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INTRODUCTION
• THIS CHAPTER BEGINS WITH A GROSS ANATOMY OF THE THROAX AND
ABDOMEN.
• IT DISCUSSES THE INTERNAL ORGANS THAT CAN BE INJURED THROUGH
SPORTS PARTICIPATION.
• THE INTERNAL ORGANS AND STRUCTURES COVERED INCLUDE THE HEART
AND LUNGS, LIVER, KIDNEYS, SPLEEN, STOMACH, AND DIAPHRAGM.
INTRODUCTION
•THE CHAPTER ALSO DISCUSSES EXTERNAL INJURIES SUCH AS
FRACTURES TO THE RIBS, VARIOUS JOINT-RELATED PROBLEMS,
AND BREAST INJURIES AND CONTUSIONS.
•MANY OF THESE INJURIES CAN BE DEBILITATING AND EVEN LIFETHREATENING.
ANATOMY REVIEW
• THE THORAX AND ABDOMINAL
CAVITIES CONTAIN THE MAJORITY
OF THE VITAL ORGANS OF THE BODY.
• THIS AREA IS ENCLOSED BY THE
SPINAL COLUMN, RIB CAGE, AND
THE CLAVICLE , WHICH PROVIDE
BONY PROTECTION FOR THE AREA.
ANATOMY REVIEW
• THE VERTEBRAE IN THIS AREA INCLUDE THE 12
THORACIC VERTEBRAE AND THE 5 LUMBAR
VERTEBRAE LOCATED POSTERIOR TO THE
ABDOMEN.
• THERE ARE 12 PAIRS OF RIBS IN BOTH MALES
AND FEMALES.
• THE FIRST 7 PAIRS OF RIBS ARE CONNECTED
TO THE SPINAL COLUMN POSTERIORLY AND
THE STERNUM ANTERIORLY.
ANATOMY REVIEW
• THE ANTERIOR CONNECTION OF THE TRUE RIBS IS
MADE VIA A COSTAL CARTILAGE FOR EACH RIB.
• THE REMAINING RIBS, SPECIFICALLY RIBS 8
THROUGH 10, CONNECT VIA A COMMON COSTAL
CARTILAGE.
• RIBS 11 AND 12 DO NOT CONNECT TO THE
STERNUM ANTERIORLY; THUS, THEY ARE CALLED
FLOATING RIBS.
• THE 8TH TO 12TH PAIRS ARE SOMETIMES REFERRED
TO AS FALSE RIBS.
ANATOMY REVIEW
• ALL OF THE JOINTS BETWEEN THE RIBS AND
THE SPINAL COLUMN ARE REINFORCED WITH
STRONG LIGAMENTOUS SUPPORT.
• THE AREA IS FURTHER STRENGTHENED BY
THE ANTERIOR LONGITUDINAL LIGAMENT,
WHICH RUNS ON THE ANTERIOR SURFACE OF
THE SPINAL COLUMN FROM THE OCCIPITAL
BONE OF THE SKULL TO THE PELVIC SURFACE
OF THE SACRUM.
ANATOMY REVIEW
• THE MAIN JOINTS OF THE THORAX INCLUDE THE
INTERVERTEBRAL JOINTS, THE VERTEBRAL AND
RIB JOINTS, THE STERNOCOSTAL AND
COSTOCHONDRAL JOINTS, AND THE
STERNOCLAVICULAR JOINTS.
• THE INTERVERTEBRAL JOINTS ARE THOSE
BETWEEN EACH OF THE VERTEBRAL BODIES.
• THESE JOINTS ARE STABILIZED BY
LIGAMENTS AND THE INTERVERTEBRAL
DISKS LOCATED BETWEEN EACH VERTEBRAL
BODY.
ANATOMY REVIEW
• THE INTERVERTEBRAL DISKS ARE MOSTLY FIBROCARTILAGINOUS AND PLAY AN IMPORTANT ROLE IN THE
WEIGHT-BEARING ABILITY OF THE SPINE.
