Intro to Sports Medicine Chapter 17 Injuries to the Chest and Abdomen

Thorax- anterior view

Thorax- posterior view

Thorax Musculature

Thorax- Respiration

Thorax- Heart view

Cardiac Rhythms

Thorax- Acute Injuries  Muscle Strains  Costochondral Separation  Rib Contusions  Respiratory “Wind knocked out” Pneumothorax Asthma Rib Fractures

Thorax- Emergency Management  Muscular Strains Special testing of the suspected muscle Ice, heat, ROM exercises, rest, NSAIDS

Thorax-Emergency Mgmt  Costochondral Separation Direct blow, twisting, falling Similar to a rib fracture Pain is located along the attachment of the rib cartilage and the rib (sternum) Management and treatment:  Rest  Compression wrap/Rib brace

Thorax- Emergency Mgmt  Wind Knocked Out Spasm of the diaphragm Inability to inhale Have the athlete remain calm Loosen clothing “breathe together” Deep breaths as breathing returns Re-assurance

Thorax- Emergency Mgmt  Pneumothorax  Collapsed lung  Accumulation of air into the pleural cavity that disrupts the lungs ability to expand  Spontaneous-no trauma to thorax air fills pleural sac collapsing lung  Tension-air pressure causes the lung to collapse putting pressure on other lung  Hemothorax-blood fills pleural space

Respiratory symptoms  Difficulty breathing  Difficulty speaking  Do not remove any object impaled  Cover the wound with an occlusive dressing  Administer oxygen  Hospitalization

Rib Fractures Emergency Management  5 th through 9 th ribs most commonly fractured  Palpation along the ribs  Pain directly at the fracture site  Pain worsens with breathing  Flail chest- 4 or more ribs fractured causing segments to collapse instead of expanding with exhalation

Thorax  X-rays  Compression wrap with a 6” double length elastic wrap  Consider a swathe  Rest  CAUTION!!!!! Hypostatic pneumonia

Heart Injuries  Contusions-heart is compressed between the sternum and the spine  Blow from a missile (baseball, hockey puck, lacrosse, etc.)  Commotio Cordis-mechanical energy converts into electrical energy disrupting the normal cardiac cycle  Causes arrthymias

Abdomen

Abdomen – Four Quadrants

Referred Pain Patterns

Abdomen-Common Injuries  Kidneys:  Contusions  Kidney stones  UTI  Cystitis  Direct blow by external force  Shock  Hematuria (blood in the urine)  hospitalization

Liver common injuries  Second most commonly injured organ  Contusion  Laceration  Hospitalization

Abdomen  Indigestion-eliminate irritating foods, reduce stress, medications  Appendicitis- highest incidence males between 15 and 25 Tenderness at McBurney’s point Fever Abdominal rigidity General surgery is required

Abdomen-Reproductive  Scrotal contusion:  Loosen tight clothing  Place athlete in a sitting position  Lift armpits and drop  Ice

Abdomen- Spleen  Direct blow  “Kehr’s” Sign-Rupture-pain radiates to L shoulder and 1/3 rd of the way down the arm.  Immediate hospitalization  Rule Out Mononucleosis

The End