Abdominal and Thoracic Injuries

• Abdominal and thoracic injuries:

  • due to high velocity sports, being struck, inadequate equipment
  • injury to abdomen = rare (10% of all athletic injuries)
  • includes spleen, liver, kidney, bladder
• Thorax:

  • from neck to diaphragm
  • made of spine, ribs, and sternum
  • function = protect cardiovascular and respiratory organs
• Thoracic injuries:

  • due to blunt trauma
  • also due to forceful contractions
  • rib injuries are common (painful and debilitating)
  • heart and lung injuries = less common
• Rib contusions:

  • like a bruise
  • blow to the front or side = rib contusion
  • blow to back = paraspinal contusion
  • local pain (during inspiration and palpitation)
  • manipulation of rib through ring will not increase pain (indirect test)
• Rib fractures:

  • direct or indirect
  • occurs at site of trauma or away from impact
  • ribs 5-9 most commonly injured due to rigid fixation
  • ribs fracture at weakest point (angle of rib)
  • displaced (examine internal structures) or undisplaced
  • spleen trauma in 20% of lower left rib fractures
  • liver trauma in 10% of lower right rib fractures
• Symptoms and signs of rib fractures:

  • pain with coughing, inspiration, and trunk movements
  • visible contusion and palpable crepitus
  • athlete is splinting/leaning toward injury
  • pain with manipulation of ring
• Intercostal muscle strain:

  • most common
  • due to violent external forces/trauma/overstretching via rotation
• Intercostal muscle strain symptoms and signs:

  • pain with inspiration and movement
  • no pain with pressure through ring
  • positive STTT
  • tender with palpitation between ribs
• Managing rib injuries:

  • x-ray if fractured
  • POLICE/PEACE/LOVE
  • stabilize/wrap (may cause hypostatic pneumonia)
  • pad for return to play
  • 4-8 weeks
• Lung injuries:

  • not common
• Pneumothorax:

  • air enters pleural cavity
  • can progress to complete lung collapse
  • difficulty breathing
  • shortness of breath
  • cyanosis
• Tension pneumothorax:

  • pleural sac fills with air until lung collapses
  • displaces lungs and heart to the side
  • trachea may deviate
  • critical
• Hemothorax:

  • blood in pleural cavity
  • with or without rib fracture
  • difficulty breathing
  • shortness of breath
  • cyanosis
  • coughing up frothy pink blood
• Commotio cordis:

  • blunt trauma over heart during repolarization
  • causes cardiac arrest
  • young athletes more at risk
  • immediate death in 50% of cases
  • resuscitation = rarely successful
  • get AED ASAP
  • defibrillation within 1 minute = 90% survival rate
  • within 3 minutes = 25%
  • after 3 minutes = 3%
• Abdomen:

  • between diaphragm and pelvis
  • lined by parietal peritoneum
  • organs covered in visceral peritoneum
  • makes a cavity for organs to move around (also enough room to bleed to death)
  • injury to abdominal wall = local pain
  • injury to viscera = referred pain
• Abdominal wall injuries:

  • muscular contusions
  • local pain and tenderness
  • increase pain on contraction
  • internal bleeding = wall will not relax
  • no referred pain
  • treat with cold pack and compression
• Abdominal wall injuries:

  • muscle strain
  • rectus abdominus most common
  • lower rib origin or pubic insertion
  • maybe periosteum of pubic rami or osteitis pubis
  • seen with external or internal obliques
  • due to violent contraction or twisting or microtrauma
  • pain and spasm at site of injury
  • STTT positive
• Solar plexus contusion:

  • nerves under diaphragm
  • trauma to relaxed abdominal wall or back
  • temporary paralysis of diaphragm
  • wind knocked out of you
  • minimize restrictive clothing
  • flex hips and bring knees to chest
  • slow expiration and short inspiration
• Intra-abdominal injuries:

  penetrating:

  • not common
  • usually superficial
  • leave object
  • control bleeding

  blunt:

  • most common
  • severity can vary
  • possible peritoneal irritation
• Right upper quadrant:

  • liver
  • right kidney
  • gall bladder
  • colon
  • pancreas
• Left upper quadrant:

  • stomach
  • left kidney
  • spleen
  • colon
  • pancreas
• Right lower quadrant:

  • appendix
  • colon
  • small intestine
  • ureter
  • major artery and vein to right leg
• Left lower quadrant:

  • colon
  • small intestine
  • ureter
  • major artery and vein to left leg
• Midline:

  • aorta
  • pancreas
  • small intestine
  • bladder
  • spine
• Peritoneal irritation:

  • abdominal rigidity
  • guarding/splinting
  • referred pain
  • loss of bowel sounds
  • due to blood in peritoneal cavity or viscera
• Spleen:

  • located deep to left 9-11 ribs in left upper quadrant
  • injured with blunt trauma or rib fracture
  • slow onset
  • pain in left upper quadrant and left shoulder due to diaphragmatic irritation
  • spleen’s capsule contains bleeding
  • most frequently injured organ in sport
  • most common cause of death in athletes
• Liver:

  • second most common
  • located in right upper quadrant
  • referred pain in right shoulder and scapula
  • maybe some nausea and vomiting
  • bruised = no peritoneal signs
  • lacerated = peritoneal signs
• Kidney:

  • MOI = blunt trauma to flank or abdomen
  • upper half of kidneys located above 12th rib
  • flank/lower back pain, tenderness, bruising/hematuria
• Bladder:

  • protected by pelvic ring
  • decreased trauma with empty bladder
  • blunt trauma over pubic rami
  • inability to pee
  • tender over supra-pubic region
  • visible bruising
  • hematuria