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Anatomy & Injuries to the
Abdomen & Thorax
SPORTS MEDICINE
SPAIN PARK HIGH SCHOOL
Anatomy
 Abdominal cavity
 Borders
Diaphragm superiorly
 Pelvis inferiorly
 Spine posteriorly
 Abdominal wall anteriorly

Anatomy
 Divided into 4 quadrants
 Line runs through navel at midline of body
 UL
 UR
 LL
 LR
Anatomy--Quadrants
 UL
 Stomach
 Part of liver & Pancreas
 Left kidney
 Spleen
 Parts of large & small intestine
Anatomy--Quadrants
 UR
 Liver
 Part of pancreas
 Right kidney
 Gall bladder
 Parts of large & small intestine
Anatomy--Quadrants
 LL
 Parts of Lg & Sm intestines
 Part of bladder
 Uterus-females
 Left ovary-females
 Prostate- males
 Ureter-male
Anatomy--Quadrants
 LR
 Parts of Lg & Sm intestines
 Appendix
 Part of bladder
 Uterus-female
 Right ovary-female
 Prostate-male
 Ureter-male
Anatomy
 Organs are part of:
 Urinary system


Digestive system


Kidneys, bladder
Stomach, liver, pancreas, gall bladder, large & small intestine,
spleen
Reproductive system

Uterus, ovaries, prostate, seminal vesicles
Anatomy
 Solid organs
 More often & easily injured
 Can cause rapid death due to large blood supply—internal
bleeding
 Spleen, liver, kidney, pancreas
 Hollow organs
 Injuries are rare because tubes are hollow—assist in
transporting substances from one organ to another
Digestive organs
 Digestion begins in mouth
 Stomach
 Secretes gastric juices that assist in breaking down food before
entering small intestine
 Liver
 Detoxifies chemicals that the body perceives as poisonous,
stores vitamins, produces bile, assists with food metabolism
 Gall bladder
 Storage tank for bile, which passes into sm intestine where it
assists in metabolism of fat
Digestive Organs
 Pancreas
 Produces insulin and enzymes for digestion
 Small intestine
 Completes 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 intestine
 All 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 organs
 Appendix
 Part of large intestine
 No known function
 Spleen
 Produces & destroys red blood cells
 Storage site for blood
 Aids in destruction of harmful microorganisms
Urinary system
 Kidneys
 Responsible for maintaining acid-base in body, which if
changed causes body system to shut down eventually resulting
in death
 Filter blood and remove waste products of metabolism to
maintain stable acid-base relationship
 If blood supply is inadequate, can cause hypertension from
chemical constriction of body’s blood vessels
 Bladder
 Holding tank for liquid waste in body
Reproductive system
 Females
 Ovaries


Produces eggs and estrogen (stimulates development of &
maintains feminine characteristics)
Uterus

Fertilized eggs develop here
 Males
 seminal vesicles
 Prostate gland

Responsible for adding fluid & nutrients to seminal fluid
Anatomy
 Pelvis
 Provides bony base and protection for internal organs
 Wider in females to accommodate childbirth
 Abdominal muscles
 Provides protection for organs
 Rectus abdominus gives “washboard” affect; attaches to
pelvis & lower ribs & sternum—trunk flexion
 Obliques (external & internal) attaches to lateral aspect of
lower ribs & runs diagonally to pelvis—flexion and rotation
 Transverse abdominus—holds internal organs in cavity
Pelvis
Muscles
Anatomy of thorax
 Part of body between neck & abdomen
 Contains heart & lungs
Anatomy
 Throat
 Carotid arteries
One on each side of trachea
 Carry oxygenated blood to brain


Jugular veins
One on each side of trachea
 Carry unoxygenated blood away from brain

Anatomy

Larynx
Modified upper part of trachea
 Contains vocal chords


Trachea
Made up of circular rings of cartilage
 Main trunk of system of tubes by which air passes to & from lungs
for exchange of CO2 and O2


Esophagus
Passageway for food going from the mouth to the stomach
 Sits in front of the cervical vertebrae and behind the trachea &
larynx

Anatomy of thorax
 Bony structures
 Thoracic vertebrae posterior
 12 ribs on each side
 Sternum anterior

