The Thorax and Abdomen

Question 1

Thoracic Cavity

Answer 1

Commonly known as the chest, which lies between the base of the neck and the diaphragm. It consist of the thoracic vertabrae, the 12 pairs of ribs with their associated costal cartilages, and the sternum.

Its main functions are to protect the vital respiratory and circulatory organs and to assist the lings in inspiration and expiration during breathing.

Question 2

Ribs

Answer 2

Upper 7 = Sternal/True ribs because each rib is joined to the sternum by a separate costal cartilage.

8-10 = False ribs have a common cartilage that joins the 7th rib before attaching to the sternum.

11th and 12th = Floating ribs that are unattached to the sternum (they do have muscle attachments).

Question 3

External Intercostal Muscles

Answer 3

Elevate the diaphragm during inspiration.

Question 4

Internal Intercostal Muscles

Answer 4

Depress the rib cage to assist with expiration.

Question 5

Rib Contusion

Answer 5

Blow to the rib cage.

Sx's:
Painful breathing (particularly if muscles are involved).
Point tenderness.

Management:
RICE and NSAID’s
Rest and decrease in activity.

Question 6

Rib Fractures

Answer 6

Direct blow or result of violent muscular contraction.
Can be caused by violent coughing and sneezing

Signs and Sx’s:
History is critically important.
Pain with inspiration, point tenderness and possible deformity with palpation.

Management:
refer for x-rays
Support and rest/brace.

A big concern with a rib fracture is a rib that can puncture an organ.

Question 7

Flail Chest

Answer 7

3+ consecutive ribs are fractures.

Question 8

Costochondral Separation

Answer 8

Direct blow to the anterolateral aspect of the rib cage.

Sign’s and Sx’s:
Localized pain at the costochondral junction.
Pain with movement; difficulty breathing
Point tenderness and possible deformity.

Management:
Rest and immobilization
Healing may take 1-2 months (a very slow healing process).

Question 9

Sternum Fractures

Answer 9

Caused by a high impact blow to the chest. Underlying cardiac muscles may also by contused.

Sign’s and Sx’s:
Point tenderness over the sternum.
Pain with deep inspiration and forceful expiration.
Signs of shock, or weak rapid pulse may indicate more severe injuries.

Management:
Refer for x-ray.
Monitor athlete for signs of trauma to the heart.

Question 10

Muscle Injuries

Answer 10

Direct blows or sudden torsion of the trunk

Sign’s and Sx’s
Pain with active motions
Pain with inspiration and expiration, coughing, sneezing or laughing.

Management:
Immediate pressure.
Application of cold.
Immobilize the injury for athlete comfort.

Question 11

Lung Injuries

Answer 11

Pneumothorax
Tension Pneumothorax
Hemothorax.
Traumatic Asphyxia

Management:
Medical emergencies that require immediate attention.
Transport Immediately

Question 12

Hyperventilation

Answer 12

Anxiety, stress or asthma induced.
Develop a decreased amount of carbon dioxide relative to oxygen.

Sign’s and Sx’s
Difficulty inhaling and struggling to breath
In a panic state
Gasping and wheezing.

Management:
Decrease rate of carbon dioxide loss
Slow down respiration rate
Breath into a bag
Normal respiration should return within 1-2 minutes
Initial cause must be determined.

Question 13

Sudden Cardiac Death Syndrome

Answer 13

Look at slides.

Question 14

Commotio Cordis

Answer 14

A syndrome resulting in cardiac arrest due to traumatic blunt impact to the chest. It is an unfortunate timing relative to re-polarization phase of the cardiac cycle. Younger athletes are at risk.

Signs and Sx’s
Ventricular fibrillation.

Management:
Resuscitation of victim is seldom successful.
Early de-fibrillation with AED and resuscitation is critical.

Question 15

Heart Contusion

Answer 15

Compression between sternum and spine - could cause an aortic rupture.

Sign’s and Sx’s:
Severe shock and heart pain
Heart may exhibit arrhythmias causing a decrease in cardiac output, followed by death if medical attention is not administered.

Management:
Immediate referral to an emergency room
Prepare to administer CPR and treat for shock.

Question 16

Kidney Contusion

Answer 16

Caused by an external force (force and angle dependent). Susceptible to injury due to normal distention of blood.

Sing’s and Sx’s
May display signs of shock
Nausea, vomiting, rigidity or back muscles and hematuria (blood in the urine).
Referred pain (costovertebral angle posteriorly radiating forward around the trunk).

Management:
24 hour observation and gradual increase of fluid intake.
Surgery required if hemorrhage fails to stop.
Bed rest and close observation after activity resumes.

Question 17

Kidney Stones

Answer 17

Cause is unknown. They may be small (grain of sand), large (marble sized), smooth or jagged.
May remain in kidney causing blockage and pressure in renal system.
Very painful if stone dislodges and travels through urinary system.

Sign's and Sx's
Sudden, sharp, severe pain.
Referred pain in low back, flank and groin.
Nausea and vomiting
Cool, clammy, pale and sweaty skin
Burning upon frequent urination
May be blood in urine.

Management:
Fluids - especially water
Analgesics for pain
In 80-85% of cases smaller stones move through ureter into the bladder and are excreted.
Larger stones may require surgery for removal or a procedure to break up the stone.

Question 18

Contusion of Ureters, Bladder and Urethra

Answer 18

Blunt force to the lower abdomen may avulse ureter or contuse/rupture the bladder.
Hematuria is often associated with contusion of the bladder during running.

