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ABDOMEN and THORAX

ABDOMEN: lies between the diaphragm and the pelvis and is bounded by the margin of the lower
ribs; superior border is the base of the ribs and the inferior border is the pelvic area (iliac spine); the
abdomen is divided into four quadrants:
upper right: liver, gall bladder, stomach, large and small intestine
upper left: stomach, pancreas, spleen
lower right: large and small intestine, ascending colon, appendix
lower left: large and small intestine, descending colon

Muscles include the rectus abdominus, external oblique, and internal oblique and each is involved
in trunk flexion, rotation, and lateral flexion. Another muscle, transverse abdominus (deepest of
abdominal muscles), holds the abdominal contents in place and aids in forced expiration. The
abdominal viscera are made up of hollow and solid organs. The hollow organs include the stomach,
intestines, gallbladder, and urinary bladder. The solid organs, which are more at jeopardy from an
injury, are the kidneys, spleen, liver, and pancreas.

The pelvic cavity lies next to the abdominal cavity and includes the reproductive system, urinary tract,
and parts of the low digestive system.

THORACIC CAVITY: housed within the thoracic vertebrae and the 12 pairs of ribs. The main
functions are to protect the vital respiratory and circulatory organs and assist the lungs in inspiration
and expiration. The first 7 ribs (sternal or true ribs) are attached to the sternum by a separate costal
cartilage. The 8th, 9th, and 10th ribs (false ribs) have cartilages that join each other and the 7th rib, while
the 11th and 12th ribs (floating ribs) remain unattached to the sternum but do have muscle attachments.
The boundaries of the thoracic cavity are:
posterior: mid spine
superior: shoulder girdle (clavicle area)
lateral: rib cage
anterior: ribs/sternum
inferior: diaphragm
Structures housed in the thoracic cavity include the heart, lungs, trachea, bronchii, esophagus, etc.

INJURIES TO ABDOMEN AND THORACIC CAVITY:

CONTUSIONS: not very common but will occur most often in collision sports or ones involving
sports implements or high-velocity projectiles. Remember, if there is a penetrating object, do not
remove. A contusion (esp. to the rectus abdominus) can be very disabling. Severity depends on the
amount of force and where it is located (bladder, kidney, rib, etc.):

BLOW TO THE SOLAR (CELIAC) PLEXUS: produces a transitory paralysis of the


diaphragm (wind knocked out) stopping respiration, leading to anoxia, which may lead to
hysteria. Care includes reassuring athlete, loosening clothing, bending knees to chest, and
encouraging the athlete to initiate short inspirations and long expirations. May lead to
hyperventilation.
KIDNEY CONTUSION: purpose is to excrete urine and to help in the regulation of water,
electrolyte balance, and acid-base content of the blood. A severe outside force, usually to
the back, may cause a contusion of the kidney. Pain may be felt high on the back and
radiate forward around the trunk into the lower abdominal region. After a blow to the
kidney, athlete should save their urine for the next two or three times and look for blood in
the urine (hematuria). If blood is present, refer to MD.

BLOW TO THE TESTICLES: (scrotal contusion) may produce an accumulation of fluids


causing pain, swelling in the lower abdomen, and nausea. Apply cold packs to the scrotum
and refer to MD. To relieve pain, have athlete lie on back and flex his thighs to his chest.

RIB CONTUSIONS: a blow to the rib cage may cause a contusion of the intercostal
muscles, a fracture (usually 4th -9th rib), or costochondral seperation resulting in pain, swelling,
hematoma, and difficulty breathing. Displaced fractured rib may result in some complications:

pneumothorax: air in the pleural cavity (membrane that surrounds the lungs); may
be spontaneous, appearing following activity or after a cough (more common in lean
males in early 20's) or traumatic, due to a punctured lung from rib fracture; may put
pressure on the heart causing tension pneumothorax. Signs and symptoms include rapid
and progressive dyspnea, chest pain, and shallow rapid breathing

hemothorax: bleeding in the pleural cavity. S/S include coughing up of red blood,
shock and cyanosis, and dyspnea

traumatic asphyxia: a blow to the rib cage resulting in a cessation of breathing; signs
include a purple discoloration of the upper trunk and head as well as subcutaneous
emphysema

STRAINS: a sudden twisting can result in a tear of an abdominal muscle causing severe pain and
hematoma formation. A hernia (protrusion of abdominal viscera through the abdominal wall) may
develop. Hernias may be congenital or acquired. An acquired hernia occurs when a natural weakness
is aggravated by either a strain or a direct blow. Can be recognized by the following:

1. previous history of a blow or strain to the groin area that has produced pain and
prolonged discomfort
2. superficial protrusion in the groin area that is increased by coughing
3. reported feeling of weakness and pulling sensation in the groin area

The most common hernia is in the groin area (inguinal and femoral hernias). Refer to MD.