Protects organs of thorax
Anatomy
 Heart
 Size of fist
 Pumps blood to all parts of body
 Divided into 4 chambers
 Right & left atrium


Upper chambers
Right & left ventricle
Lower chambers
 Larger with thicker walls

 Heart
 Pumps blood to lungs and throughout body
 Right atrium fills w/ blood from vein



Carries waste products and CO2
Right ventricle receives blood from atrium (through tricuspid
valve)
Pulmonary arteries carry UNOXYGENATED blood to lungs
 Heart
 Blood is mixed with O2 in the lungs
 OXYGENATED blood is carried back to heart by the
pulmonary veins
 Goes into the left atrium
 Flows to the left ventricle through the bicuspid valve
 Is pumped to the rest of the body through the aorta
 Heart
 Main branches (arteries) off the aorta
 Ascending and descending aortas
Carotid
 Subclavian
 Axillary
 Brachial

• Radial & ulnar

Common iliac
 Femoral
• Anterior & Posterior Tibial
 Veins
 Run parallel with the arteries
 Superior vena cava
 Inferior vena cava
 Two extra in arm
 Cephalic
 basilic
 Two extra in leg
 Greater saphenous
 Lesser saphenous
 Lungs
 Right has 3 lobes
 Left has 2 lobes
 Function:
 to exchange O2 and CO2
 To dissipate heat from the body
 Trachea divides into two bronchi
 Bronchi are filled with cilia

Hair like projections that help remove foreign substances like dust
& pollen
 Bronchi divide into bronchioles
 Bronchioles end in alveoli
 Alveoli 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 rate
 Lung function & breathing rate controlled by CO2
receptors
 If there is too much CO2, inhalation occurs to bring
in more O2
 Exercise increases cell metabolism

Causes cells to need more O2 and eliminate more CO2
Respiration Rate
 With exercise lungs’ ability to exchange
air more efficiently increases
 Breaths become deeper & more forceful
 Return to normal breathing quicker
 Pleura
 Thin lubricated tissue
 Lines each half of thorax
 Folded back over the surface of the lung on same side
 Allow for smooth movement of lungs as they encounter the
wall of ribs during inhalation & exhalation
Lungs
Lungs
Muscular Anatomy
 Intercostal muscles sit between ribs
 Internal and external intercostals
 Aid in inhalation and exhalation
Intercostal muscles
Intercostals
Abdominal & Thoracic Injuries
 Injuries are rare
 Solid organs most often injured
 Life threatening
Abdominal Strains
 Rectus abdominus most often injured
 Potentially can be incapacitating
 Mxn:
 sudden twisting of trunk or reaching overhead
 S/S:
 pain with movements of the trunk, POT over affected muscle,
tightness of muscles
 TX:
 ice, compression, gentle stretching, no exercise until ROM is
pain free
Abdominal contusions
 Not common but most likely to occur in collision
sports
 Mxn:

direct blow to abdomen, compressive force to abdominal wall
 S/S:
 pain, tightness, hematoma formation under the fascial tissue
surrounding muscle
 Tx:
 ice, compression, look for signs of internal injury, no activity
until pain free
Hernia
 Protrusion of abdominal viscera through a portion of
abdominal wall
 Those resulting from sports occur in groin area
 Inguinal hernias occur most often in men ( more
than 75%)
 Femoral hernias occur most often in women
Hernias
 Inguinal
 Results from abnormal enlargement of opening in inguinal
canal through which vessels and nerves of male reproductive
system pass
 Femoral
 Arises in canal that transports vessels & nerves that go the
thigh and lower limb
Hernias
 When 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
Hernias
 Mxn:
 improperly lifting a heavy object, increased abdominal
pressure, blow to groin area, weakness of abdominal wall
 S/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 area
 Tx:
 surgical repair
hernias
 Complications:
 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 Plexus
 Commonly known as “getting the wind knocked out”
 Mxn: blow to the middle of the abdomen or solar
plexus
 S/S: transitory paralysis of diaphragm, inability to
breath (inhale) or trouble breathing for a brief period
of time, cyanosis, short term panic
 Tx: calm athlete, loosen belt/clothing around
abdomen, bend knees, , control breathing-short
inspirations, long expirations
Blow to solar plexus
 Complications: fear of not being able to breath may
cause athlete to hyperventilate