Sign’s and Sx’s:
Pain
Discomfort in the lower abdominal area.
abdominal rigidity, nausea, vomiting, shock, bleeding from the urethra, increased quantity of bloody urine. Inability to urinate sign of ruptured bladder.
Referred pain to the low back and trunk, anterior upper thigh and suprapubically.

Prevention
Monitor for blood in urine
Empty the bladder prior to practice or competition.
Wear protective equipment.

Question 19

GI Bleeding

Answer 19

Distance running, gastritis, iron deficiency anemia, ingestion of aspirin or NSAID’s, stress, bowel irritation and colitis.

Sign’s and Sx’s:
Blood in stool
Abdominal pain, watery stool, dehydration, intermittent fever (if colitis is involved).

Management:
Refer to a physician.
Any suspicions to an injury to organs always refer.

Question 20

Liver Contusion

Answer 20

Blunt Trauma, more susceptible if enlarged (hepatitis).

Sign’s and Sx’s:
Hemorrhaging and shock may be present.
May require immediate surgery.
Referred pain in the right scapula, shoulder and substernal area
Occasionally referred pain in left anterior side of chest.

Management:
Referral to a physician

Question 21

Indigestion (Dyspepsia)

Answer 21

Food idiosyncrasies which cause distress after eating.
Reaction before competition.
Emotional stress, esophageal and stomach spasms, or inflammation mucous linings in stomach and esophagus

Management:
Elimination of irritating foods.
Development of regular eating habits
Avoidance of anxieties that cause gastric distress
If problems persist, refer.

Question 22

Appendicitis

Answer 22

You don’t want the appendix to rupture.

Inflammation of the vermiform appendix.
Can be chronic or acute
Blockage, swelling or lymph or carcinoid tumor
Early stages presents as a gastric distress
Gradually develops into a gangrenous structure that can rupture causing peritonitis.

Question 23

Appendicitis Sign’s/Sx’s and Management

Answer 23

Mild to severe pain in lower abdomen.
Nausea vomiting and low grade fever
Pain localized in lower right abdomen.

Management:
Surgical intervention.

Question 24

Scrotal Contusion

Answer 24

Caused by blunt trauma.

Sign’s and Sx’s:
Hemorrhaging, fluid effusion, muscle spasm, severe disabling pain.

Management:
Reduction of testicular spasm
-With pt seated, lift and drop pt a few inches.
-Patient brings knees to chest and performs a valsalva maneuver.
Application of cold pack
unresolved pain after 15-20 minutes requires referral to a physician.

Question 25

Spermatic Cord Torsion

Answer 25

Testicle revolving in the scrotum following a direct blow or as the result of coughing or vomiting.

Sign’s and Sx’s:
Acute testicular pain.
Nausea, vomiting and inflammation in the area.

Management:
Immediate referral to prevent irreparable damage.

Question 26

Contusion of the Female Genitalia

Answer 26

Low incidence of injury in sports caused by blunt trauma.

Sign’s and Sx’s:
Hematoma may form
Public Symphysis
Osteitis Pubis: Inflammation

Question 27

Injury of the Spleen

Answer 27

Direct blow or infectious mononucleosis.

Sign’s and Sx’s:
History of a direct blow, signs of shock, abdonminal rigidity. nausea and vomiting.
Kehr’s sign: left Shoulder

Management:
Conservative treatment involves 1 week of hospitalization and gradual return to activity..
Surgery requires three months of recovery time.
Removal of spleen requires 6 months of recovery time with no activity.

Question 28

Abdominal Muscle Strain.

Answer 28

Sudden twisting or reaching with trunk.

Sign’s and Sx’s
Severe pain and possible hematoma formation
Rectus abdominus most commonly injured.

Management:
Ice and compression
Exercises within pain free limits.

Question 29

Contusions of Abdominal Wall

Answer 29

Compressive force - collision sports. The extent of the injury depends on whether fore is blunt or penetrating.

Sign’s and Sx’s:
May cause a hematoma to develop under fascia of surrounding muscle tissue.
Swelling may cause pain and tightness within the area.

Management:
Cold pack and compression
Check and monitor for signs of internal injuries.

Always look for injury to internal organs.

Question 30

Hernia

Answer 30

rotusion of abdonminal viscera through portion of abdonmial wall (congenital or aquired).
Inguinal vs. Femoral hemias
Complications and strangulated ernias.

Sign's and Sx's
Acquired hernia occurs when inherent weakness is further aggravated by a direct blow of strain.
-History of direct blow to groin area
-Pain and prolonged discomfort
-Superficial protrusion
-Pain increases with coughing
-Pulling sensation in groin area.

Management:
Mechanical devices not suitable for athletics due to friction and irritation.
Surgery is preferred method of treatment.

Question 31

Blow to Solar Plexus

Answer 31

Transitory paralysis of the diaphragm due to a direct blow.

Sign’s and Sx’s:
Stops respiration and causes anoxia.
Generally transitory.

Management:
Overcome apprehension
Control  breathing
Use short inspiration and long expiration
Calm athlete, prevent hyperventilation.
Check and monitor for internal injury.

Question 32

Stitch in the Side

Answer 32

Idiopathic condition
Potential causes include:
-constipation, intestinal gas, overeating
-Diaphragmatic spasm
-Poor conditioning, lack of visceral support and weak abdominals.
-Distended spleen
-Breathing techniques resulting in lack of oxygen
-Ischemia of diaphragm or intercostal muscles.

Question 33

Stitch in the Side Sign’s/Sx’s and Management

Answer 33

Cramp-like pain.
Develops on right of left costal angle during hard physical activity.

Management:
Relax spasm
-Stretch arm on affected side
-Flex Trunk
Monitor.