1. 1 Injuries to the Thorax and Abdomen PE 236 Amber Giacomazzi MS, ATC

2. 2 Anatomy Review Thoracic cage has 12 pairs of ribs. The first 7 pairs connect directly to sternum Pairs 8 through 10 connect via common costal cartilage Pairs 11 and 12 are “_________” Major thoracic joints include: ______________

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5. 5 Anatomy Review Muscles of the trunk (posterior view) Trapezius Rhomboids Latissimus dorsi and others

6. 6 Anatomy Review Internal thoracic organs and major blood vessels of the region are: Heart & pericardium Lungs & pleura Thoracic aorta Pulmonary artery & veins Vena cava Trachea & esophagus

7. 7 Anatomy Review Abdominal quadrants RUQ LUQ RLQ LLQ

8. 8 Anatomy Review Abdominal Organs and Structures RUQ contains: _______________________________ RLQ contains: _______________________________ LUQ contains: ________________________________ LLQ contains: ________________

9. 9 Common Thoracic Injuries Fractures can occur to ____, _________, _______, or ______ _________ Injuries must be treated immediately to avoid _____________ or ___________ Injuries must be treated immediately to avoid _____________ or ___________ Are not uncommon in sport Can be either direct or indirect trauma

10. 10 Common Thoracic Injuries Signs and symptoms of rib fractures include: Extreme ___________ that is aggravated by _______, _______, and _____________ Extreme ___________ that is aggravated by _______, _______, and _____________ Athlete _____________ at point of injury Athlete _____________ at point of injury Mild swelling at site; there may be ____________ Mild swelling at site; there may be ____________ Breathing difficulties; _________ _________________ Breathing difficulties; _________ _________________ First Aid Monitor vital signs and watch for respiratory distress Monitor vital signs and watch for respiratory distress Transport to medical facility Transport to medical facility

11. Joint _________ and ___________ of thoracic skeletal joints can occur ___________________ involve disunion of _______ and _____ Have a higher incidence than _________ _____________________ 11 Common Thoracic Injuries

12. 12 Common Thoracic Injuries Signs and symptoms of subluxations and dislocations include: History of _________________ sensations History of _________________ sensations Pain and tenderness over __________________ Pain and tenderness over __________________ _____________________, and swelling in the localized area _____________________, and swelling in the localized area Maximum or near-maximum ________ may be very difficult Maximum or near-maximum ________ may be very difficultTreatment Apply ice and light compression immediately Apply ice and light compression immediately Treat for shock and transport to medical facility Treat for shock and transport to medical facility

13. 13 Lung Injuries __________________ may occur as complication of a rib fracture, contusion, or other type of lung injury __________________ may occur as complication of a rib fracture, contusion, or other type of lung injury Fractured rib can _______________, causing ______________ Fractured rib can _______________, causing ______________ ___________________ can occur ___________ (reported in weight lifters and runners) ____________ occurs when _____________________ ____________ occurs when _____________________ This condition can be life threatening

14. 14 Lung Injuries Signs and symptoms include: Severe pain in chest, sometimes radiating to thoracic spine Severe pain in chest, sometimes radiating to thoracic spine Breathing problems (__________) Breathing problems (__________) May have _____________ and _____________ May have _____________ and _____________

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16. 16 Lung Injuries Treatment Treat for shock Treat for shock Monitor vital signs Monitor vital signs Transport to medical facility immediately Transport to medical facility immediately

17. 17 Heart Injuries Heart 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 _______________ can occur Use of ___________ is the most practical way to ____________ of people experiencing ________ _______ Use of ___________ is the most practical way to ____________ of people experiencing ________ _______

18. 18 Sudden Death Syndrome in Athletes Cause of Condition Cause of Condition ________________- thickening of cardiac muscle w/ no increase in chamber size ___________- abnormality in connective tissue results in __________________________ Series of additional cardiac causes Non-cardiac causes include drugs and alcohol, intracranial bleeding, obstructive respiratory disease Signs and Symptoms Signs and Symptoms Most _________________________________ May exhibit _________, ____________, _______, ________, ___________, _____________, _______ _____________ Heart Injuries Heart Injuries

19. 19 Care Care Immediate medical attention is necessary – ___ ____________________ Prevention Prevention _________________ are critical in ____ ____________ and ________ of sudden death Screening questions should address the following History of ____________ History of ____________ ____________________ ____________________ Periods of ________ during exercise Periods of ________ during exercise Family history Family history Thickening of heart or history of Marfan’s syndrome Thickening of heart or history of Marfan’s syndrome Cardiac screening - electrocardiograms and echocardiograms may be needed to determine existing pathology

