11

Injuries to the Injuries to the Thorax and Thorax and AbdomenAbdomen

PE 236PE 236Juan Cuevas, ATCJuan Cuevas, ATC

22

Anatomy ReviewAnatomy Review

Thoracic cage has 12 pairs of ribs.Thoracic cage has 12 pairs of ribs.

The first ___ pairs connect directly to sternum. The first ___ pairs connect directly to sternum. Pairs 8 through 10 connect via common costal cartilage.Pairs 8 through 10 connect via common costal cartilage. Pairs 11 and 12 are “______________”Pairs 11 and 12 are “______________”

Major thoracic joints include:Major thoracic joints include:

Intervertebral.Intervertebral.________________________________________Sternocostal. Sternocostal. ________________________________________

33

44

55

Anatomy Review Anatomy Review (continued)(continued)

Muscles of the trunk Muscles of the trunk (posterior view)(posterior view) ______________.______________. Rhomboids.Rhomboids. Latissimus dorsi and Latissimus dorsi and

others.others.

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Anatomy Review Anatomy Review (continued)(continued)

Internal thoracic organs Internal thoracic organs and major blood vessels and major blood vessels of the region are:of the region are:

________ & pericardium.________ & pericardium. Lungs & ________.Lungs & ________.

Thoracic aorta.Thoracic aorta.Pulmonary artery & Pulmonary artery & veins.veins.___________.___________.

Trachea & esophagus.Trachea & esophagus.

77

Anatomy ReviewAnatomy Review

Abdominal Abdominal quadrantsquadrants ______________ ______________ RLQRLQ LLQLLQ

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Anatomy Review Anatomy Review (continued)(continued)

Abdominal Organs and StructuresAbdominal Organs and Structures

RUQ contains:RUQ contains:_______, gallbladder, and right kidney._______, gallbladder, and right kidney.

RLQ contains:RLQ contains:_____________ and ascending colon._____________ and ascending colon.

LUQ contains:LUQ contains:Stomach, __________, left kidney, and pancreas.Stomach, __________, left kidney, and pancreas.

LLQ contains: LLQ contains: Descending colon.Descending colon.

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Common Sports Common Sports InjuriesInjuries

Fractures can occur to ribs, Fractures can occur to ribs, sternum, clavicle, or thoracic sternum, clavicle, or thoracic vertebrae.vertebrae. Injuries must be treated immediately Injuries must be treated immediately

to avoid to avoid ____________________________ or or ____________________________________. .

Joint dislocations and Joint dislocations and subluxations of thoracic skeletal subluxations of thoracic skeletal joints can occur. joints can occur. _________________separations _________________separations involve disunion of sternum and involve disunion of sternum and ribs.ribs.

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Common Sports Common Sports Injuries (continued)Injuries (continued)Signs and symptoms of rib Signs and symptoms of rib

____________ include:____________ include: Extreme localized pain that is Extreme localized pain that is

aggravated by sneezing, ________, aggravated by sneezing, ________, and forced inhalation.and forced inhalation.

Athlete grasps chest wall at point of Athlete grasps chest wall at point of injury.injury.

Mild swelling at site; there may be Mild swelling at site; there may be bony __________.bony __________.

Breathing difficulties; rapid _______ Breathing difficulties; rapid _______ breathing.breathing.

First AidFirst Aid Monitor vital signs and watch for Monitor vital signs and watch for

respiratory distress.respiratory distress. Transport to medical facility.Transport to medical facility.

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Common Sports Common Sports Injuries (continued)Injuries (continued)

Signs and symptoms of subluxations and Signs and symptoms of subluxations and dislocations include:dislocations include:

History of snap or _________ sensations.History of snap or _________ sensations. Pain and tenderness over costochondral junction.Pain and tenderness over costochondral junction. Palpable ________ may be felt, and swelling in the Palpable ________ may be felt, and swelling in the

localized area.localized area. Maximum or near-maximum inhalation may be Maximum or near-maximum inhalation may be

very difficult.very difficult.

First AidFirst Aid Apply ice and light compression immediately.Apply ice and light compression immediately. Treat for ______ and transport to medical facility.Treat for ______ and transport to medical facility.

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Heart InjuriesHeart Injuries

While rare, contusions to the chest While rare, contusions to the chest wall can bruise the heart, resulting wall can bruise the heart, resulting in death.in death.

____________________________________ can occur. can occur.

Use of ______ device is the most Use of ______ device is the most practical way to save the lives of practical way to save the lives of people experiencing commotio people experiencing commotio cordis. cordis.

