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Chapter 21 The Thorax and Abdomen

CHAPTER 21
The Thorax and Abdomen
OVERVIEW

Although fewer sports injuries occur to the trunk region compared with injuries to
the upper and lower limbs, injuries in this region may be life threatening or may
cause major long-term disability. It is vitally important to have a good understanding
of the characteristics of each of the major organs of the thorax and abdominal
cavity and know what injuries are potentially serious and how to properly manage
them.

LEARNING OBJECTIVES

After studying Chapter 21, the student will be able to:

Identify the bony anatomy of the thorax.


Identify the different injuries that occur to the breast region in athletes.
Identify the hollow and solid organs.
Describe the referred pain patterns for injury to the spleen, kidneys, liver,
appendix, and bladder.
Describe the common causes of exercise-induced sudden death.
Identify the anatomy of the abdomen and the abdominal muscles.
Explain how to care for a stitch in the side and an injury to the solar plexus.
Explain how to care for an athlete with a testicular contusion.
Differentiate between rib contusions, rib fractures, and costal cartilage injuries.
Describe pneumothorax, tension pneumothorax, and hemothorax.

KEY TERMINOLOGY
Board-like rigidity - Hardness in the abdomen that cannot be voluntarily relaxed
CAD Coronary Artery Disease
Dyspnea - Difficult breathing
Hematuria - Condition in which blood is found in the urine which may be indicative
of kidney damage or other internal trauma
Hemothorax - Condition in which there is a collection of blood in the pleural cavity
Hernia - Protrusion of abdominal viscera through a portion of the abdominal wall
Hypertrophic cardiomyopathy A condition in which there is thickened cardiac
muscle with no evidence of chamber enlargement and extensive myocardial
scarring
Kehrs sign - Pain that radiates to the left shoulder and one third the way down
the arm associated with an injury to the spleen
McBurneys point - One-third the distance between the anterosuperior iliac spine
and the umbilicus, associated with appendicitis
Peritoneum - Serous membrane lining the abdominal-pelvic walls and investing the
viscera
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Chapter 21 The Thorax and Abdomen

Pneumothorax - Collapse of one of the lungs by the pleural cavity becoming filled
with air that has entered through an opening in the chest
Solar plexus - The middle portion of the abdomen
Tension pneumothorax Pleural cavity on one side fills with air and displaces the
lung and heart towards the opposite side, thus compressing the opposite side
Traumatic asphyxia - Cessation of breathing resulting from direct trauma to the rib
cage or abdominal region. This condition requires immediate mouth-to-mouth
resuscitation and medical attention.
Viscera - Internal abdominal organs

DISCUSSION QUESTIONS
1. What muscles protect the abdominal viscera?
2. What organs are in the abdominal viscera? What injuries can occur to each
organ? Which organ injuries can be life-threatening?
3. What are some common intra-abdominal conditions? How are they managed?
4. What are some common injuries to the genitourinary system? How are they
managed?
5. What other conditions might produce pain in the abdominal region?
6. What structures make up the thorax?
7. What are some soft tissue and bony injuries that can occur in the thoracic
region? How are they managed?
8. What internal complications can occur as a result of sports trauma?
9. Differentiate between rib contusions, rib fractures, and costochondral
separations.

CLASS ACTIVITIES
1. Invite a local physician to speak about the variety of problems that can occur
concerning the internal organs and the importance of recognizing them quickly
and seeking proper medical attention.
2. Present the signs and symptoms of particular conditions and have the students
identify probable injuries or syndromes.
3. Have students select one visceral organ and discuss its functions, how it may be
traumatized, signs and symptoms of injury, why pain may be referred to another
site in the thorax or abdomen, treatments, and what complications can result if
the injury is mismanaged. They may also want to discuss whether athletes are
adequately protected against injuries to this area.

