SPORTS MEDICINE SPAIN PARK HIGH SCHOOL Anatomy & Injuries to the Abdomen & Thorax

AnatomyAbdominal cavityBordersDiaphragm superiorlyPelvis inferiorlySpine posteriorlyAbdominal wall anteriorly

Anatomy Divided into 4 quadrantsLine runs through navel at midline of bodyULURLLLR

Anatomy--QuadrantsULStomachPart of liver & PancreasLeft kidneySpleenParts of large & small intestine

Anatomy--QuadrantsURLiverPart of pancreasRight kidneyGall bladderParts of large & small intestine

Anatomy--QuadrantsLLParts of Lg & Sm intestinesPart of bladderUterus-femalesLeft ovary-femalesProstate- malesUreter-male

Anatomy--QuadrantsLRParts of Lg & Sm intestinesAppendixPart of bladderUterus-femaleRight ovary-femaleProstate-maleUreter-male

AnatomyOrgans are part of:Urinary systemKidneys, bladderDigestive systemStomach, liver, pancreas, gall bladder, large & small intestine, spleenReproductive systemUterus, ovaries, prostate, seminal vesicles

AnatomySolid organsMore often & easily injuredCan cause rapid death due to large blood supplyinternal bleedingSpleen, liver, kidney, pancreasHollow organsInjuries are rare because tubes are hollowassist in transporting substances from one organ to another

Digestive organsDigestion begins in mouthStomachSecretes gastric juices that assist in breaking down food before entering small intestineLiverDetoxifies chemicals that the body perceives as poisonous, stores vitamins, produces bile, assists with food metabolismGall bladderStorage tank for bile, which passes into sm intestine where it assists in metabolism of fat

Digestive OrgansPancreasProduces insulin and enzymes for digestionSmall intestineCompletes digestion, absorbed the products into circulatory system. Peristalsis (sequential contraction/relaxation of intestinal muscle) pushes the food through the intestines to the large intestine. At this point all material that has not been absorbed is considered waste.Large intestineAll materials not absorbed into the system in sm intestine is passed into large intestine as waste. Water is absorbed leaving solid waste for excretion

Digestive organsAppendixPart of large intestineNo known functionSpleenProduces & destroys red blood cellsStorage site for bloodAids in destruction of harmful microorganisms

Urinary systemKidneysResponsible for maintaining acid-base in body, which if changed causes body system to shut down eventually resulting in deathFilter blood and remove waste products of metabolism to maintain stable acid-base relationshipIf blood supply is inadequate, can cause hypertension from chemical constriction of bodys blood vesselsBladderHolding tank for liquid waste in body

Reproductive systemFemalesOvariesProduces eggs and estrogen (stimulates development of & maintains feminine characteristics) UterusFertilized eggs develop hereMalesseminal vesiclesProstate glandResponsible for adding fluid & nutrients to seminal fluid

AnatomyPelvisProvides bony base and protection for internal organsWider in females to accommodate childbirthAbdominal musclesProvides protection for organsRectus abdominus gives washboard affect; attaches to pelvis & lower ribs & sternumtrunk flexionObliques (external & internal) attaches to lateral aspect of lower ribs & runs diagonally to pelvisflexion and rotationTransverse abdominusholds internal organs in cavity

Pelvis

Muscles

Anatomy of thoraxPart of body between neck & abdomenContains heart & lungs

AnatomyThroatCarotid arteriesOne on each side of tracheaCarry oxygenated blood to brainJugular veinsOne on each side of tracheaCarry unoxygenated blood away from brain

AnatomyLarynxModified upper part of trachea Contains vocal chordsTracheaMade up of circular rings of cartilageMain trunk of system of tubes by which air passes to & from lungs for exchange of CO2 and O2EsophagusPassageway for food going from the mouth to the stomachSits in front of the cervical vertebrae and behind the trachea & larynx

Anatomy of thoraxBony structuresThoracic vertebrae posterior12 ribs on each sideSternum anteriorProtects organs of thorax

AnatomyHeartSize of fistPumps blood to all parts of bodyDivided into 4 chambersRight & left atriumUpper chambersRight & left ventricleLower chambersLarger with thicker walls