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Sudden ________ Syndrome in AthletesSudden ________ Syndrome in Athletes Cause of ConditionCause of Condition

_____________ cardiomyopathy- thickening of cardiac _____________ cardiomyopathy- thickening of cardiac muscle w/ no increase in chamber _______muscle w/ no increase in chamber _______

___________ syndrome- abnormality in connective ___________ syndrome- abnormality in connective tissue results in weakening of _______ and cardiac tissue results in weakening of _______ and cardiac vesselsvessels

Series of additional cardiac causesSeries of additional cardiac causes

Non-cardiac causes include drugs and alcohol, Non-cardiac causes include drugs and alcohol, intracranial _________, obstructive respiratory diseaseintracranial _________, obstructive respiratory disease

Signs of ConditionSigns of ConditionMost _______ exhibit any signs prior to deathMost _______ exhibit any signs prior to death

May exhibit chest pain, heart palpitations, __________, May exhibit chest pain, heart palpitations, __________, nausea, profuse sweating, shortness of breath, malaise nausea, profuse sweating, shortness of breath, malaise and/or feverand/or fever

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CareCare___________ medical attention is necessary – life ___________ medical attention is necessary – life threatening conditionthreatening condition

______________ ______________ Counseling and screening are critical in early Counseling and screening are critical in early identification and prevention of sudden deathidentification and prevention of sudden death

Screening questions should address the followingScreening questions should address the following History of ______________History of ______________ Chest pain during _______________Chest pain during _______________ Periods of _____________ during exercisePeriods of _____________ during exercise Family historyFamily history Thickening of _________-or history of Marfan’s syndromeThickening of _________-or history of Marfan’s syndrome

Cardiac screening - electrocardiograms and Cardiac screening - electrocardiograms and echocardiograms may be needed to determine existing echocardiograms may be needed to determine existing pathologypathology

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Lung InjuriesLung Injuries

Pulmonary contusions may occur as Pulmonary contusions may occur as complication of _____ fracture, complication of _____ fracture, contusion, or other type of lung injury.contusion, or other type of lung injury.

Fractured rib can puncture pleural Fractured rib can puncture pleural sac, causing _____________. sac, causing _____________.

Spontaneous pneumothorax can occur Spontaneous pneumothorax can occur _________ trauma (reported in weight _________ trauma (reported in weight lifters and runners). lifters and runners).

_____________ occurs when _____________ occurs when fractured rib punctures lung.fractured rib punctures lung.

This condition can be ______________.This condition can be ______________.

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Lung Injuries Lung Injuries (continued)(continued)

Signs and symptoms include:Signs and symptoms include:

Severe _______ in chest, sometimes Severe _______ in chest, sometimes radiating to thoracic spine.radiating to thoracic spine.

Breathing problems (___________).Breathing problems (___________). May have nonproductive _______ and May have nonproductive _______ and

tachycardia.tachycardia.

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Lung Injuries Lung Injuries (continued)(continued)

First AidFirst Aid

Treat for ________.Treat for ________. Monitor ____________.Monitor ____________. Transport to medical facility immediately.Transport to medical facility immediately.

1919

Internal Injuries to the Internal Injuries to the Thorax and AbdomenThorax and Abdomen

Liver, Kidneys, Spleen and Bladder Liver, Kidneys, Spleen and Bladder InjuriesInjuries

Although fairly safe, the liver is Although fairly safe, the liver is susceptible to ________________.susceptible to ________________.

Diseases such as ____________ make Diseases such as ____________ make liver more vulnerable.liver more vulnerable.

Heavy consumption of ________ Heavy consumption of ________ and/or use of steroids damages the and/or use of steroids damages the liver.liver.

2020

Internal Injuries to the Internal Injuries to the Thorax and Abdomen Thorax and Abdomen

(continued)(continued)

Kidneys are susceptible to blunt trauma Kidneys are susceptible to blunt trauma directed at the ______________.directed at the ______________.

Kidneys may also be injured as a result of Kidneys may also be injured as a result of heat strokeheat stroke

Be alert for ________________.Be alert for ________________.

Refer athlete to a physician.Refer athlete to a physician.

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Injury of the ___________Injury of the ___________ Cause of Injury Cause of Injury

Result of a direct blow to _________Result of a direct blow to _________Infectious mononucleosis (causing an enlarged Infectious mononucleosis (causing an enlarged spleen)spleen)

Signs of InjurySigns of InjuryIndications of a ruptured spleen involve history of Indications of a ruptured spleen involve history of a direct blow, signs of _______, abdominal a direct blow, signs of _______, abdominal rigidity, nausea, vomitingrigidity, nausea, vomiting

Be alert for _____________ sign.Be alert for _____________ sign.Referred pain in upper left shoulder Referred pain in upper left shoulder

Decreased peripheral circulation.Decreased peripheral circulation. Check nail beds and ________Check nail beds and ________

Ability to splint self may produce delayed Ability to splint self may produce delayed hemorrhaging - easily disrupted resulting in hemorrhaging - easily disrupted resulting in internal bleedinginternal bleeding