WORKSHEET ANSWERS
Matching
1.
2.
3.
4.

d
e
a
j

5.
6.
7.
8.

h
g
b
c

9. i
10. f

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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 21 The Thorax and Abdomen

Short Answer
11.Inguinal and femoral
12.Refer immediately to a physician
13.Previous history of a blow or strain to the groin area that has produced pain and
prolonged discomfort, superficial protrusion in the groin area that is increased by
coughing, or reported feelings of weakness and a pulling sensation in the groin
area
14.Infectious mononucleosis
15.Reflex pain occurring about 30 minutes after the injury, which radiates to the left
shoulder and one third of the way down the left arm. Spleen
16.Shock, nausea, vomiting, rigidity of the back muscles, and hematuria (blood in
the urine). Pain may radiate forward around the trunk into the lower abdominal
region.
17.Commonly causes referred pain to the lower trunk including the upper thigh
anteriorly. With a bladder rupture, the athlete will be unable to urinate. Should
also check for blood in the urine.
18.McBurneys Point is an area between the anterior superior iliac spine of the ilium
and the umbilicus. Appendicitis
19.Its main function is to protect the vital respiratory and circulatory organs and to
assist the lungs in inspiration and expiration during the breathing process
20.Hyperventilation is an increased rate of ventilation that results in increased
levels of oxygen and decreased levels of carbon dioxide; have the athlete slowly
breathe into a paper bag to increase carbon dioxide levels.
21.The floating ribs are the 11th and 12th ribs; they are not attached to the sternum.
22.The athlete should be placed on his side and instructed to flex his thighs to his
chest.
Listing
23.Kidneys
24.Spleen
25.Liver
26.Pancreas
27.Adrenal glands
28.Hypertrophic cardiomyopathy
29.Anomalous origin of the left coronary artery
30.Marfans syndrome
Essay
31-33.Rib contusion: Athlete will have pain with both inspiration and expiration.
Rib fracture: Athlete will complain of severe pain with inspiration.
Costal cartilage injury: Sharp pain during sudden movement of the trunk
and difficulty in breathing deeply.
34-38.A stitch in the side is a cramp-like pain that develops on either the left or
right costal border with hard physical activity. Can be caused by any of the
following (constipation, intestinal gas, overeating, diaphragmatic spasm due
to poor conditioning, lack of visceral support due to weak abdominals,
distended spleen, breathing techniques that lead to lack of oxygen in the
diaphragm, and ischemia of diaphragm or intercostals muscles). Treatment
consists of stretching the arm on the affected side as high as possible or by
flexing the trunk forward on the thighs.
39-41.Pneumothorax: Pleural cavity surrounding the lung becomes filled with air
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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 21 The Thorax and Abdomen

that has entered through an opening in the chest; the lung on the side that
fills with air collapses.
Tension Pneumothorax: Pleural cavity on one side fills with air and
displaces the lung and the heart towards the opposite side, thus compressing
the opposite lung.
Hemothorax: Presence of blood within the pleural cavity resulting from the
tearing or puncturing of the lung or pleural tissue and involving the blood
vessels in the area.

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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 21 The Thorax and Abdomen

NAME ______________________________
SECTION__________

CHAPTER 21 WORKSHEET
The Thorax and Abdomen
MATCHING: Match each structure with the appropriate name.
_____ 1. Sternal angle
_____ 2. Sternal body
_____ 3. Clavicle
_____ 4. Costal cartilage
_____ 5. False ribs
_____ 6. Floating ribs
_____ 7. Jugular notch
_____ 8. Manubrium
_____ 9. True ribs
_____10. Xiphoid Process

SHORT ANSWER: Answer the following questions with a brief response.


11.What are the two types of hernias?
12.What is the general rule for any suspected internal injury?
13.How can an acquired hernia be recognized?
14.What disease may enlarge the spleen and predispose it to blunt trauma?
15.What organ injury is it related to Kehrs sign?
16.What are the signs of a kidney injury?
17.What are the signs of an injury to the bladder?
18.Where is McBurneys Point, and what condition does it signify?
19.What are the main functions of the thorax?
20.What is the cause of hyperventilation and how is it treated.
21.Which ribs are known as the floating ribs? Why?
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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 21 The Thorax and Abdomen

22.What is the recommended technique for relieving testicular spasm?


LISTING
List the five solid organs of the human body.
23.
24.
25.
26.
27.
List the possible causes of sudden death syndrome among athletes.
28.
29.
30.
ESSAY
31-33.Differentiate between the signs of a rib contusion, a rib fracture, and a
costocartilage injury.

34-38.Describe a stitch in the side, give two causes, and explain the immediate
treatment.

39-41.Define the following lung injuries.


Pneumothorax:
Tension pneumothorax:

Hemothorax:

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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.