Increased 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, feet
Care for hyperventilation:
Have athlete breath into a paper bag to increase levels of CO2 to
restore normal breathing
 If athlete does pass out, normal breathing should be restored

Stitch in Side
 Name given to an idiopathic condition that occurs in
some athletes
 Causes:








Constipation
Intestinal gas
Overeating
Diaphragmatic spasm as result of poor conditioning
Lace of visceral support because of weak abdominal muscles
Distended spleen
Breathing techniques that lead to lack of O2 in diaphragm
Ischemia of either the diaphragm or intercostal muscles
Stitch in Side
 S/S:
 Cramp like pain in side at either right or left costal border
during hard physical activity
 Tx:
 Relax the spasm
Stretch arm on affected side above the head and side bend to the
same side
 Flex the trunk over the thighs
 Ice
 If pain/spasm persists seek medical evaluation

Spleen injury
 Mxn:
 Direct blow to upper left quadrant
 Falling on UL quadrant
 Infectious mononucleosis causes enlarged spleen putting
athlete at risk

If 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 injury
 S/S:
 History of injury
 Signs of shock-dizziness, thirst, pale, sweating, rapid
pulse/respirations
 Abdominal rigidity
 Nausea
 Vomiting
 Kehr’s sign

Reflex (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 arm
 Referred pain—pain felt in one part of the body other than its
actual origin
Spleen injury
 Can hemorrhage profusely into abdominal cavity
causing athlete to die of internal bleeding days or
weeks after injury
 Tx:





Call 911, monitor athlete, conservative, non-operative
treatment with about 1 week of hospitalization
At 3 weeks can engage in light conditioning
Return to full activity at 4 weeks
If surgical repair is needed athlete will return to activity at 3
months
If surgical removal is necessary, return to activity at 6 months
Spleen injury
Kidney Contusion
 Mxn: blow to the back
 S/S:
 signs of shock
 nausea
 vomiting
 rigidity of muscles of back
 hematuria (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
urine
 Call 911 if necessary
 Treat for shock
 Immediate physician referral there is hematuria
 24 hour hospitalization for observation
 Gradual increase in fluid intake
 If hemorrhage fails to stop, surgical intervention
 Usually takes 2 weeks bed rest prior to return to activity
Kidney contusion
 Kidney contusion
Kidney Laceration
Liver Contusion/laceration
 Mxn:
 hard blow to right side of abdomen
 S/S:
 hemorrhage
 signs of shock
 referred pain
just below the right scapula
 right shoulder
 substernal area
 anterior left side of chest (occasionally)

Liver contusion/laceration
 Tx:
 Call 911
 Treat for shock
 Monitor athlete
 Immediate surgical intervention
Appendicitis
 Mxn:
 inflammation of appendix
 Chronic or acute
 Caused by fecal obstruction
 Initially appendix is red & swollen
 Can become gangrenous, rupture into bowels & cause
peritonitis
Appendicitis
 S/S:
 Mild to sever pain in lower abdomen
 Nausea
 Vomiting
 Low grade fever
 Cramps in lower right side
 Abdominal rigidity
 Referred pain is at McBurney’s point (between the ASIS and
the umbilicus)
Appendicitis
 Tx:
 Monitor athlete
 Refer when necessary
 Surgical removal of inflamed appendix
 Not an emergency unless there is a bowel obstruction
 An obstructed bowel, with an acute rupture is life-threatening