• THE RIBS ARTICULATE WITH THE VERTEBRAE IN AN INTERESTING MANNER.
•
EACH RIB ARTICULATES WITH TWO ADJACENT VERTEBRAE AND THE INTERVERTEBRAL DISK.
• THESE JOINTS ARE STRENGTHENED BY THE LIGAMENTS THAT ALLOW THE GLIDING MOVEMENTS OF THE RIBS AT
THE VERTEBRAL COLUMN
• ANTERIORLY, THE FIRST THOUGH THE SEVENTH RIBS ARTICULATE WIT THE STERNUM DIRECTLY FROM THEIR
COSTAL CARTILAGE.
• RIBS 8 THROUGH 10 ARTICULATE WITH THE STERNUM THROUGH A COMMON CARTILAGE.
•
THESE JOINTS ARE KNOWN AS THE STRENOCOSTAL JOINTS.
• THE POINT AT WHICH THE RIB ATTACHES TO THE COSTAL CARTILAGE IS KNOWN AS THE COSTOCHONDRAL
JOINT.
•
TYPICALLY THERE IS NO MOVEMENT AT THIS JOINT.
ANATOMY REVIEW
• ONE OF THE MAIN JOINTS OF THE THORAX
IS THE STERNOCLAVICULAR JOINT.
• ARTICULATION BETWEEN THE
CLAVICLE AND THE STERNUM
• THE ONLY BODY ARTICULATION BETWEEN
THE THORAX AND THE ARM, AND IT IS
SUPPORTED BY STRONG LIGAMENTS.
ANATOMY REVIEW
• SEVERAL MUSCLES SURROUND THE
THORAX AND ABDOMEN.
• THE MAIN THORACIC MUSCLES INCLUDE
THE INTERCOSTAL MUSCLES, BOTH
INTERNAL AND EXTERNAL, WHICH
FUNCTION PRIMARILY TO LIFT THE RIB
CAGE AND ASSIST WITH BREATHING.
ANATOMY REVIEW
• MORE SUPERFICIALLY, THE
PECTORALIS MAJOR AND MINOR
ARE LOCATED IN THE UPPER CHEST
AREA AND MAINLY CONTROL ARM
MOVEMENT.
• IN THE POSTERIOR THORAX SEVERAL
MUSCLES RUNNING THE LENGTH OF THE
SPINAL COLUMN ARE RESPONSIBLE FOR A
VARIETY OF MOVEMENTS AS WELL AS
STABILIZATION OF THE SPINE.
• MOST OF THE DEEP MUSCLES RUNNING
THE LENGTH OF THE BACK, INCLUDING
THE SPINALIS, LONGISSIMUS,
ILIOCOSTALS, AND OTHERS ARE
RESPONSIBLE FOR KEEPING THE SPINE
ERECT.
ANATOMY REVIEW
• MORE SUPERFICIALLY, MUSCLES SUCH
AS THE LATISSIMUS DORSI,
RHOMBOIDS, TRAPEZIUS, AND
DELTOID ARE MAINLY RESPONSIBLE
FOR MOVEMENTS OF THE UPPER
EXTREMITY.
ANATOMY REVIEW
• IN THE ABDOMINAL REGION THERE ARE ALSO
SEVERAL IMPORTANT MUSCLES.
• THE MAIN MUSCLES OF THE ANTERIOR
ABDOMINAL REGION ARE THE EXTERNAL AND
INTERNAL OBLIQUES AND THE RECTUS
ABDOMINIS.
• THE OBLIQUE MUSCLES HELP TO FLEX AND
ROTATE THE TRUNK.
• THE RECTURS ABDOMINIS IS THE MAIN MUSCLE
OF THE ANTERIOR ABDOMINAL WALL.
