CHAPTERS 12 & 13Abdominal, Thorax, and

Throat Injuries

Abdominal Cavity

Boundaries Superior – Diaphragm Inferior – Pelvis Posteriorly – Lumbar

Spine Anteriorly –

Abdominal Musculature

Abdominal Quadrants

Abdomen divided into 4 quadrants Right Upper Quadrant

RUQ Left Upper Quadrant

LUQ Right Lower Quadrant

RLQ Left Lower Quadrant

LLQ Based on the patient’s

left and right side not the evaluator.

Abdominal Regions

Abdomen is divided into 9 regions by two horizontal lines and two vertical lines.

Regions are: Top row (R to L)

Right Hypochondriac Epigastric Left Hypochondriac

Middle Row (R to L) Right Lumbar Umbilical Left Lumbar

Bottom Row (R to L) Right Inguinal (Iliac) Hypogastric Left Inguinal (Iliac)

Hollow vs. Solids Organs

Hollow organs: Injuries rarely

result in rapid death.

Tendency to move out of the way when hit.

Are basically tubes used to transport substances from one organ to another.

Solid Organs: Aid in body

chemistry Can cause rapid

death because of large blood supply

Digestive System Pathway:

Mouth Pharynx Esophagus Stomach Small Intestine Large Intestine Rectum Anus

Salivary Glands Liver Gallbladder Pancreas

Urinary System

Kidneys Ureters Bladder

Thoracic Cavity

Bony Anatomy Ribs

True Ribs False Ribs Floating Ribs

Costal Cartilage Sternum

Manubrium Body Xiphoid Process

Thoracic Vertebrae

Circulatory System Starting at:

Right Atrium Right Ventricle Pulmonary Artery Trunk Right & Left Pulmonary Arteries Right & Left Pulmonary Arterioles Right & Left Pulmonary Capillaries Right & Left Pulmonary Venules Right & Left Pulmonary Veins Left Atrium Left Ventricle Aorta Thoracic Aorta Abdominal Aorta Carotid Arteries Upper Extremities Arteries, Arterioles, & Capillaries Thoracic Organs Arteries, Arterioles, & Capillaries Abdominal Organs Arteries, Arterioles, & Capillaries Lower Extremities Arteries, Arterioles, & Capillaries Upper Extremities Venules & Veins Thoracic Organs Venules & Veins Abdominal Organs Venules & Veins Lower Extremities Venules & Veins Inferior Vena Cava Superior Vena Cava Azygous Vein

Respiratory System

Pathway of Air Nose/Mouth

Sinuses Pharynx Larynx

Epiglottis Trachea Right/Left Mainstem

Bronchus Right/Left Bronchial

Tree Alveoli

Lymphatic System

Network of tissues and organs Spleen Thymus 600 to 700 lymph

nodes

Muscles of the Abdomen & Thorax

Rectus Abdominis Origin

Pubic crest, pubic symphysis.

Insertion Cartilage of fifth, sixth,

and seventh ribs and xiphoid process.

Action Flex the vertebral

column and tilt the pelvis posteriorly.

Muscles of the Abdomen & Thorax External Obliques

Origin External surfaces of fifth to

twelfth ribs. Insertion

Anterior part of the iliac crest, abdominal aponeurosis to linea alba.

Action Unilaterally – Laterally flex

the vertebral column to the same side, rotate the vertebral column to the opposite side.

Bilaterally – Flex the vertebral column, compress the abdominal contents.

Muscles of the Abdomen & Thorax Internal Obliques

Origin Lateral inguinal ligament,

iliac crest and thoracolumbar fascia.

Insertion Internal surface of lower

three ribs, abdominal aponeurosis to linea alba.

Action Unilaterally – Laterally flex

the vertebral column to the same side, rotate the vertebral column to the opposite side.

Bilaterally – Flex the vertebral column, compress the abdominal contents.

Muscles of the Abdomen & Thorax Transverse Abdominis

Origin Lateral inguinal

ligament, iliac crest, thoracolumbar fascia and internal surface of the lower six ribs.

Insertion Abdominal aponeurosis

to linea alba. Action

Compress the abdominal contents.