Highest incidence in males between ages of 15 & 25.
Appendicitis
Appendicitis
 Inflamed appendix
perforated appendix
Injuries to Bladder
Mxn:



blunt force to lower abdominal region if the bladder is
distended by urine
Hematuria associated with contusion of bladder during
running
Known as runner’s bladder
 S/S:
 blood in urine
 Referred pain to lower trunk, upper thigh anteriorly
 With rupture, athlete will be unable to urinate
Bladder injuries
 Tx:
 Monitor athlete
 Physician referral if necessary
Testicular/Scrotal contusion
 Due to considerable sensitivity & vulnerability,
contusions to the scrotum & testicles cause extreme
pain, nausea and disability
 Important for males to wear proper protection to
prevent incidence of contusions
 Mxn:
 direct blow to the genitalia
Testicular/Scrotal contusion
 S/S:
 hemorrhage
 fluid effusion
 muscle spasm
 Vomiting is severe
 Tx:
 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 Contusion
 Mxn:
 blow to rib cage
 S/S:
 sharp pain with breathing
 POT over contused area
 pain with compression of rib cage
 Tx:
 RICE
 NSAIDS
 cessation of activity until pain subsides
 self limiting
Rib Fractures
 Most common in collision sports
 Ribs 5-9 most commonly fractured
 Possibility of cause damage to or puncturing a lung
 Mxn:
 direct impact
 compression of rib cage
Rib Fractures
 S/S:
 severe pain during inspiration
 POT over fracture site
 Crepitus
 Pain with movement of trunk
Rib Fractures
 Tx:
 Refer for x-ray
 ice
 Support
 Rest
 Heal within 3-4 weeks
 Rib brace may offer some stabilization and comfort
Rib Fractures
Costal Cartilage Injury
 More common than rib fractures
 Mxn:
 direct blow to thorax
 Indirectly from sudden twist of fall on a ball compressing the
rib cage
Costal cartilage injury
 S/S:
 similar to rib fracture except pain is localized in the junction of
the rib cartilage and the rib
 Sharp pain during sudden movements
 Difficulty in breathing deeply
 POT with swelling
 Rib deformity
 Ribs make crackling noise (crepitus) as it moves in and out of
place
Costal cartilage injury
 Tx:
 Ice
 Rest
 Immobilization with rib brace
 1-2 months healing time
Costal cartilage injury
Intercostal Muscle Strain
 Mxn:
 Direct blow
 Sudden torsion of trunk
 S/S:
 Pain w/ active motion
 Pain w/ inspiration/expiration, laughing, coughing, sneezing
 Tx:
 Ice
 Compression
 Immobilization for comfort
Lung Injuries
 Injures to lungs are rare but can be life threatening
 Pneumothorax
 Tension Pneumothorax
 Hemothorax
 Traumatic asphyxia
Pneumothorax
 Condition in which pleural cavity surround lung
becomes filled w/ air that has entered through an
opening in the chest
 As pleural cavity fills with air, lung on that side
collapses
Tension pneumothorax
 Occurs 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
Hemothorax
 Presence of blood within the pleural cavity or pleural
tissue involving the blood vessels in the area
Traumatic asphyxia
 Occurs 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 injuries
 S/S:
 Difficulty breathing
 Shortness of breath
 Chest pain on side of injury
 Coughing up blood
 Cyanosis
 shock
 Tx:
 Call 911
 Monitor athlete
 Treat for shock
Pneumothorax
Pneumothorax
Tension pneumothorax
Hemothorax
Sudden Death Syndrome
 Athletes 35 years and younger
 Most common cause of death is congenital
cardiovascular abnormality
 3 prevalent causes:



Hypertrophic cardiomyopathy (HCM)
Anomalous origin of the coronary artery
Marfan’s syndrome
Hypertrophic Cardiomyopathy
 Condition in which there is thickened cardiac muscle
with no evidence or chamber enlargement or
extensive myocardial scarring
Anomalous origin of coronary artery
 One of the two coronary vessels originates at a
different site than normal
 This compromises or obstructs the artery because of
its unusual course
Marfan’s syndrome
 Abnormality 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 death
 Results from atherosclerosis which causes a
narrowing of the coronary arteries due to
hypercholesterolemia in the young athlete
Sudden death
 S/S:
 chest pain or discomfort during exertion
 Heart palpitations or flutters
 Syncope
 Nausea
 Profuse sweating
 Heart murmurs
 Shortness of breath
 General malaise
 Fever
Sudden death
 Tx:
 Life-threatening
 Call 911
 Be prepared to perform CPR
 Have AED ready to use
 Early detection/screening/identification could
prevent sudden death from occuring