• FLEXES THE TRUNK
INTERNAL ORGANS
• TWO MAIN ORGANS IN THE THORAX ARE THE LUNGS AND HEART
• EACH LUNG IS ENCASED IN SEPARATE AND CLOSED SPACE CALLED
THE PLEURAL SAC
• HELPS TO MAKE RESPIRATION A SMOOTH PROCESS
• OXYGENATE BLOOD AS IT CIRCULATES
• NORMALLY LIGHT, SOFT, SPONGY, AND PINKISH IN A HEALTHY PERSON
• RIGHT LUNG HAS THREE LOBES; THE LEFT HAS TWO
• RIGHT IS A LITTLE LARGER AND HEAVIER
INTERNAL ORGANS
• LOCATED DIRECTLY BETWEEN THE TWO LUNGS IS
THE HEART
• HEART IS SITUATED IN AN AREA CALLED THE
MEDIASTINUM
• HOUSES MAJOR BLOOD VESSELS AND PARTS
OF THE RESPIRATORY AND DIGESTIVE
SYSTEMS
• TRACHEA AND ESOPHAGUS
• ALSO HOUSES NERVE AND LYMPHATIC
TISSUES
INTERNAL ORGANS
• INFERIOR TO THE PLEURAL CAVITIES AND THE
MEDIASTINUM IS A MUSCLE CALLED THE
DIAPHRAGM.
• SEPARATES THE THORACIC AND ABDOMINAL
CAVITIES
• MAIN MUSCLE OF RESPIRATION
• IT IS A CIRCULAR MUSCLE WITH A TENDON IN
THE MIDDLE WHICH ALLOWS THE MUSCLE TO
CONTRACT AND ASSIST WITH BREATHING.
INTERNAL ORGANS
• THE ABDOMINAL REGION IS DIVIDED INTO 4 QUADRANTS:
• RIGHT UPPER QUADRANT
• RIGHT LOWER QUADRANT
• LEFT UPPER QUADRANT
• LEFT LOWER QUADRANT
• UMBILICUS SERVES AS THE CENTER POINT.
INTERNAL ORGANS
• RIGHT UPPER QUADRANT
• LIVER, GALLBLADDER, AND RIGHT KIDNEY
• RIGHT LOWER QUADRANT
• ASCENDING COLON
• APPENDIX
• LEFT UPPER QUADRANT
• STOMACH, SPLEEN, PANCREAS, AND LEFT KIDNEY
• LEFT LOWER QUADRANT
• DESCENDING COLON
EXERCISE…
• WITH YOUR NOTE CARD, MAKE FOUR QUADRANTS AND FILL IN THE ORGANS FOR EACH.
• THIS WILL BE A STUDY GUIDE FOR YOU AS WE CONTINUE THE POWER POINT.
COMMON SPORTS INJURIES
• ARE RELATIVELY UNCOMMON IN CHILDREN AND ADOLESCENTS.
• IF INJURIES DO HAPPEN SOME REQUIRE IMMEDIATE ATTENTION TO PREVENT LONG-TERM
DISABILITY AND POSSIBLY EVEN DEATH.
• WE WILL FIRST FOCUS ON EXTERNAL INJURIES INVOLVING THE SKELETAL, MUSCULAR, AND
OTHER EXTERNAL COMPONENTS OF THE REGION.
EXTERNAL INJURIES…FRACTURES
• FRACTURES CAN OCCUR AS A RESULT OF DIRECT
TRAUMA
• MAY FRACTURE A RIB, THE STERNUM, CLAVICLE,
OR ANOTHER PART OF THE VERTEBRA.
• IF A FRACTURE OCCURS IT SHOULD BE TREATED
IMMEDIATELY
• W/O PROPER CARE, COMPLICATIONS CAN OCCUR
• MAY DEVELOP PNEUMOTHORAX OR
HEMOTHORAX
EXTERNAL INJURIES..FRACTURES
• A PNEUMOTHORAX IS THE PRESENCE OF AIR IN THE PLEURAL CAVITY.
• A HEMOTHORAX IS THE PRESENCE OF BLOOD IN THE PLEURAL CAVITY.
• WITH A STERNAL FX, TWO COMPLICATIONS MAY ARISE.
