Injuries to the Thorax and Abdomen

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• Injuries to the Thorax and Abdomen

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Anatomy

• Thoracic cage
• 12 pairs of ribs -- first 7 pair connect directly
  to sternum
• major joints include
• sternoclavicular
• sternocostal
• costochondral
• intervertebral
• vertebral/rib

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Anatomy

• Muscles of the trunk (anterior group)
• intercostals
• pectoralis major minor
• rectus abdominis
• internal/external obliques
• serratus anterior

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Anatomy

• Muscles of the trunk (posterior view)
• erector spinae
• trapezius
• rhomboids
• latissimus dorsi
• teres major
• semispinalis capitis
• semispinalis cervicis

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• Major structures
• heart pericardium
• lungs pleura
• thoracic aorta
• pulmonary artery veins
• vena cava
• trachea esophagus

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Anatomy

• Abdominal quadrants (major structures)

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Common External Injuries

• Fractures - ribs, sternum or clavicle
• typical mechanism involves direct blows to chest
  wall
• Joint dislocations/subluxations
• similar mechanism as for fractures
• external blow to chest wall
• intense contractions of large muscles such as
  those of the pectoral region

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Common External Injuries

• Signs/symptoms (fractures)
• extreme localized pain
• mild swelling
• breathing difficulties (possible pneumothorax)
• holding the injured area

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• Signs/symptoms (dislocations/Subluxations)
• localized pain
• mild swelling
• breathing difficulties
• holding injured area
• First Aid (for fractures dislocations/subluxati
  ons)
• monitor vital signs
• treat for shock
• apply ice
• transport to medical facility

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 Severe Fracture Treated with Open Reduction and
Internal Fixation
Severe Clavicle Fracture                                                                              
X-ray immediately after fixation with a plate and screws                                                                                                                                                           
X-ray 10 weeks after surgery (Notice new bone formation at arrow tips)                                                                              

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Internal Injuries to the Thorax and Abdomen

• Heart and lung injuries
• While rare, contusions to the chest wall can
  bruise the heart, resulting in death.
• pulmonary contusions uncommon in sports
• traumatic and/or spontaneous pneuomothorax
• Both may be related to direct blows to the chest.

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• Hemothorax
• occurs when lung tissue is punctured by rib
  fracture
• Can be life threatening
• Signs/symptoms
• severe pain in chest
• breathing problems (dyspnea)
• blood in sputum (differentiate from wounds in
  mouth)
• may indicate bleeding within the chest cavity
• First Aid
• treat for shock
• monitor for vital signs
• transport to medical facility immediately

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Internal Injuries to the Thorax and Abdomen

• Liver, kidneys, spleen and bladder
• Liver
• susceptible to blunt trauma
• Diseases such as hepatitis make liver more
  vulnerable.
• Heavy consumption of alcohol and/or use of
  steroids enlarges the liver.
• kidneys
• susceptible to blunt trauma directed at the back
  of the torso (lumbar area)
• may also be injured as a result of heat stroke
• Be alert for hematuria (educate the athlete).

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Internal Injuries to the Thorax and Abdomen

• spleen
• susceptible to blows in the LUQ
• serves as a reservoir for RBCs
• has an ability to splint itself when lacerated
• be on the alert for a Kehrs sign
• mononucleosis -- MUST be cleared by a physician
  to return to participation
• bladder
• not commonly injured in sports
• encourage athletes to empty their bladder prior
  to participation