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CareCareConservative treatment involves 1 wk of Conservative treatment involves 1 wk of hospitalization and a gradual return to _______hospitalization and a gradual return to _______Surgery will result in three months of recovery Surgery will result in three months of recovery while removal of spleen will result in a ___ while removal of spleen will result in a ___ month removal from activitymonth removal from activityIn cases of mononucleosis athlete may resume In cases of mononucleosis athlete may resume training in ________ if spleen not enlarged and training in ________ if spleen not enlarged and if there is no feverif there is no fever

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Injuries to the BladderInjuries to the Bladder Cause of InjuryCause of Injury

Blunt force to the ____________ may cause injury to urinary Blunt force to the ____________ may cause injury to urinary bladder if distended with urinebladder if distended with urine

_________ is often associated with contusion of bladder _________ is often associated with contusion of bladder during running (runner’s bladder)during running (runner’s bladder)

Signs of InjurySigns of InjuryPain, discomfort of lower abdominal region, abdominal Pain, discomfort of lower abdominal region, abdominal rigidity, nausea, vomiting, shock, bleeding from the _______, rigidity, nausea, vomiting, shock, bleeding from the _______, increased quantity of bloody urineincreased quantity of bloody urine

Athlete should be instructed to monitor ______ Athlete should be instructed to monitor ______

Inability to urinate will present in case of ruptured bladderInability to urinate will present in case of ruptured bladder

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Scrotal/Testicular ContusionScrotal/Testicular Contusion Cause of InjuryCause of Injury

Result of blunt trauma and______ to the Result of blunt trauma and______ to the vulnerable and sensitive scrotumvulnerable and sensitive scrotum

Signs and SymptomsSigns and SymptomsHemorrhaging, fluid effusion, _____________, Hemorrhaging, fluid effusion, _____________, severe pain (disabling)severe pain (disabling)

May cause nauseating, disabling and painful May cause nauseating, disabling and painful conditioncondition

CareCarePlace athlete on side with knees to chestPlace athlete on side with knees to chest

Apply ________ as pain subsidesApply ________ as pain subsides

If pain persist after 15-20 minutes referral will be If pain persist after 15-20 minutes referral will be necessarynecessary

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____________________ Cause of InjuryCause of Injury

Protrusion of abdominal viscera through portion of Protrusion of abdominal viscera through portion of abdominal ______ (congenital or acquired)abdominal ______ (congenital or acquired)

Inguinal vs. ____________ hernias Inguinal vs. ____________ hernias

Complications and strangulated herniasComplications and strangulated hernias Signs of InjurySigns of Injury

Acquired hernia occur when ______________ is further Acquired hernia occur when ______________ is further aggravated by a direct blow or strainaggravated by a direct blow or strain

History of direct blow to groin area, pain and prolonged History of direct blow to groin area, pain and prolonged discomfort, superficial protrusion with pain increasing with discomfort, superficial protrusion with pain increasing with coughing & reported pulling sensation in ________ areacoughing & reported pulling sensation in ________ area

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Abdominal HerniaAbdominal Hernia __________ of the abdominal viscera through a __________ of the abdominal viscera through a

portion of the abdominal ________portion of the abdominal ________

_____________ Hernia_____________ Hernia Protrusion of the spermatic cord through the Protrusion of the spermatic cord through the

inguinal ________-inguinal ________-

Signs and SymptomsSigns and Symptoms Previous history of a blow or strain to the groin/lower Previous history of a blow or strain to the groin/lower

abdomen region that produces pain and prolonged abdomen region that produces pain and prolonged __________________________

Protrusion is increased by ___________Protrusion is increased by ___________ Reported feeling of weakness and pulling sensation Reported feeling of weakness and pulling sensation

in the groin/lower abdomen region.in the groin/lower abdomen region.

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CareCareMost physicians prefer athlete to refrain from Most physicians prefer athlete to refrain from hard physical activity until ___________ hard physical activity until ___________ repairedrepaired

Mechanical devices are not suitable for Mechanical devices are not suitable for athletics due to friction and irritation they athletics due to friction and irritation they produceproduce

While exercise is thought to be beneficial with While exercise is thought to be beneficial with regards to strengthening, that is not the caseregards to strengthening, that is not the case

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Hernias (cont’)Hernias (cont’)

First Aid/ TreatmentFirst Aid/ Treatment Refer to MDRefer to MD Surgery!!!Surgery!!!

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Internal InjuriesInternal Injuries

Always rule out internal injuries whenever there Always rule out internal injuries whenever there is a blow to the ribs or abdomen.is a blow to the ribs or abdomen.

Internal injuries “sneak up” due to no immediate Internal injuries “sneak up” due to no immediate warning signs.warning signs.

Always re-evaluate 20-30 minutes after injury.Always re-evaluate 20-30 minutes after injury.

***When in doubt…REFER!!!***When in doubt…REFER!!!