HeartPumps blood to lungs and throughout bodyRight atrium fills w/ blood from veinCarries waste products and CO2Right ventricle receives blood from atrium (through tricuspid valve)Pulmonary arteries carry UNOXYGENATED blood to lungs

HeartBlood is mixed with O2 in the lungs OXYGENATED blood is carried back to heart by the pulmonary veinsGoes into the left atrium Flows to the left ventricle through the bicuspid valveIs pumped to the rest of the body through the aorta

HeartMain branches (arteries) off the aortaAscending and descending aortasCarotid Subclavian Axillary BrachialRadial & ulnarCommon iliacFemoralAnterior & Posterior Tibial

VeinsRun parallel with the arteriesSuperior vena cavaInferior vena cavaTwo extra in armCephalicbasilicTwo extra in legGreater saphenousLesser saphenous

LungsRight has 3 lobesLeft has 2 lobesFunction: to exchange O2 and CO2 To dissipate heat from the body

Trachea divides into two bronchiBronchi are filled with ciliaHair like projections that help remove foreign substances like dust & pollenBronchi divide into bronchiolesBronchioles end in alveoliAlveoli are air containing cells of the lungs O2 and CO2 are exchanged here

Coughing & sneezing help keep trachea and bronchi clear & remove phlegm and allergy-causing agents from lungs

Respiration rateLung function & breathing rate controlled by CO2 receptorsIf there is too much CO2, inhalation occurs to bring in more O2Exercise increases cell metabolismCauses cells to need more O2 and eliminate more CO2

Respiration RateWith exercise lungs ability to exchange air more efficiently increasesBreaths become deeper & more forcefulReturn to normal breathing quicker

PleuraThin lubricated tissueLines each half of thoraxFolded back over the surface of the lung on same sideAllow for smooth movement of lungs as they encounter the wall of ribs during inhalation & exhalation

Lungs

Lungs

Muscular AnatomyIntercostal muscles sit between ribsInternal and external intercostalsAid in inhalation and exhalation

Intercostal muscles

Intercostals

Abdominal & Thoracic InjuriesInjuries are rareSolid organs most often injuredLife threatening

Abdominal StrainsRectus abdominus most often injuredPotentially can be incapacitatingMxn: sudden twisting of trunk or reaching overheadS/S: pain with movements of the trunk, POT over affected muscle, tightness of musclesTX: ice, compression, gentle stretching, no exercise until ROM is pain free

Abdominal contusionsNot common but most likely to occur in collision sportsMxn: direct blow to abdomen, compressive force to abdominal wallS/S: pain, tightness, hematoma formation under the fascial tissue surrounding muscleTx: ice, compression, look for signs of internal injury, no activity until pain free

HerniaProtrusion of abdominal viscera through a portion of abdominal wallThose resulting from sports occur in groin area Inguinal hernias occur most often in men ( more than 75%)Femoral hernias occur most often in women

HerniasInguinalResults from abnormal enlargement of opening in inguinal canal through which vessels and nerves of male reproductive system passFemoralArises in canal that transports vessels & nerves that go the thigh and lower limb

HerniasWhen intra-abdominal tension is produced in these areas, muscles produce a contraction around canal openings.If muscles fail to react abdominal contents may be pushed through opening

HerniasMxn: improperly lifting a heavy object, increased abdominal pressure, blow to groin area, weakness of abdominal wallS/S: pain and prolonged discomfort in groin area, protrusion in the groin area that is present when standing (or when coughing) but goes away when lying down, feeling of weakness or pulling sensation in groin areaTx: surgical repair

herniasComplications:Strangulated hernia: If hernia is not treated, the bulge can get stuck in abdominal wall or inguinal canal.The blood supply to the tissue will be cut off and eventually die.If the intestine is involved, a bowel obstruction will result and prevents the passage of waste material from the body causing pain and illness

Hernias

Hernias

Hernias

Hernias

Blow to Solar PlexusCommonly known as getting the wind knocked outMxn: blow to the middle of the abdomen or solar plexusS/S: transitory paralysis of diaphragm, inability to breath (inhale) or trouble breathing for a brief period of time, cyanosis, short term panicTx: calm athlete, loosen belt/clothing around abdomen, bend knees, , control breathing-short inspirations, long expirations