1. MANUBRIUM IF DISLOCATED AND MOVES POSTERIORLY, COULD
LEAD TO AN AIRWAY OBSTRUCTION.
2. IF THE STERNUM AND RIBS ARE SEPARATED COMPLETELY, A FAIL
CHEST (LOSS OF STABILITY TO THE THORACIC CAGE) CAN
OCCUR.
•
CAN LEAD TO PNEUMOTHORAX OR HEMOTHORAX
EXTERNAL INJURIES..FRACTURES
• A MORE COMMON FRACTURE IN SPORTS IS TO
THE RIBS.
• MOST OFTEN, RIBS ARE FRACTURED IN CONTACT
SPORTS WHEN TWO PLAYERS COLLIDE AND THE
RIB CAGE IS VIOLENTLY COMPRESSED.
• THE 5TH THROUGH THE 9TH PAIRS OF RIBS ARE
GENERALLY MORE SUSCEPTIBLE TO FRACTURE.
• THE BONES CAN BE BROKEN IN VARYING
DEGREES OF SEVERITY, FROM GREENSTICK TO
DISPLACED FX.
EXTERNAL INJURIES..FRACTURES
• S&S:
• EXTREME LOCALIZED PN AT THE SITE OF INJURY
THAT IS AGGRAVATED BY SNEEZING,
COUGHING, FORCED INHALATION, OR
SOMETIMES MOVEMENT.
• MAY GRASP THE CHEST WALL AT THE POINT OF
INJURY.
• MILD SWELLING, THERE MAY BE BONY
DEFORMITY.
• MAY C/O BREATHING DIFFICULTIES AND TAKE
RAPID, SHALLOW BREATHS.
• TX:
• MONITOR THE ATHLETE’S VITAL SIGNS
AND WATCH FOR ANY RESPIRATORY
DISTRESS.
• ARRANGE FOR TRANSPORT TO A HEALTH
CARE FACILITY.
EXTERNAL INJURIES..FRACTURES
• MAY ALSO EXPERIENCE SUBLUXATIONS AND DISLOCATIONS.
• MAINLY YOU WILL SEE COSTOCHONDRAL SEPARATIONS, WHICH INVOLVE SOME TYPE OF
DISUNION OF THE STERNUM AND RIBS.
• IN A COSTOCHONDRAL SEPARATION, THE CARTILAGE PORTION OF THE COSTOSTERNAL UNION IS
EITHER SEPARATED FROM THE STERNUM MEDIALLY OR FROM THE RIB LATERALLY.
• TYPICALLY , THE ATHLETES WITH A COSTOCHONDRAL SEPARATION EXPERIENCES A GREAT DEAL OF
PAIN AT THE TIME OF THE INJURY AND IN MANY CASES WILL C/O PAIN FOR WEEKS AFTER THE
INJURY.
COSTOCHONDRAL SEPARATION
• S&S:
• REPORT A POP OR A SNAP OCCURRED
• PALPABLE DEFECT MAY BE FELT BECAUSE
DEFORMITY
• SWELLING IN THE AREA
• MAXIMUM OR NEAR MAXIMUM INHALATION
MAY BE VERY DIFFICULT
• EXPERIENCES LOCALIZED PN AND
TENDERNESS OVER THE AREA
• TX:
• IMMEDIATELY APPLY ICE AND LIGHT
COMPRESSION
• TREAT FOR SHOCK IF NECESSARY
• ARRANGE FOR TRANSPORT TO A MEDICAL
FACILITY
INTERNAL INJURIES…
• MANY ORGANS AND STRUCTURES CAN BE INJURED FROM DIRECT TRAUMA
IN COLLISION AND CONTACT SPORTS.
• IF IS NOT ALWAYS EASY TO DETERMINE
• THEREFORE, THE COACH OR ATHLETIC TRAINER MUST BE EDUCATED AND
KNOWLEDGEABLE ABOUT THE SIGNS AND SYMPTOMS OF POSSIBLY INJURY
TO AN INTERNAL ORGAN
HEART INJURIES…
• ALTHOUGH CONSIDERED A RARE OCCURRENCE, SUDDEN DEATH AMONG ATHLETES HAS
BECOME A MORE PUBLICIZED EVENT IN RECENT YEARS.
