1 Injuries to the Thorax and Abdomen

2 Anatomy Thoracic cage Thoracic cage 12 pairs of ribs -- first 7 pair connect directly to sternum major joints include: sternoclavicular sternocostal costochondral intervertebral vertebral/rib

3Anatomy Muscles of the trunk (anterior group) Muscles of the trunk (anterior group) intercostals pectoralis major & minor rectus abdominis internal/external obliques serratus anterior

4Anatomy Muscles of the trunk (posterior view) Muscles of the trunk (posterior view) erector spinae trapezius rhomboids latissimus dorsi teres major semispinalis capitis semispinalis cervicis

5 Major structures Major structures heart & pericardium lungs & pleura thoracic aorta pulmonary artery & veins vena cava trachea & esophagus

6Anatomy Abdominal quadrants (major structures) Abdominal quadrants (major structures)

7 Common External Injuries Fractures - ribs, sternum or clavicle Fractures - ribs, sternum or clavicle typical mechanism involves direct blows to chest wall typical mechanism involves direct blows to chest wall Joint dislocations/subluxations Joint dislocations/subluxations similar mechanism as for fractures similar mechanism as for fractures external blow to chest wall external blow to chest wall intense contractions of large muscles such as those of the pectoral region intense contractions of large muscles such as those of the pectoral region

8 Common External Injuries Signs/symptoms: (fractures) Signs/symptoms: (fractures) extreme localized pain extreme localized pain mild swelling mild swelling breathing difficulties (possible pneumothorax) breathing difficulties (possible pneumothorax) holding the injured area holding the injured area

9 Signs/symptoms: (dislocations/Subluxations) localized pain localized pain mild swelling mild swelling breathing difficulties breathing difficulties holding injured area holding injured area First Aid: (for fractures & dislocations/subluxations) First Aid: (for fractures & dislocations/subluxations) monitor vital signs monitor vital signs treat for shock treat for shock apply ice apply ice transport to medical facility transport to medical facility

10 Severe Fracture Treated with Open Reduction and Internal Fixation Severe Clavicle Fracture X-ray immediately after fixation with a plate and screws X-ray 10 weeks after surgery (Notice new bone formation at arrow tips)

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12 Internal Injuries to the Thorax and Abdomen Heart and lung injuries Heart and lung 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. pulmonary contusions uncommon in sports pulmonary contusions uncommon in sports traumatic and/or spontaneous pneuomothorax traumatic and/or spontaneous pneuomothorax Both may be related to direct blows to the chest. Both may be related to direct blows to the chest.

13 Hemothorax Hemothorax occurs when lung tissue is punctured by rib fracture occurs when lung tissue is punctured by rib fracture Can be life threatening Can be life threatening Signs/symptoms: Signs/symptoms: severe pain in chest severe pain in chest breathing problems (dyspnea) breathing problems (dyspnea) blood in sputum (differentiate from wounds in mouth) blood in sputum (differentiate from wounds in mouth) may indicate bleeding within the chest cavity may indicate bleeding within the chest cavity First Aid: First Aid: treat for shock treat for shock monitor for vital signs monitor for vital signs transport to medical facility immediately transport to medical facility immediately

14 Internal Injuries to the Thorax and Abdomen Liver, kidneys, spleen and bladder Liver, kidneys, spleen and bladder Liver Liver susceptible to blunt trauma susceptible to blunt trauma Diseases such as hepatitis make liver more vulnerable. Diseases such as hepatitis make liver more vulnerable. Heavy consumption of alcohol and/or use of steroids enlarges the liver. Heavy consumption of alcohol and/or use of steroids enlarges the liver. kidneys kidneys susceptible to blunt trauma directed at the back of the torso (lumbar area) susceptible to blunt trauma directed at the back of the torso (lumbar area) may also be injured as a result of heat stroke may also be injured as a result of heat stroke Be alert for hematuria (educate the athlete). Be alert for hematuria (educate the athlete).

15 Internal Injuries to the Thorax and Abdomen spleen spleen susceptible to blows in the LUQ susceptible to blows in the LUQ serves as a reservoir for RBCs serves as a reservoir for RBCs has an ability to “splint” itself when lacerated has an ability to “splint” itself when lacerated be on the alert for a Kehr’s sign be on the alert for a Kehr’s sign mononucleosis -- MUST be cleared by a physician to return to participation mononucleosis -- MUST be cleared by a physician to return to participation bladder bladder not commonly injured in sports not commonly injured in sports encourage athletes to empty their bladder prior to participation encourage athletes to empty their bladder prior to participation