Blow to solar plexusComplications: fear of not being able to breath may cause athlete to hyperventilateIncreased rate of ventilations that results in increases levels of O2 which can cause dizziness, lump in throat, pounding of heart, fainting, tingling/numbness in hands, face, feetCare for hyperventilation: Have athlete breath into a paper bag to increase levels of CO2 to restore normal breathingIf athlete does pass out, normal breathing should be restored

Stitch in SideName given to an idiopathic condition that occurs in some athletesCauses: ConstipationIntestinal gasOvereatingDiaphragmatic spasm as result of poor conditioningLace of visceral support because of weak abdominal musclesDistended spleenBreathing techniques that lead to lack of O2 in diaphragmIschemia of either the diaphragm or intercostal muscles

Stitch in SideS/S:Cramp like pain in side at either right or left costal border during hard physical activityTx:Relax the spasmStretch arm on affected side above the head and side bend to the same sideFlex the trunk over the thighsIceIf pain/spasm persists seek medical evaluation

Spleen injuryMxn:Direct blow to upper left quadrantFalling on UL quadrantInfectious mononucleosis causes enlarged spleen putting athlete at riskIf spleen is enlarged due to mono, may resume activity after 3 weeks if the spleen is no longer enlarged or painful and there is no fever

Spleen injuryS/S:History of injurySigns of shock-dizziness, thirst, pale, sweating, rapid pulse/respirationsAbdominal rigidityNauseaVomitingKehrs signReflex (referred) pain that comes on about 30 minutes after injury where pain radiates to the left shoulder and 1/3 the way down the left armReferred painpain felt in one part of the body other than its actual origin

Spleen injuryCan hemorrhage profusely into abdominal cavity causing athlete to die of internal bleeding days or weeks after injuryTx: Call 911, monitor athlete, conservative, non-operative treatment with about 1 week of hospitalizationAt 3 weeks can engage in light conditioningReturn to full activity at 4 weeksIf surgical repair is needed athlete will return to activity at 3 monthsIf surgical removal is necessary, return to activity at 6 months

Spleen injury

Kidney ContusionMxn: blow to the backS/S: signs of shocknausea vomiting rigidity of muscles of backhematuria (blood in urine)referred pain radiates forward around the trunk into the lower abdominal region

Kidney Contusion Tx:Have athlete urinate 2-3 times to determine if there is blood in urineCall 911 if necessaryTreat for shockImmediate physician referral there is hematuria24 hour hospitalization for observationGradual increase in fluid intakeIf hemorrhage fails to stop, surgical interventionUsually takes 2 weeks bed rest prior to return to activity

Kidney contusionKidney contusion Kidney Laceration

Liver Contusion/lacerationMxn: hard blow to right side of abdomenS/S: hemorrhage signs of shock referred pain just below the right scapularight shouldersubsternal areaanterior left side of chest (occasionally)

Liver contusion/lacerationTx:Call 911Treat for shockMonitor athleteImmediate surgical intervention

AppendicitisMxn: inflammation of appendixChronic or acuteCaused by fecal obstructionInitially appendix is red & swollenCan become gangrenous, rupture into bowels & cause peritonitis

AppendicitisS/S:Mild to sever pain in lower abdomenNauseaVomitingLow grade feverCramps in lower right sideAbdominal rigidityReferred pain is at McBurneys point (between the ASIS and the umbilicus)

AppendicitisTx:Monitor athleteRefer when necessarySurgical removal of inflamed appendixNot an emergency unless there is a bowel obstructionAn obstructed bowel, with an acute rupture is life-threatening

Highest incidence in males between ages of 15 & 25.

