Higher Education. All rights reserved.

Peptic Ulcer Etiology Acids destroy mucous lining of stomach or small intestine Occurs in individuals with long periods of severe anxiety Signs and Symptoms Gnawing pain, localized to gastric region Appears 1-3 hours following a meal Dyspepsia, heartburn, nausea, vomiting, w/ pain lasting minutes rather than hours Management Antacids if pain persists If hemorrhaging or perforation occurs, surgery may be required © 2011 McGraw-Hill Higher Education. All rights reserved.

Gastroesophageal Reflux Etiology Reflux or backward flow of the acidic gastric contents into the esophagus (malfunctioning esophageal sphincter) Result of a hiatal hernia w/ incidence increased with activity Repeated bouts can result in inflammation of lower esophagus (esophagitis) Signs and Symptoms Heartburn-like retrosternal pain - similar to angina pectoris sensation Burning feeling with sour liquid taste in throat Management Medication first, surgery if condition persists © 2011 McGraw-Hill Higher Education. All rights reserved.

Diarrhea Etiology Abnormal, loose stool or passage of fluid, unformed stool Acute or chronic Caused by a problem in diet, inflammation of the intestinal lining, GI infection, ingestion of certain drugs and psychogenic factors Signs and Symptoms Abdominal cramps, nausea, vomiting and frequent elimination of stools Loss of appetite, and a light brown or gray, foul-smelling stool Extreme weakness caused by dehydration © 2011 McGraw-Hill Higher Education. All rights reserved.

Diarrhea (continued) Management Determine cause (irritant, infection, or emotional upset) Athletic trainer can treat less severe cases by omitting certain foods from athlete’s diet Have patient consume bland food that does not irritate system Provide pectins 2-3 times daily to absorb excess fluid © 2011 McGraw-Hill Higher Education. All rights reserved.

Constipation Etiology Failure of the bowels to evacuate feces Causes include, lack of abdominal tone, insufficient moisture in the feces, lack of roughage and bulk in diet to stimulate peristalsis, poor bowel habits, nervousness, anxiety, and overuse of laxatives and enemas Signs and Symptoms Feeling of fullness, with occasional cramping and pain in lower abdomen If straining occurs during defecation, blood vessels may be ruptured Management Regulate eating patterns (cereal, fruits, vegetables) Deal with psychological aspects Avoid medications unless prescribed by a physician © 2011 McGraw-Hill Higher Education. All rights reserved.

Irritable Bowel Syndrome Etiology Group of gastrointestinal tract disorders Signs and Symptoms Abdominal pain that is relieved with defecation, irregular pattern of defecation (at least 25% of the time), alterations in stool frequency, form, and passage, abdominal bloating and distension Management Refer to physician for long-term management Diet modification and antidiarrheal medications may be helpful initially as well as psychological counseling Long term prognosis -- good © 2011 McGraw-Hill Higher Education. All rights reserved.

Appendicitis Etiology Inflammation of the vermiform appendix (chronic or acute) Result of blockage, lymph swelling, or carcinoid tumor Early stages it presents as a gastric complaint, that gradually develops from red swollen vessel to a gangrenous structure that can rupture into bowels causing peritonitis © 2011 McGraw-Hill Higher Education. All rights reserved.

Appendicitis Signs and Symptoms Mild to severe pain in lower abdomen, associated with nausea, vomiting and low grade fever Pain may localize in lower right abdomen (McBurney’s point) Management Surgical intervention is often necessary (particularly if it is resulting in an obstructed bowel = life threatening) © 2011 McGraw-Hill Higher Education. All rights reserved.

Hemorrhoids (Piles) Etiology Varicosities of the hemorrhoidal venous plexus of the anus Constant straining or constipation may result in stretching of anal vessels, protrusion and bleeding, or a thrombus forming in the external vessels Signs and Symptoms Painful nodular swellings near the anal sphincter May cause slight bleeding and itching © 2011 McGraw-Hill Higher Education. All rights reserved.

Hemorrhoids (Piles) Management Use of proper bowel habits, ingestion of mineral oil daily to assist in lubricating a dry stool, application of suppository and anesthetic (for pain and itching) Surgery may be required if these measures fail © 2011 McGraw-Hill Higher Education. All rights reserved.

Injuries and Conditions Related to Reproductive Organs

Scrotal Contusion Etiology Result of blunt trauma and contusion to the vulnerable and sensitive scrotum Signs and Symptoms Hemorrhaging, fluid effusion, muscle spasm, severe pain (disabling) Management Reduction of testicular spasm With patient seated , lift and drop patient a few inches Have patient bounce while in kneeling position Patient brings knees to chest and performs Valsalva maneuver Application of cold pack Unresolved pain after minutes requires referral to a physician © 2011 McGraw-Hill Higher Education. All rights reserved.

