KIN 191B – Advanced Assessment of Upper

Extremity Injuries

Abdomen and Thorax Injuries

Pathologies Thoracic Injuries

Review bony injuries Pneumothorax Hemothorax Solar plexus contusions Heart contusion

Abdominal Injuries Liver Injury Splenic injury Kidney/urinary pathologies Appendix pathologies Hollow organ injury General medical issues Male/female reproductive system pathologies

Thoracic Injuries

Review Bony Injuries Rib fractures

Common fracture sites Why?

Flail chest Definition Classic presentation

Costochondral/chondrosternal injuries Types of injury Nature of articulation

Flail Chest

Pneumothorax Accumulation of air in pleural cavity that affects ability of lung to

expand Decreased oxygen, hypoxia, respiratory distress

Open vs. closed presentation Closed = spontaneous pneumothorax

Air leaks into cavity With/without trauma, post-op, poor breathing during strenuous exercise

Open pneumothorax Penetrating wound from rib fracture and/or foreign object “Sucking chest wound” – cover with nonporous material to prevent passage of

air

Pneumothorax

Pneumothorax

Tension pneumothorax If left untreated, spontaneous pneumo may

progress to tension pneumo = “collapsed lung” If tension pneumo untreated, pressure continues

to build ultimately affecting other lung, heart and great vessels

Tracheal shift and JVD

Tension Pneumothorax

Pneumothorax

Signs and symptoms Dyspnea, pain with respirations, guarding or

splinting of affected area, possible cyanosis If associated with trauma, pain at site of impact,

rib fracture or foreign object Decreased or absent breath sounds on

auscultation of affected lung Vitals – signs of shock

Heart rate, respirations Blood pressure

Hemothorax

Accumulation of blood in the pleural cavity Bleeding from lacerated lung and/or rupture of blood vessel

within thoracic cavity May be from penetrating injury

Often occurs simultaneously with pneumothorax

Essential signs and symptoms identical Also may present with coughing up of bloody sputum

Hemothorax

Solar Plexus Contusion Solar (celiac) plexus is large network of nerves associated with

abdomen/thorax

Blunt force trauma can cause contusion which causes transient paralysis of diaphragm leading to breathing difficulties

Condition is self-limiting and breathing will return – must minimize panic

Deep breaths, pant, loosen clothing

Must rule out other abdominal injury

Heart Contusion Uncommon due to anatomical location and bony protection

May be affected by forceful trauma to anterior chest/sternal region

Signs and symptoms Chest pain JVD Dyspnea Vitals – signs of shock

Can cause immediate death due to interruption of normal cardiac rhythm

Abdominal Injuries

Liver Injury

Typically associated with blunt force trauma to upper right quadrant – contusion vs. laceration

Risk is higher if liver is enlarged (hepatitis) from viral infection or alcohol consumption

Generally have acute onset of symptoms, but may have delayed onset depending on severity of injury

Liver Injury

Signs and symptoms Pain at site of injury (upper right quadrant) Referred pain to right shoulder/scapula Nausea and/or vomiting (appearance) Significant bleeding may present with abdominal

rigidity and/or rebound tenderness Vitals – signs of shock

Heart rate/respirations Blood pressure Due to internal bleeding (hypovolemic)

Liver Laceration

Splenic Injury

Typically associated with blunt force trauma to upper left quadrant – may be atraumatic

Risk is higher if spleen enlarged due to systemic condition (mono, pneumonia, etc.)

Generally have acute onset of symptoms, but may have delayed onset depending on severity of injury

Splenic Injury

Signs and symptoms Pain at site of injury (upper left quadrant) Referred pain to left shoulder (Kehr’s sign) Nausea and/or vomiting (appearance) Significant bleeding may present with abdominal

rigidity and/or rebound tenderness Vitals – signs of shock

Heart rate/respirations Blood pressure Due to internal bleeding (hypovolemic)

Splenic Injury

Kidney Contusion/Laceration

Well protected anatomically by rib cage, vertebrae and spinal musculature

Typically associated with blunt force trauma to “flank” region

Contusion generally isolated injury while laceration generally associated with rib fracture displacement

Kidney Contusion/Laceration

Signs and symptoms Pain to “flank” region at site of trauma Referred pain around thoracoabdominal region Associated symptoms of rib fracture Significant bleeding may present with abdominal

rigidity and/or rebound tenderness Hematuria

If significant - easily seen, but if minor – requires further analysis to rule out or verify

Vitals – signs of shock

Kidney Laceration

Kidney Stones

Result from collection of incomplete kidney filtration

Family history, stress, hypertension, high salt intake increase risk

Other foods may decrease risk Apple/grapefruit juice Coffee/tea/beer/wine Potassium rich foods (bananas, tomatoes)

Kidney Stones

Signs and symptoms Pain in affected side Pain on urination May feel larger stones move through ureter and

ultimately urethra (most pain) If on right side, must differentiate from appendix

pathology

Kidney Stones

Urinary Tract Infections (UTI)

Caused by bacterial infections of the bladder and/or urethra – may spread to ureter/kidney If urethritis, must consider STDs

Must differentiate from kidney stones

Signs and symptoms Dysuria – frequent need to urinate Abnormal appearance/odor of urine Other systemic symptoms (fever, etc.)