• MANY TIMES, SUDDEN DEATH IN ATHLETES IS A RESULT OF A CARDIAC PROBLEM.
• IN A REPORT FROM THE U.S. NATIONAL REGISTRY OF SUDDEN DEATH IN ATHLETES
(MINNEAPOLIS HEART INSTITUTE FOUNDATION) FROM 1980 – 2006, THERE WERE 1866
REPORTED SUDDEN DEATH EVENTS IN ATHLETES.
HEART INJURIES…
• ANY TIME THE HEART IS COMPRESSED BETWEEN THE STERNUM AND THE SPINAL COLUMN
BY A VIOLENT EXTERNAL FORCE, SUCH AS MIGHT BE CAUSED BY BEING HIT BY A BASEBALL,
LACROSSE BALL, OR HOCKEY PUCK, A CARDIAC CONTUSION OR OTHER THORACIC
INJURIES CAN RESULT.
• WHEN AN ATHLETE IS HIT IN THE CHEST AND THE IMPACT IS TIMED EXACTLY WITH THE
REPOLARIZATION PHASE OF THE CONTRACTING HEART, IT IS POSSIBLE FOR THE ATHLETE
TO EXPERIENCE VENTRICULAR FIBRILLATION LEADING TO DEATH.
• THIS INJURY IS KNOWN AS COMMOTIO CORDIS AND APPEARS TO BE MORE PREVALENT IN
MALE YOUTH PLAYING LACROSSE, HOCKEY, FOOTBALL, BASKETBALL AND OTHER SPORTS .
HEART INJURIES…
• ADDITIONALLY, A BLUNT TRAUMA TO THE CHEST MAY ALSO CAUSE AORTIC RUPTURE, INJURE THE
PERICARDIUM OR CORONARY ARTERIES, OR CAUSE VALVULAR DAMAGE.
• AORTIC INJURY IS OFTEN FATAL AND MUST BE GIVEN IMMEDIATE ATTENTION IF SUSPECTED.
• A MAJORITY OF PEOPLE WHO SUFFER FROM AORTIC INJURY DIE BEFORE EMERGENCY CARE IS
INSTITUTED.
• WATCH ANY ATHLETE WITH A CHEST INJURY FOR BREATHING PROBLEMS, FAINTING, DECREASES IN
HEART RATE AND BLOOD PRESSURE, AND C/O SEVERE CHEST PAINS.
HEART INJURIES…
• HYPERTROPHIC CARDIOMYOPATHY (HCM) IS
A GENETIC DISORDER MOST OFTEN
DISCOVERED AFTER THE DEATH OF AN
ATHLETE.
• EX) IN GLORY ROAD
• HCM IS GENERALLY DESCRIBED AS AN
EXCESSIVE THICKENING OF THE LEFT
VENTRICLE WALL, RESULTING IN A VENTRICLE
THAT IS LESS EFFICIENT IN PUMPING THE
NECESSARY VOLUME OF BLOOD
HEART INJURIES…
• THE PREVENTION OF INJURIES TO THE HEART, LUNGS, AND CHEST IS PRIMARILY A FUNCTION OF
PROTECTIVE EQUIPMENT AS PART OF THE SPORT OR ACTIVITY.
• IN BASEBALL AND SOFTBALL, THE CATCHER IS EQUIPPED WITH A CHEST PROTECTOR.
• IN FOOTBALL, HOCKEY, LACROSSE, AND SOME OTHER CONTACT SPORTS, PART OF THE UNIFORM IS
PROTECTIVE EQUIPMENT DESIGNED TO REDUCE POSSIBLE IMPACT TO THE HEART AND CHEST AREA.
