Basic Athletic Training Chapter 9 Thorax and Abdomen

Chapter Objectives Recognize the importance of performing the primary survey Identify the rehabilitation protocol for the thorax and abdomen Identify the preventative/supportive techniques and protective devices for the thorax and abdomen Discuss the special tests used to determine injury to the thorax or abdomen Recognize the importance of the secondary survey (history and physical examination) Identify the anatomical structures in the thorax and abdomen Identify musculoskeletal conditions/disorders for the thorax and abdomen

Evaluation of Thorax and Abdomen Injuries to the thorax and abdomen are less common than extremity injuries but more life threatening The evaluation of the thorax and abdomen must follow this precise assessment process: primary and secondary survey Primary Survey Survey scene for indications of injury and approach athlete calmly Be prepared to clear and maintain the airway free of obstructions Assist patient in finding the most comfortable position for breathing

Evaluation of Thorax and Abdomen Secondary Survey: consists of two elements History examination (questions athlete must answer in regard to injury) Physical examination (check for vital signs) Following vital signs, physical examination progresses to: Inspection Auscultation (listening for sounds) Percussion (tapping) Palpation and special tests

Thorax and Abdomen Anatomy Bones Muscles and their functions Anatomical planes Internal organs Right upper (superior) quadrant Left upper (superior) quadrant Right lower (inferior) quadrant Left lower (inferior) quadrant Hollow organs Solid organs Dermatomes Myotomes

Assessment Tests Tests for Bone Integrity Palpation, compression, and distraction (outward force applied to thorax and ribs through expiration) Compression Tests: Thorax/Ribs Anterior/posterior and lateral: compression force applied to thorax and ribs through manual pressure Compression Tests: Pelvis Anterior/posterior and medial/lateral: compression force applied to pelvis through manual pressure Breathing: Inspiration and expiration

Assessment Tests Range of Motion: Torso Signs of Acute Abdomen Flexion, extension, lateral flexion, and rotation Signs of Acute Abdomen Rebound tenderness, rigidity, and guarding Tests to Detect Possible Peritoneal Irritation Iliopsoas test Obturator test Heel pound test Valsalva maneuver

Immediate Referral is Necessary if the Following Signs and Symptoms are Present in a Thoracic and/or Abdominal Assessment Difficulty in breathing or shortness of breath Severe pain increasing in chest Vomiting or coughing up blood Diminished chest movement on the affected side Shifting or moving of trachea with each breath Suspected rib fracture or costochondral separation Signs of acute abdominal pain Rebound tenderness Rigidity Guarding

Immediate Referral is Necessary if the Following Signs and Symptoms are Present in a Thoracic and/or Abdominal Assessment Blood in the urine or stool Prolonged discomfort, sensation of weakness, or pulling in groin Superficial protrusion or palpable mass Circulation or neurological impairment Increasing nausea Vomiting Presence of fever Doubt regarding the nature and severity of the thorax or abdomen injury Presence of radiating or referred pain Signs of shock

Common Injuries and Problems: Thorax Signs and Symptoms of Myocardial Infarction Persistent chest pain or pressure unrelieved by rest, position changes, or medication Breathing difficulty: nosier, shorter, faster than normal Irregular pulse rate: faster or slower than normal Cyanosis Moist face or profuse sweating Radiation of pain to the left side (neck, shoulder, arm) Levine’s sign (clenched fist over chest) Hypotension or shock

Common Injuries and Problems: Thorax Signs and Symptoms of Rib Fractures Pain at fracture site aggravated by coughing, breathing, movement, and compression tests Dyspnea (shortness of breath) Localized tenderness Bony or air crepitation Contusion Ecchymosis (escaping of blood into tissue) Respiratory Conditions Asthma Bronchitis Hyperventilation Influenza Pleuritic chest wall pain Pneumonia

Common Injuries and Problems: Abdomen Signs and symptoms of spleen injury: Signs of acute abdominal pain Abdominal pain in left upper quadrant Pain radiating to the left shoulder and one third of the way down the arm or neck pain Shock Possible left, lower rib fracture Signs of symptoms of acute liver injury: Acute of gradual onset of abdominal pain, palpable tenderness, rebound tenderness, rigidity, guarding Abdominal pain in the right upper quadrant Right shoulder or neck pain Possible right, lower rib fracture

Musculoskeletal Conditions/ Disorders Thorax Arrhythmia Bradycardia Costochondral sprains/separations/contusi ons Flat chest Hemopneumothorax Hemothorax Muscular sprains Pulmonary contusion Rib contusions Abdomen Dysmenorrhea Ectopic pregnancy Gastroenteritis Hematomas Hernia Muscular strains

Rehabilitation ROM Exercises: Torso Flexion Extension Lateral flexion Rotation ROM Exercises: Anatomical Plane Movement Sagittal Frontal Transverse Thorax and Abdomen Exercises Abdominal crunches Abdominal lift Abdominal sit-up/curl-up Arm extension Arm flexion Bench press Incline press Pelvic tilts Prone extension Prone push-up

Preventive/Supportive Techniques Wrapping Techniques for Support Hip flexor Hip adductor Glenohumeral joint wrap Taping Techniques for the Hip Hip pointer Taping Techniques for the Thorax and Low Back Rib Low back Taping Techniques for the Shoulder Acromioclavicular joint Glenohumeral joint

Protective Devices Athletic supporter with cup Back brace Breast support bra Low back brace/support Rib protector Thigh sleeve Shoulder pads Sport-specific pads Sports compression girdle Sternum protector

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