1. The Thorax and Abdomen Chapter 21 Pages 516-535

2. Anatomy of the Thorax Anatomy of the Thorax: The thorax is known as the chest, which lies between the base of the neck and the diaphragm Main function is to protect the heart and lungs True ribs (1-7) attach to the sternum by costal cartilage False ribs (8-10) have cartilage that join 7-10 to the sternum Floating ribs (11&12) do not attach to the sternum Muscles: intercostal muscles and the diaphragm muscle function in inspiration and expiration.

3. Anatomy of the Abdomen Anatomy of the Abdomen: Abdominal muscles produce trunk flexion and rotation Protect underlying abdominal viscera Composed of solid organs: kidneys, spleen, liver, pancreas, and adrenal glands Composed of hollow organs: stomach, intestines, gallbladder, and urinary bladder

4. Abdominal Quadrants & Organs

5. Prevention of Injuries to the Thorax and Abdomen Wear appropriate protective equipment, especially with collision sports. Strengthen the muscles of the abdomen. Empty the stomach and bladder prior to competition.

6. H Injury Assessment: History What happened to cause this injury? Was there direct contact? What position were you in? Describe the type of pain? Was the pain immediate or gradual? Do you feel pain anywhere else? Have you had any difficulty breathing? Are certain positions more comfortable than others? Do you feel faint/lightheaded/nauseous? Do you feel any pain in your chest? Did you hear or feel a pop or crack in your chest? Have you had any muscle spasms? Have you noticed any blood in your urine? Is there any difficulty or pain with urination? Was the bladder full or empty? How long has it been since you’ve eaten?

7. O Injury Assessment: Observation Is the athlete breathing? Is the athlete having difficulty breathing deeply or struggling to catch their breath? Does breathing cause pain? Is the athlete holding the chest wall? Is there symmetry in movement of the chest during breathing? If the wind was knocked out, did normal breathing return rapidly or was there prolonged difficulty? What is the body position of the athlete? Is there protrusion of the abdomen? Does the thorax appear to be symmetrical? Are the abdominal muscles tight and guarding? Is the athlete holding/splinting part of the abdomen?

8. P Injury Assessment: Palpation Thorax The hands should be placed on either side of the chest wall to check for symmetry during inspiration/expiration. This also helps to locate areas that are point tender. Abdomen Athlete should be laying on their back with arms at the side and abdominal muscles relaxed. Looking for muscle guarding, rigidity, referred pain. McBurney’s Point

9. Recognition and Management of Thoracic Injuries Rib contusions Rib fractures Costal cartilage injury Intercostal muscle strain Injuries to the lungs Pneumothorax Tension pneumothorax Hemothorax Traumatic asphyxia Sudden Death Syndrome in Athletes Congenital cardiovascular abnormality Breast problems

10. Rib Contusions & Fractures Rib Contusion MOI: Blow to ribcage. S&S: Pain is sharp when breathing, point tenderness, and pain when the ribcage is compressed. Treatment: X-ray, RICE, NSAIDS, and rest. Rib Fracture S&S: Severe pain with inspiration and sharp pain with palpation. Treatment: Similar to contusion. Simple fractures heal within 3-4 weeks.

11. Costal Cartilage Injury & Intercostal Muscle Injury Costal Cartilage Injury MOI: Direct or indirect trauma. S&S: Similar to rib contusion and fracture. Deformity and crepitus may be present. Treatment: Similar to rib fracture. Healing 1-2 months. Intercostal Muscle Injury MOI: Direct trauma or sudden torsion of the trunk. S&S: Pain with active motion, and pain with inspiration/expiration, laughing, coughing, or sneezing. Treatment: Ice and compression, immobilization for comfort

12. Injuries to the Lungs MOI: Pneumothorax is a condition where the pleural cavity surrounding the lung becomes filled with air that has entered through an opening in the chest. The lung on the other side collapses. Tension Pneumothorax occurs when the pleural cavity on one side fills with air and displaces the lung and heart toward the opposite side. Hemothorax is the presence of blood within the pleural cavity. Traumatic Asphyxia occurs as the result of a violent blow/compression of the ribcage, causing a cessation of breathing. S&S: SOB, chest pain on side of injury, coughing up blood, cyanosis, and/or shock. Treatment: Medical emergency treatment ASAP!

