1. Basic Athletic Training Chapter 9 Thorax and Abdomen

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. Questions ?