• ATC’S AND OTHER LIKELY EARLY CARE PROVIDERS MUST BE CURRENT IN THEIR CPR TRAINING AND
PREPARED WITH EITHER AN AED OR AN EAP THAT WOULD PROVIDE IMMEDIATE CARE FOR A PLAYER
EXPERIENCING SIGNS AND SYMPTOMS OF SUDDEN CARDIAC ARREST.
LUNG INJURIES…
• AN ATHLETE MAY EXPERIENCE A PULMONARY
CONTUSION.
• CAN BE A COMPLICATION OF A RIB FX, CONTUSION, OR
SOME OTHER TYPE OF PULMONARY INJURY AND CAN GO
UNDETECTED.
• PULMONARY CONTUSION HAS BEEN REPORTED IN UP TO
70% OF PEOPLE EXPERIENCING BLUNT CHEST TRAUMA.
• RIBS CAN PUNCTURE AND FRACTURE THE PLEURAL SAC
THAT SURROUNDS THE LUNG(S).
• IF AIR GETS INTO THE PLEURAL CAVITY, THERE IS A
POSSIBILITY OF A LUNG COLLAPSE (PNEUMOTHORAX).
LUNG INJURIES…
• PNEUMOTHORAX IS THE PRESENCE OF AIR
OR A GAS IN THE PLEURAL CAVITY (SPACE
BETWEEN THE LUNGS AND CHEST WALL),
WHICH MAY CAUSE A PARTIAL OR
COMPLETE COLLAPSE OF THE LUNG.
• WITH AIR IN THE CAVITY, IT INHIBITS THE
LUNG’S ABILITY TO EXPAND FOR NORMAL
BREATHING TO OCCUR.
LUNG INJURIES…
• THERE IS ALSO THE POSSIBILITY OF SPONTANEOUS PNEUMOTHORAX AMONG ATHLETES.
• OCCURS WITHOUT A PRECEDING TRAUMATIC EVENT.
• THIS INJURY IS SIGNIFICANT AND MUST BE ATTENDED TO BY A PHYSICIAN.
• THE PROGRESS OF THE ATHLETE SHOULD BE MONITORED OVER A PERIOD OF DAYS BY THE ATHLETE’S HEALTH
CARE PROVIDER BECAUSE SOME INJURIES HAVE A TENDENCY TO EXHIBIT COMPLICATIONS LATER.
LUNG INJURIES…
S&S
• C/O SEVERE PN IN THE CHEST AREA, SOMETIMES
RADIATING TO THE THORACIC SPINE.
• EXPERIENCE BREATHING PROBLEMS-EITHER SOB
OR PAINFUL BREATHING EXHIBITED BY SHORT,
SHALLOW BREATHS.
• LOSS OF CHEST WALL MOVEMENT DURING
BREATHING.
• NONPRODUCTIVE COUGH AND MAY HAVE A
TACHYCARDIA HEART RATE.
TX:
• TREAT THE ATHLETE FOR POSSIBLE SHOCK
• MONITOR VITAL SIGNS CONTINUOUSLY
• ARRANGE FOR TRANSPORT TO A MEDICAL
FACILITY
LIVER INJURIES…
• AIDS IN THE PRODUCTION OF PLASMA PROTEINS AND THE
DETOXIFICATION OF ALCOHOL AND OTHER SUBSTANCES.
• HAS DIGESTIVE FUNCTIONS.
• IT IS LOCATED IN THE UPPER RIGHT QUADRANT OF THE
ABDOMEN AND CAN BE SUSCEPTIBLE TO BLUNT TRAUMA IN
COLLISION SPORTS SUCH AS FOOTBALL.
• MAY BE IMPLICATED IF A RIB FX OCCURS IN THE UPPER RIGHT
ABDOMINAL QUADRANT.
• THE LIVER IS FAIRLY SAFE FROM INJURY ASSOCIATED WITH
SPORTS PARTICIPATION
KIDNEY INJURIES..
• SERVE TO MAINTAIN THE PROPER LEVELS OF WASTE,
GAS, SALT, WATER, AND OTHER CHEMICALS IN THE
BLOODSTREAM.