13. Pictures of Lung Injuries

14. Sudden Death Syndrome The most common cause of exercise-induced sudden death is due to a congenital cardiovascular abnormality. The 3 most common causes: Hypertrophic cardiomyopathy Anomalous origin of the coronary artery Marfan’s Syndrome Noncardiac causes: Alcohol, cocaine, amphetamines, erythropoietin Cerebral aneurysm or head trauma Obstructive respiratory diseases S&S: Chest pain, heart palpitations, syncope, nausea, profuse sweating, heart murmurs, SOB, malaise, and fever. Treatment: Medical emergency treatment ASAP! Prevention: PPE

15. Recognition and Management of Abdominal Injuries Injuries to abdominal wall Hernia Inguinal hernia in males Femoral hernia in females Blow to the Solar Plexus Stitch in the side Injury to the spleen Mono Kidney contusion Liver contusion Appendicitis Injuries to the bladder Scrotal/testicular contusion Gynecological injuries

16. Hernia MOI: A hernia is a protrusion of abdominal viscera through a portion of the abdominal wall. Types: Inguinal Femoral S&S: A history of a blow or strain to the groin area that produced pain and prolonged discomfort, superficial protrusion in the groin area that is increased by coughing, or weakness/pulling sensation in the groin area. Treatment: Remove from activity until repair is made.

17. Blow to the Solar Plexus MOI: Blow to the middle portion of the abdomen, which produces a transitory paralysis of the diaphragm. S&S: Paralysis stops respiration, the athlete is unable to inhale, and may panic. Treatment: Calm the athlete, and monitor hyperventilation.

18. Injury to the Spleen MOI: Fall/direct blow to the left upper quadrant of the abdomen. Infectious mononucleosis. S&S: History of a severe blow to the abdomen, signs of shock, abdominal rigidity, nausea, vomiting, and/or Kehr’s Sign. Treatment: Hospitalization, return to participation in 3-4 weeks, surgery will require a longer resting period.

19. Kidney Contusion MOI: Direct trauma. S&S: Signs of shock, nausea, vomiting, rigidity of back muscles, hematuria, and/or referred low back pain. Treatment: Check urine for the presence of blood, referral to physician, surgery, and 2 weeks of bedrest. Liver Contusion

20. Appendicitis MOI: Acute or chronic onset, inflammation of the appendix, bacterial infection a major concern. S&S: Mild-to-severe pain in the right lower abdomen, nausea, vomiting, fever, cramps, abdominal rigidity, and point tenderness at McBurney’s Point. Treatment: Medical emergency treatment ASAP!

21. Scrotal/Testicular Contusion MOI: Direct trauma. S&S: Hemorrhage, fluid effusion, and muscle spasm. Treatment: Place the athlete on his side and instruct him to flex thighs to chest, apply an ice bag after pain decreases. If pain does not resolve within 15-20 minutes, refer to a physician.

22. Visual Aids Courtesy of the Following Websites: http://www.highlands.edu/subwebs/shender son/API/lab_manual/body_quads.jpg http://www.highlands.edu/subwebs/shender son/API/lab_manual/body_quads.jpg http://www.nlm.nih.gov/medlineplus/ency/i mages/ency/fullsize/19589.jpg http://www.nlm.nih.gov/medlineplus/ency/i mages/ency/fullsize/19589.jpg http://connection.lww.com/products/smeltze r9e/images/figurelarge21-12b.gif http://connection.lww.com/products/smeltze r9e/images/figurelarge21-12b.gif http://www.laparoscopic- surgeon.co.uk/images/typesofhernia.jpg http://www.laparoscopic- surgeon.co.uk/images/typesofhernia.jpg