Spermatic Cord Torsion Etiology Result of testicle revolving in the scrotum following a direct blow or as the result of coughing or vomiting Signs and Symptoms Acute testicular pain, nausea, vomiting and inflammation in the area Management Immediate medical care is required to prevent irreparable complications Figure 27-23 © 2011 McGraw-Hill Higher Education. All rights reserved.

Traumatic Hydrocele of the Tunica Vaginalis Etiology Fluid accumulation caused by a severe blow to the testicular region (venous plexus on the posterior aspect of the testicle becomes engorged) Rupture of the plexus results in rapid accumulation of blood in the scrotum (hematocele) Signs and Symptoms Pain and significant swelling in the scrotum Management Cold pack application and referral to a physician Figure 27-24 © 2011 McGraw-Hill Higher Education. All rights reserved.

Vaginitis Etiology Inflammation of the vagina can be caused by a variety of microorganisms, bacterial infections, chemicals from douching, irritation from a tampon or poor hygiene habits Signs and Symptoms Purulent and bloody vaginal discharge; strong odor with vaginal itching Frequent and painful urination Vagina is red and painful to the touch Management Vaginitis caused by an STD will require appropriate antibiotic or antifungal medication Instruction on proper bladder and bowel hygiene as well as sexual behavior may also be necessary © 2011 McGraw-Hill Higher Education. All rights reserved.

Contusion of the Female Genitalia Etiology Low incidence of injury in sports Most common occurrence involve contusion of external genitalia (vulva - including the labia, clitoris and the vaginal vestibule) Signs and Symptoms Hematoma results from contusion - may also involve pubic symphysis resulting in osteitis pubis © 2011 McGraw-Hill Higher Education. All rights reserved.

Injury to Lymphatic Organs and Abdominal Wall

Injury of the Spleen Etiology Result of a direct blow or infectious mononucleosis (causing an enlarged spleen) Signs and Symptoms Indications of a ruptured spleen involve history of a direct blow, signs of shock, abdominal rigidity, nausea, vomiting Kehr’s sign Management Ability to splint self may produce delayed hemorrhaging - easily disrupted resulting in internal bleeding Conservative treatment involves 1 wk of hospitalization and a gradual return to activity Surgery will result in three months of recovery while removal of spleen will result in a 6 month removal from activity © 2011 McGraw-Hill Higher Education. All rights reserved.

Abdominal Muscle Strain Etiology Result of sudden twisting or reaching of trunk, tearing abdominal musculature Signs and Symptoms Severe pain and hematoma formation Generally involves rectus abdominis Management Ice and compression with conservative treatment Exercise within pain free limits © 2011 McGraw-Hill Higher Education. All rights reserved.

Contusions of Abdominal Wall Etiology Caused by a compressive force - generally occurring in collision sports Extent of injury depends on whether force is blunt or penetrating Signs and Symptoms May cause a hematoma to develop under fascia of surrounding muscle tissue Swelling may cause pain and tightness w/in the region Management Cold pack and compression Be sure to check for signs of internal injuries © 2011 McGraw-Hill Higher Education. All rights reserved.

Hernia Etiology Protrusion of abdominal viscera through portion of abdominal wall (congenital or acquired) Inguinal vs. femoral hernias Complications and strangulated hernias Signs and Symptoms Acquired hernia occur when natural weakness 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 groin area Management Surgery is preferred by most physicians Mechanical devices are not suitable for athletics due to friction and irritation they produce © 2011 McGraw-Hill Higher Education. All rights reserved.

Blow to Solar Plexus Etiology Transitory paralysis of the diaphragm due to direct blow to stomach Signs and Symptoms Stops respiration and leads to anoxia Generally transitory Management Must help athlete overcome apprehension Use short inspirations and long expirations Calm athlete, prevent hyperventilation Athletic trainer should question possibility of internal injury © 2011 McGraw-Hill Higher Education. All rights reserved.

Stitch in the Side Etiology Idiopathic condition with obscure cause and several hypotheses Potential causes include constipation, intestinal gas, overeating, diaphragmatic spasm, poor conditioning, lack of visceral support and weak abdominals, distended spleen, breathing techniques resulting in lack of oxygen, ischemia of diaphragm or intercostal muscles © 2011 McGraw-Hill Higher Education. All rights reserved.

Signs and Symptoms Cramp-like pain that develops on either the right or left costal angle during hard physical activity Management Relaxation of the spasm Stretch arm on affected side as high as possible Flex trunk forward on the thighs Additional problems may warrant further study © 2011 McGraw-Hill Higher Education. All rights reserved.

Chapter 27: The Thorax and Abdomen

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