20. Appendicitis The importance of _____________ could save the athletes life The importance of _____________ could save the athletes life Inflammation of the appendix can be chronic (clears itself) or acute Inflammation of the appendix can be chronic (clears itself) or acute Caused by _________________ from a variety of causes Caused by _________________ from a variety of causes Highest incidence is between _________ Highest incidence is between _________ 20 Internal Injuries to the Abdomen

21. Signs and Symptoms Mild to severe cramp in ___________ Mild to severe cramp in ___________ ____________________ ____________________ Low-grade fever Low-grade fever Pain in _______________ Pain in _______________ Positive ______________ Positive ______________ Elevated white blood cell count Elevated white blood cell countTreatment Refer to physician Refer to physician 21 Internal Injuries to the Abdomen

22. _____________________ Can lead to ____________ of the _________ and unconsciousness Can lead to ____________ of the _________ and unconsciousness “___________________________” “___________________________” Signs and Symptoms Signs and Symptoms Athlete is unable to inhale Treatment Treatment Loosed athletes belt and clothing around abdomen Tell athlete to _____________ 22 Internal Injuries to the Abdomen

23. 23 Hernia Cause of Injury Cause of Injury Protrusion of abdominal viscera through portion of ____________ (_________________) The danger of a hernia is the possibility that it may become ______________________ Inguinal vs. femoral hernias Inguinal– __________________ Inguinal– __________________ Femoral—__________________ Femoral—__________________ Complications __________________ Internal Injuries to the Abdomen

24. 24 Abdominal Hernia Protrusion of the _______________ through a portion of the abdominal wall Protrusion of the _______________ through a portion of the abdominal wall Inguinal Hernia Protrusion of the ____________ through the _____________ Protrusion of the ____________ through the _____________ Signs and Symptoms Previous history of a blow or strain to the groin/lower abdomen region that produces pain and prolonged discomfort Previous history of a blow or strain to the groin/lower abdomen region that produces pain and prolonged discomfort _________________________ _________________________ Reported feeling of ____________ and _____ ____________________________________ Reported feeling of ____________ and _____ ____________________________________ Internal Injuries to the Abdomen

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26. 26 Treatment Treatment Most physicians prefer athlete to __________ _______________________________ Mechanical devices are not suitable for athletics due to _______________ they produce While exercise is thought to be beneficial with regards to strengthening, that is not the case Internal Injuries to the Abdomen

27. 27 Internal Injuries to the Thorax and Abdomen Liver, Kidneys, Spleen and Bladder Injuries Although fairly safe, the liver is susceptible to ____________ Although fairly safe, the liver is susceptible to ____________ Diseases such as __________ make liver more vulnerable ___________________________ ___________________________

28. 28 Internal Injuries to the Abdomen Kidneys are susceptible to ________ directed at ____________ Kidneys are susceptible to ________ directed at ____________ Kidneys may also be injured as a result of ___________ Kidneys may also be injured as a result of ___________ Be alert for _________ Refer athlete to a physician Refer athlete to a physician

29. 29 Injury of the Spleen Cause of Injury Cause of Injury Result of a _____________ _________________ (causing an enlarged spleen) Signs and Symptoms Signs and Symptoms Indications of a ruptured spleen involve history of a ________, __________, ___________, ________, _________ Be alert for ____________ Be alert for ____________ Referred pain in ________________ ____________________________ Check nail beds and eyelids Check nail beds and eyelids ________________ may produce delayed hemorrhaging - easily disrupted resulting in internal bleeding Internal Injuries to the Abdomen

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31. 31 Treatment Treatment Conservative treatment involves 1 wk of hospitalization and a ____________________ Surgery will result in three months of recovery while removal of spleen will result in a 6 month removal from activity In cases of mononucleosis athlete may resume training in ___________ if spleen not _______ and if there ___________ Internal Injuries to the Abdomen

32. 32 Injuries to the Bladder Cause of Injury Cause of Injury Blunt force to the lower abdomen may cause injury to urinary bladder if distended with urine __________ is often associated with _________ of bladder during running (_________________) Signs and Symptoms Signs and Symptoms Pain, discomfort of lower abdominal region, _________ _____, nausea, ______, _____, ______________ _________, increased quantity of _____________ Athlete should be instructed to ____________ Inability to _____ will present in case of _____________ Internal Injuries to the Abdomen

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34. 34 _______________________ Cause of Injury Cause of Injury Result of blunt trauma and contusion to the vulnerable and sensitive scrotum Signs and Symptoms Signs and Symptoms ________________________________________ _________________ May cause nauseating, disabling and painful condition Treatment Treatment Place athlete _______________________ Apply cold pack as pain subsides If pain persist after ________________ will be necessary Internal Injuries to the Abdomen

35. 35 Internal Injuries Always rule out internal injuries whenever there is a blow to the ribs or abdomen Internal injuries “sneak up” due to no immediate warning signs Always ___________________ after injury ***____________________________