Appendicitis

Appendicitis

Inflamed appendixperforated appendix

Injuries to BladderMxn: blunt force to lower abdominal region if the bladder is distended by urineHematuria associated with contusion of bladder during runningKnown as runners bladderS/S:blood in urineReferred pain to lower trunk, upper thigh anteriorlyWith rupture, athlete will be unable to urinate

Bladder injuriesTx: Monitor athletePhysician referral if necessary

Testicular/Scrotal contusionDue to considerable sensitivity & vulnerability, contusions to the scrotum & testicles cause extreme pain, nausea and disabilityImportant for males to wear proper protection to prevent incidence of contusions

Mxn: direct blow to the genitalia

Testicular/Scrotal contusionS/S: hemorrhagefluid effusion muscle spasmVomiting is severeTx: place athlete on his side flex thighs to chest ice to scrotum as pain diminishes Immediate medical referral for increasing or unresolved pain after 15-20 minutes

Rib ContusionMxn: blow to rib cageS/S: sharp pain with breathingPOT over contused area pain with compression of rib cageTx: RICENSAIDScessation of activity until pain subsides self limiting

Rib FracturesMost common in collision sportsRibs 5-9 most commonly fracturedPossibility of cause damage to or puncturing a lung

Mxn: direct impact compression of rib cage

Rib FracturesS/S: severe pain during inspirationPOT over fracture siteCrepitusPain with movement of trunk

Rib FracturesTx: Refer for x-rayiceSupportRestHeal within 3-4 weeksRib brace may offer some stabilization and comfort

Rib Fractures

Costal Cartilage InjuryMore common than rib fracturesMxn: direct blow to thoraxIndirectly from sudden twist of fall on a ball compressing the rib cage

Costal cartilage injuryS/S: similar to rib fracture except pain is localized in the junction of the rib cartilage and the ribSharp pain during sudden movements Difficulty in breathing deeply POT with swellingRib deformityRibs make crackling noise (crepitus) as it moves in and out of place

Costal cartilage injuryTx:IceRestImmobilization with rib brace1-2 months healing time

Costal cartilage injury

Intercostal Muscle StrainMxn:Direct blowSudden torsion of trunkS/S:Pain w/ active motionPain w/ inspiration/expiration, laughing, coughing, sneezingTx:IceCompressionImmobilization for comfort

Lung InjuriesInjures to lungs are rare but can be life threatening

PneumothoraxTension PneumothoraxHemothoraxTraumatic asphyxia

PneumothoraxCondition in which pleural cavity surround lung becomes filled w/ air that has entered through an opening in the chestAs pleural cavity fills with air, lung on that side collapses

Tension pneumothoraxOccurs when the pleural cavity on one side fills with air & displaces the lung and the heart toward the opposite side, this compressing the opposite lung

HemothoraxPresence of blood within the pleural cavity or pleural tissue involving the blood vessels in the area

Traumatic asphyxiaOccurs as the result of a violent blow to or compression of the rib cage causing a cessation of breathing.Demands immediate mouth-to-mouth resuscitation & immediate medical attention

Lung injuriesS/S: Difficulty breathingShortness of breathChest pain on side of injuryCoughing up bloodCyanosisshockTx:Call 911Monitor athleteTreat for shock

Pneumothorax

Pneumothorax

Tension pneumothorax

Hemothorax

Sudden Death SyndromeAthletes 35 years and youngerMost common cause of death is congenital cardiovascular abnormality3 prevalent causes:Hypertrophic cardiomyopathy (HCM)Anomalous origin of the coronary arteryMarfans syndrome

Hypertrophic CardiomyopathyCondition in which there is thickened cardiac muscle with no evidence or chamber enlargement or extensive myocardial scarring

Anomalous origin of coronary arteryOne of the two coronary vessels originates at a different site than normalThis compromises or obstructs the artery because of its unusual course

Marfans syndromeAbnormality of connective tissue resulting weakening of the aorta and cardiac valves which can lead to a rupture of either a valve or of the aorta itself

Coronary artery disease (CAD)One other potential cause of sudden cardiac deathResults from atherosclerosis which causes a narrowing of the coronary arteries due to hypercholesterolemia in the young athlete

Sudden deathS/S: chest pain or discomfort during exertionHeart palpitations or fluttersSyncopeNauseaProfuse sweatingHeart murmursShortness of breath General malaiseFever

Sudden deathTx: Life-threateningCall 911 Be prepared to perform CPRHave AED ready to useEarly detection/screening/identification could prevent sudden death from occuring

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