STITCH IN THE SIDE: an idiopathic condition described as a cramplike pain that develops on either
side of the trunk during hard physical activity. May be due to:
1. constipation
2. intestinal gas
3. diaphragmatic spasm as a result of poor conditioning or lack of oxygen
4. ischemia of either the diaphragm or the intercostals
5. lack of visceral support because of weak abdominal muscles
6. distended spleen
7. overeating
Treatment includes relaxation of the spasm by either stretching the arm on the affected side as far as
possible or flexing the trunk forward on the thighs.

RUPTURED SPLEEN: solid organ filled with blood that stores blood and filters various bacteria and
other matter. Use "odd number rule" to describe the spleen: 1" x 3" x 5" in shape, weighs 7 ounces,
located between the 9th and 11th ribs. Injuries result from a fall that jars or a direct blow to the left
upper quadrant. Infectious mononucleosis will cause spleen to enlarge, predisposing to injury.
Symptoms must be recognized immediately or death may result. Indications of a ruptured spleen
include a blow to the abdomen, shock, abdominal rigidity, nausea, and vomiting. An associated sign is
Kehr's sign, a reflex pain that radiates to the left shoulder and down the left arm. The spleen has an
amazing ability to splint itself (stops bleeding), but any strain (cough, etc.) may cause it to start
bleeding days to weeks afterward. Ruptured spleen must be surgically removed.

OTHER CAUSES OF ABDOMINAL PAIN:


-indigestion or dyspepsia causes pain just below the sternum
-appendicitis creates pain at McBurney's point (1/3 of the distance between the
anterosuperior iliac spine and the umbilicus-lower right)

BREAST PROBLEMS: to prevent injuries to the breast area, a well designed bra that has minimal
elasticity and allows little vertical or horizontal movement as well as appropriate protective padding
should be worn. Injuries include bruises and strains that may stretch Cooper's ligament that may result
in premature sagging of the breasts.

BACK INJURIES:

LUMBAR HERNIATION (herniated disk): rupture or protrusion of the nucleus pulposus through
the annulus fibrosis. Most commonly in the L4 and L5 area. S/S include localized pain, radiating pain
down the legs, loss of skin sensation, muscle weakness. Refer to MD for further evaluation. Requires
either rest, exercises (lumbar stabilization) and/or surgery.

SPONDYLOLYSIS: defect in pars interarticularis; may be congenital or acquired


SPONDYLOLISTHESIS: forward slippage of a vertebra through the spondylitic defect; usually
between the 4th and 5th lumbar vertebra or 5th lumbar and the sacrum. Most common in gymnastics,
football, and weight lifting.
S/S include low back pain (esp. with hyperextension) with possible radiating pain.
Treatment: rest, drug therapy, bracing, restriction of activities, and possible spinal fusion.

STRAINS: low back pain; muscular injury in low back; congenital, direct blow or sudden twist
ASSESSMENT OF LOW BACK is extremely important and includes: major complaint,
general observation, kinetic observation (watch how they walk and sit), static postural
observation (look for obvious asymmetries from front, side, and back), a detailed
inspection while athlete is standing, supine, side lying, and prone, and a functional
evaluation (muscle strength, flexibility, sensation, and reflexes)
REHABILITATION:
1. Limitation of activity
2. Antiinflammatory and muscle relaxant medications
3. Cold and/or heat application and ultrasound
4. Passive exercise
5. Active progressive exercise (Williams flexion or McKenzie extension)
6. Relaxation training
7. Transcutaneous electrical nerve stimulation (TENS) application
8. Education for proper back usage
a. sleep on a firm mattress
b. sleep on side with legs curled up or on back with a pillow under knees
c. sit so that thighs are slightly elevated
d. stand with back flat and knees slightly bent
e. back firmly against the back of a chair
f. do not bend over without bending knees
g. do not twist trunk when placing a load down
h. carry heavy or bulky objects close to the body
i. lift heavy objects from the floor by keeping the back straight and
bending the knees
j. avoid carrying unbalanced loads

PREVENTING LOW BACK INJURIES:


1. correction, amelioration or compensation of functional postural deviations
2. maintenance or increase of trunk and general body flexibility
3. increase of trunk and general body strength