• LOCATED POSTERIORLY AND SOMEWHAT
INFERIORLY ON EACH SIDE OF THE ABDOMEN.
• ARE SUSCEPTIBLE TO INJURY FROM BLUNT TRAUMA
OR HEAT (VIA EXTREME EXERCISE IN THE HEAT).
• CAN EXPERIENCE ACUTE RENAL FAILURE, AND THE
KIDNEYS WILL CEASE TO FUNCTION.
KIDNEY INJURIES…
• AN ATHLETE WHO HAS HEMATURIA (BLOOD IN THE URINE) AFTER BEING HIT BY AN OPPONENT IN THE
LOWER BACK OR AFTER HAVING EXPERIENCED STRENUOUSLY IN THE HEAT SHOULD BE SEEN BY A
PHYSICIAN.
• BOTH OF THESE SCENARIOS CAN LEAD TO KIDNEY PROBLEMS OR DAMAGE.
• MANY TIMES, AN ATHLETE’S EXERCISE REGIMEN MUST BE MODIFIED UNTIL THE URINE IS ONCE AGAIN
CLEAR OF ANY BLOOD.
SPLEEN INJURIES…
• THE MAIN FUNCTION OF THE SPLEEN IS TO
MAINTAIN A RESERVE OF READY-TO-USE BLOOD
CELLS FOR THE BODY.
• IT IS LOCATED IN THE UPPER LEFT QUADRANT OF
THE ABDOMEN AND IS SOMEWHAT PROTECTED BY
THE RIBS ON THE LOWER LEFT SIDE.
• THE SPLEEN IS SUSCEPTIBLE TO INJURY FROM
BOTH BLUNT TRAUMA AND INTERNAL DISORDERS.
• AN ATHLETE WHO GETS HIT HARD IN THE ABDOMEN
OVER THE SPLEEN CAN SUFFER A LACERATED
SPLEEN.
SPLEEN INJURIES…
• NEVERTHELESS, THE SPLEEN HAS THE CAPACITY TO SPLINT OR PATCH ITSELF AT THE SITE OF THE INJURY
BECAUSE OF ITS RESERVOIR OF RED BLOOD CELLS.
• IF THE SPLEEN DOES PATCH ITSELF COMPLETELY AND THE ATHLETE IS ALLOWED TO CONTINUE PARTICIPATING,
THERE REMAINS THE POSSIBILITY THAT THE PATCH MAY BE DISRUPTED BY EVEN A SMALL AMOUNT OF
TRAUMA.
• THIS CAN ALLOW INTERNAL BLEEDING TO RESUME, AND DEATH CAN OCCUR EVEN AS LONG AS DAYS
AFTERWARD.
• IF AN ATHLETE IS HIT HARD IN THE UPPER LEFT QUADRANT AND LATER C/O PAIN IN THE ABDOMEN AND/OR LEFT
SHOULDER AND UPPER THIRD OF THE LEFT ARM THIS IS KNOWN AS KEHR’S SIGN.
SPLEEN INJURIES…
• ADDITIONALLY, IF THE ATHLETE IS SUFFERING FROM MONONUCLEOSIS, THE SPLEEN WILL PROBABLY BE
ENLARGED AND SUSCEPTIBLE TO INJURY NOT ONLY FROM BLUNT TRAUMA BUT FROM EXCESSIVE
MOVEMENT DURING SPORTS PARTICIPATION.
BLADDER INJURIES…
• THE BLADDER ACTS AS A RESERVOIR FOR THE URINE PRODUCED BY THE KIDNEYS.
• IT IS LOCATED UNDER THE MIDLINE OF THE ABDOMINAL QUADRANTS; THIS IS A WELL PROTECTED AREA,
AND THE BLADDER IS RARELY INJURED BY PARTICIPATION IN SPORTS AND ATHLETICS.
• IF THE ATHLETE RECEIVES A DIRECT BLOW TO THE AREA OF THE BLADDER AND INJURY DOES OCCUR, THE
SIGNS ARE PN IN THE LOCALIZED AREA AND POSSIBLY BLOOD IN THE URINE.
