KIN 188 – Prevention and Care of Athletic Injuries

Thoracic and Abdominal

Evaluation and Injuries

Anatomy

Bony Anatomy

Thorax Anterior – sternum Lateral – ribs Posterior - vertebrae

Abdomen Posterior – vertebrae Lateral – ribs (lesser extent)

Muscular Anatomy

Muscles of inspiration Diaphragm Intercostals

Muscles of expiration Abdominal muscles

Rectus abdominus Internal/external

obliques Transversus abdominus

Respiratory Tract Anatomy

Lungs Left – 2 lobes Right – 3 lobes

Trachea Divides into bronchi

Pleural linings Parietal – lines cavity Visceral – lines lungs Creates potential space

Cardiovascular Anatomy

Heart 2 atria 2 ventricles

Vascular structures Aorta Inferior/superior vena

cava Pulmonary arteries/veins

Digestive Tract/Lymphatic Anatomy

Esophagus

Stomach

Small intestine Duodenum, jejunum,

ileum

Large intestine (colon) Cecum (appendix),

ascending/transverse/descending, sigmoid, rectum, anus

Liver/gall bladder

Spleen

Digestive Tract/Lymphatic Anatomy

Genitourinary Anatomy

Urinary anatomy Kidneys, ureters, bladder,

urethra Male reproductive

anatomy Testes, epididymis, penis

Female reproductive anatomy Ovaries, fallopian tubes,

uterus, vagina

Evaluation

History

Mechanism of injury/etiology Almost all etiology associated with direct trauma

to abdomen/thorax Another competitor Equipment Ground Increased incidence with trauma to unprotected areas

Location of pain Must know anatomy

History

Onset of symptoms If musculoskeletal, usually rapid onset If organ related, may have quick or slow onset depending

upon structure and amount/rate of bleeding

Symptoms/chief complaint/s Dyspnea, abdominal pain, nausea/vomiting (appearance),

dizziness, hematuria, blood in stool

Medical history Any prior thoracic/abdominal injuries?

Inspection/Observation

Posture/guarding Often lean toward painful area for splinting

Breathing pattern Rate/depth/quality of breaths

Capillary refill Best done at fingers for cursory vascular

evaluation

Inspection/Observation

Muscle tone Tension due to spasm/guarding or internal bleeding

Discoloration/ecchymosis Typically not visible, abrasions/etc. indicative of potential

underlying trauma

Vomiting “Coffee grounds” if blood in it

Hematuria If visible, significant for genitourinary conditions May need urinalysis for ultimate determination

Palpation

Abdominal quadrants Upper left Upper right Lower left Lower right

Palpation

Positioning Best done in “hook laying” position

Rigidity Guarding/spasm vs. internal bleeding

Rebound tenderness Tension on peritoneum (lining of abdominal cavity)

Percussion Hollow vs. solid organs

Auscultation Listen for bowel sounds (“gurgling”)

Special Tests

Vital sign assessment for shock secondary to internal bleeding Increased heart/respiratory rates, decreased blood

pressure

Neurological signs – referred pain sites L shoulder – spleen (Kerr’s sign) R shoulder – liver Flanks – kidneys Groin – gonads Medial thigh - bladder

Injuries

Thoracic Injuries

Bony injuries Rib fracture

Most common to anterior/lateral aspect of 5th-9th ribs

Flail chest 4 or more ribs fractured

in 2 or more places Sternum fracture

Potential for significant injury if posterior displacement

Thoracic Injuries

Pneumothorax Accumulation of air in

pleural cavity that affects ability of lung to expand Decreased oxygen,

hypoxia, respiratory distress

Dyspnea, pain with respirations, guarding or splinting of affected area, possible cyanosis

Decreased or absent breath sounds on auscultation of affected lung

Thoracic Injuries

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

Abdominal Injuries

Liver injury Typically associated with blunt force trauma to upper right

quadrant – contusion vs. 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.)

Kidney injury Well protected anatomically by rib cage, vertebrae and spinal

musculature Typically associated with blunt force trauma to “flank” region

Organ Injuries

Abdominal Injuries

Appendix injuries 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

Abdominal Injuries

Male reproductive injuries/conditions More common than in women due to external location of

male genitalia 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 Signs and symptoms (intense pain, nausea/vomiting, swelling

and/or mass in scrotum from occlusion of vascular structures

Testicular Torsion

Abdominal Injuries

Female reproductive injuries/conditions Less common due to protection afforded by

abdomen/anatomical location

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

Abdominal Injuries

Female reproductive injuries/conditions Dysmenorrhea

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

Signs and symptoms (nausea/vomiting, diarrhea or constipation, bloating)

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