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Injuries to the Thorax and Injuries to the Thorax and AbdomenAbdomen

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AnatomyAnatomy Thoracic cageThoracic cage

12 pairs of ribs 12 pairs of ribs -- first 7 pair -- first 7 pair connect directly connect directly to sternumto sternum

major joints major joints include:include:

sternoclavicularsternoclavicular sternocostal sternocostal costochondralcostochondral intervertebralintervertebral vertebral/ribvertebral/rib

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AnatomyAnatomy Muscles of the Muscles of the

trunk (anterior trunk (anterior group)group) intercostalsintercostals pectoralis major pectoralis major

& minor& minor rectus abdominisrectus abdominis internal/external internal/external

obliquesobliques serratus anteriorserratus anterior

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AnatomyAnatomy

Muscles of the trunk Muscles of the trunk (posterior view)(posterior view) erector spinaeerector spinae trapeziustrapezius rhomboidsrhomboids latissimus dorsilatissimus dorsi teres majorteres major semispinalis capitissemispinalis capitis semispinalis cervicissemispinalis cervicis

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Major structuresMajor structures heart & pericardiumheart & pericardium lungs & pleuralungs & pleura thoracic aortathoracic aorta pulmonary artery & pulmonary artery &

veinsveins vena cavavena cava trachea & esophagustrachea & esophagus

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AnatomyAnatomy Abdominal quadrants (major structures)Abdominal quadrants (major structures)

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Common External InjuriesCommon External Injuries Fractures - ribs, sternum or clavicleFractures - ribs, sternum or clavicle

typical mechanism involves direct typical mechanism involves direct blows to chest wallblows to chest wall

Joint dislocations/subluxationsJoint dislocations/subluxations similar mechanism as for fracturessimilar mechanism as for fractures external blow to chest wallexternal blow to chest wall intense contractions of large muscles intense contractions of large muscles

such as those of the pectoral regionsuch as those of the pectoral region

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Common External InjuriesCommon External Injuries

Signs/symptoms: (fractures)Signs/symptoms: (fractures) extreme localized painextreme localized pain mild swellingmild swelling breathing difficulties (possible breathing difficulties (possible

pneumothorax)pneumothorax) holding the injured areaholding the injured area

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Signs/symptoms: Signs/symptoms: (dislocations/Subluxations)(dislocations/Subluxations) localized painlocalized pain mild swellingmild swelling breathing difficultiesbreathing difficulties holding injured areaholding injured area

First Aid: (for fractures & First Aid: (for fractures & dislocations/subluxations)dislocations/subluxations) monitor vital signsmonitor vital signs treat for shocktreat for shock apply iceapply ice transport to medical facilitytransport 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 Internal Injuries to the Thorax and AbdomenThorax and Abdomen

Heart and lung injuriesHeart and lung injuries While rare, contusions to the chest wall While rare, contusions to the chest wall

can bruise the heart, resulting in death.can bruise the heart, resulting in death. pulmonary contusions uncommon in pulmonary contusions uncommon in

sportssports traumatic and/or spontaneous traumatic and/or spontaneous

pneuomothoraxpneuomothorax Both may be related to direct blows to the Both may be related to direct blows to the

chest.chest.

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Hemothorax Hemothorax occurs when lung tissue is punctured by rib occurs when lung tissue is punctured by rib

fracturefracture Can be life threateningCan be life threatening

Signs/symptoms:Signs/symptoms: severe pain in chestsevere pain in chest breathing problems (dyspnea)breathing problems (dyspnea) blood in sputum (differentiate from wounds blood in sputum (differentiate from wounds

in mouth)in mouth) may indicate bleeding within the chest cavitymay indicate bleeding within the chest cavity

First Aid:First Aid: treat for shocktreat for shock monitor for vital signsmonitor for vital signs transport to medical facility immediatelytransport to medical facility immediately

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Internal Injuries to the Internal Injuries to the Thorax and AbdomenThorax and Abdomen

Liver, kidneys, spleen and bladderLiver, kidneys, spleen and bladder LiverLiver

susceptible to blunt traumasusceptible to blunt trauma Diseases such as hepatitis make liver more Diseases such as hepatitis make liver more

vulnerable.vulnerable. Heavy consumption of alcohol and/or use of Heavy consumption of alcohol and/or use of

steroids enlarges the liver.steroids enlarges the liver. kidneys kidneys

susceptible to blunt trauma directed at the susceptible to blunt trauma directed at the back of the torso (lumbar area)back of the torso (lumbar area)

may also be injured as a result of heat strokemay also be injured as a result of heat stroke Be alert for hematuria (educate the athlete).Be alert for hematuria (educate the athlete).

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Internal Injuries to the Internal Injuries to the Thorax and AbdomenThorax and Abdomen

spleen spleen susceptible to blows in the LUQsusceptible to blows in the LUQ serves as a reservoir for RBCsserves as a reservoir for RBCs has an ability to “splint” itself when has an ability to “splint” itself when

laceratedlacerated be on the alert for a Kehr’s signbe on the alert for a Kehr’s sign mononucleosis -- MUST be cleared by a mononucleosis -- MUST be cleared by a

physician to return to participationphysician to return to participation bladder bladder

not commonly injured in sportsnot commonly injured in sports encourage athletes to empty their encourage athletes to empty their

bladder prior to participationbladder prior to participation