• AVOIDING INJURY TO THE BLADDER IS BEST ACCOMPLISHED BY EMPTYING IT BEFORE PRACTICE OR
COMPETITION.
ABDOMINAL PAIN…
• VARIOUS TYPES OF ABDOMINAL PN OCCUR IN ATHLETES BEFORE, DURING, AND AFTER COMPETITION.
• IF AN ATHLETE IS EXPERIENCING CHRONIC PN IN THE SAME LOCATION, THE ATHLETE SHOULD SEE A
PHYSICIAN AS SOON AS POSSIBLE.
• ANOTHER REASON FOR ABDOMINAL PN IS REFERRED PN, AS NOTED WITH THE SPLEEN.
• STOMACH PROBLEMS SUCH AS DODENAL ULCER ARE TYPICALLY LOCALIZED TO THE STOMACH AREA BUT
HAVE BEEN KNOWN TO PRODUCE LOWER BACK PN COMPLAINTS.
• SIMILARLY, LOW BACK PN CAN BE REFERRED TO OTHER REGIONS OF THE PELVIC AREA FROM PROBLEMS IN
THE LOW BACK OR ILIAC CREST REGIONS.
ABDOMINAL PAIN…
• EXERCISE-RELATED TRANSIENT ABDOMINAL PAIN (ETAP) IS A PROBLEM COMMONLY CALLED, “SIDE ACHE”
OR “STICH IN THE SIDE” BY ATHLETES.
• THIS PROBLEM TYPICALLY OCCURS DURING RUNNING EARLY IN AN EXERCISE REGIMEN OF AN
UNCONDITIONED ATHLETE.
• THE ACTUAL CAUSE OF THIS PROBLEM AS NOT BEEN EXACTLY DETERMINED, BUT DIFFERENT HYPOTHESES
HAVE BEEN PUT FORTH TO TRY TO EXPLAIN WHY THIS PROBLEM MIGHT OCCUR IN ATHLETES.
• SOME POSSIBLE EXPLANATIONS ARE ISCHEMIA IN THE DIAPHRAGM, STRESS ON THE VISCERAL
CONNECTIVE TISSUES, OR A CRAMPING OF THE LOCAL MUSCULATURE.
ABDOMINAL PAIN…
• PREEXISTING CONDITIONS OF THE CHEST THAT MAY DISQUALIFY AN ATHLETE FROM PARTICIPATION CAN
INCLUDE BUT ARE NOT LIMITED TO PROBLEMS SUCH AS HCM (ABNORMAL LEFT VENTRICLE GROWTH),
HEART MURMURS AND ARRHYTHMIAS, SIGNIFICANTLY DECREASED LUNG FUNCTION FROM DISEASE OR A
DISORDER SUCH AS CYSTIC FIBROSIS, OR CHRONIC OBSTRUCTIVE PULMONARY DISEASE.
• DISQUALIFYING FROM SPORTS PARTICIPATION BASED ON THESE CONDITIONS IS DEPENDENT ON THE
TYPE OF SPORT BEING CONSIDERED, THE AMOUNT OF STRESS THE ACTIVITY WILL PLACE ON THE
DEPENDENT STRUCTURES OR SYSTEMS, AND THE ABILITY TO CONTROL POTENTIAL PROBLEMS DURING
THE ACTIVITY.
CONCLUSION…
• ATHLETES WITH WHAT MIGHT BE CONSIDERED A SEVERE CARDIAC OR
RESPIRATORY DISORDER MAY BE ABLE TO PARTICIPATE IN SPECIFIC
ACTIVITIES DEPENDING ON THE CONTROL OF THEIR DISORDER, THE TYPE OF
ACTIVITY, AND THE WILLINGNESS OF THE PHYSICIAN TO HELP THE ATHLETE
MAKE THE NECESSARY ADJUSTMENTS FOR PARTICIPATION AT SOME LEVEL.