Appendix Pathologies

Appendicitis Initial general systemic symptoms Initial tenderness in lower right quadrant (McBurney’s

point) – rebound tenderness May have referred pain to right chest, upper trap

and/or umbilicus

Appendix rupture May be more risk with blunt force trauma to lower right

quadrant if appendix is inflamed

Appendicitis

Hollow Organ Rupture

Uncommon due to ability to deform when impacted and absorb forces

Signs and symptoms Abdominal pain at site of injury (trauma) Nausea/vomiting Abdominal rigidity and/or rebound tenderness Absence of bowel sounds on auscultation Blood in stool Vitals –signs of shock

Stomach Rupture

General Medical Conditions Gastritis

Inflammation of lining of stomach NSAIDs, alcohol, bile

Heartburn/indigestion

Ulcer Irritation of duodenum (proximal small intestine) Most are bacterial but may be due to long term use of some meds

Gastroenteritis Inflammation of the small intestine Nausea/vomiting/diarrhea Often attributable to “food poisoning”

Peptic Ulcer

General Medical Conditions Colitis

Inflammation of the large intestine Frequent diarrhea, blood if ulcerative colitis

Regional enteritis (Crohn’s disease) Primarily affects ileum Cramping, incontinence, constipation Requires diet modification

Irritable bowel syndrome (IBS) Altered motility of large intestine Diarrhea/constipation, gas, nausea/vomiting, abdominal pain Requires stress reduction and diet modification

Colitis

Male Reproductive System Pathologies

More common than in women due to external location of male genitalia

Pathologies Testicular contusion Testicular torsion Testicular dysfunction Testicular cancer

Testicular Contusion

Etiology is direct trauma

Calm injured person

Signs and symptoms Localized pain, often severe Nausea/vomiting

Must inspect for abnormalities (self-exam unless unable) once symptoms minimize Swelling, abnormal tissue density

Testicular Torsion

Twisting of spermatic cord within scrotum

Higher risk if undescended testicle and lower risk if athletic supporter worn

Signs and symptoms Intense pain Nausea/vomiting Swelling and/or mass in scrotum from occlusion of vascular

structures

Testicular Torsion

Testicular Dysfunction Hydrocele

Fluid filled “sac” into testicle

Multiple causes – often associated with inguinal hernia

Varicocele Varicose veins within scrotum – alters blood flow “Bag of worms” on palpation

Epididymitis Typically associated with UTIs/STDs Inflammation of epididymis Pain with urination/ejaculation/bowel movements

Varicocele and Hydrocele

Testicular Cancer

If detected early by self-exam, often respond well to treatment

Definitive diagnosis via advanced studies and/or biopsy

Hardening and/or enlarging of affected testicle is most common symptom

May present with referred pain to low back or inguinal area in addition to localized pain

Female Reproductive System Pathologies

Less common due to protection afforded by abdomen/anatomical location

Pathologies Amenorrhea Dysmenorrhea Female athlete triad Vaginitis Pelvic inflammatory disease

Amenorrhea Primary vs. secondary

Primary – absence of onset of menstruation by age 16 Secondary – cessation of menstruation for 6+ months

Contributing factors Exercise, weight loss, stress, anxiety Body image, societal pressures

Contributing component of female athlete triad

Dysmenorrhea

Pain and/or cramping in lower abdomen and pelvis prior to menstruation

Signs and symptoms Nausea/vomiting Diarrhea or constipation Bloating

May be related to other conditions (PID, endometriosis, etc.)

Female Athlete Triad

Comprised of three elements Amenorrhea, disordered eating, osteoporosis

Presence of one component requires screening for the others In combination, can be life threatening

Best treatment is prevention (screening) and education Team approach to clinical treatment – physiological and

psychological

Vaginitis Bacterial vaginosis

Bacterial imbalance in vagina

Trichomoniasis Most commonly affects vagina but also may involve urethra

Vulvovaginal candidiasis (“yeast infection”) Overgrowth of normally present yeast cells

Signs and symptoms Abnormal odor and/or discharge Pain with urination and/or intercourse

Pelvic Inflammatory Disease (PID)

Inflammation or infection of the uterus, ovaries or fallopian tubes

Often related to STDs

Signs and symptoms Vaginal discharge Menstrual irregularities Low back/abdominal pain Dysuria/frequent urination Fever

Pelvic Inflammatory Disease