Muscles of the Abdomen & Thorax Pectoralis Major

Origin Medial half of clavicle, sternum

and cartilage of the first through sixth ribs.

Insertion Crest of the greater tubercle of

the humerus. Action

All fibers – Adduct the shoulder, medially rotate the shoulder, assist to elevate the thorax during forced inhalation (with the arm fixed).

Upper fibers – flex the shoulder, horizontally adduct the shoulder.

Lower fibers – Extend the shoulder.

Muscles of the Abdomen & Thorax Latissimus Dorsi

Origin Inferior angle of the

scapula, spinous processes of the last six thoracic vertebrae, last three to four ribs, thoracolumbar aponeurosis and posterior iliac crest.

Insertion Intertubercular groove of

the humerus. Action

Extend the shoulder, adduct the shoulder, and medially rotate the shoulder.

Muscles of the Abdomen & Thorax Serratus Anterior

Origin External surfaces of the upper

eight or nine ribs. Insertion

Anterior surface of the medial border of the scapula.

Action With origin fixed – abduct the

scapula, upwardly rotate the scapula, depress the scapula, hold the medial border of the scapula against the rib cage.

With the scapula fixed - may act to elevate the thorax during forced inhalation.

Muscles of the Abdomen & Thorax Deltoid

Origin Lateral one-third of the

clavicle, acromion process, and spine of the scapula.

Insertion Deltoid tuberosity of the

humerus. Action

All fibers – Abduct the shoulder.

Anterior fibers – Flex the shoulder, medially rotate the shoulder and horizontally adduct the shoulder.

Posterior fibers – Extend the shoulder, laterally rotate the shoulder and horizontally abduct the shoulder.

Muscles of the Abdomen & Thorax Pectoralis Minor

Origin Third, fourth and fifth

ribs. Insertion

Medial surface of the coracoid process of the scapula.

Action Depress the scapula,

abduct the scapula, downwardly rotate the scapula.

With the scapula fixed – Assist to elevate the thorax during forced inhalation.

Muscles of the Abdomen & Thorax External Intercostals

Origin Inferior border of the rib

above, external side of rib.

Insertion Superior border of rib

below, external side. Action

Draw the ribs superiorly to assist with inhalation (increases space in the thoracic cavity).

Muscles of the Abdomen & Thorax Internal Intercostals

Origin Inferior border of the rib

above, internal side of the rib.

Insertion Superior border of the

rib below, internal side of the rib.

Action Draw the ribs inferiorly

to assist with exhalation (decreases the size of the thoracic cavity).

Muscles of the Abdomen & Thorax Subclavius

Origin First rib and cartilage.

Insertion Inferior surface of the

middle one-third of the clavicle.

Action Depress the clavicle and

draw it anteriorly, elevate the first rib (assist on inhalation), stabilize the sternoclavicular joint.

Muscles of the Abdomen & Thorax Sternocleidomastoid

Origin Sternal Head – Top of the

manubrium Clavicular head – Medial one-

third of the clavicle. Insertion

Mastoid process of the temporal bone and the lateral portion of the superior nuchal of the occipital bone.

Action Unilaterally – Laterally flex the

head and neck to the same side, rotate the head and neck to the opposite side.

Bilaterally – Flex the neck and to assist in elevating the ribcage during inhalation.

Muscles of the Abdomen & Thorax Diaphragm

Origin Costal attachment –

Inner surface of the lower six ribs.

Insertion Central tendon.

Action Draw down the central

tendon of the diaphragm to increase the volume of the thoracic cavity during inhalation.

Muscles of the Abdomen & Thorax Quadratus Lumborum

Origin Posterior iliac crest.

Insertion Last rib and transverse

processes of the first though fourth lumbar vertebrae.

Action Unilaterally – Laterally tilt

(elevate) the pelvis, laterally flex the vertebral column to the same side, and to assist in extension of the vertebral column.

Bilaterally – Fix the last rib during forced inhalation and exhalation.

Muscles of the Abdomen & Thorax Trapezius

Origin External occipital protuberance, medial

portion of the superior nuchal line of the occipital bone, ligamentum nuchae and spinous processes of C7 through T12.

Insertion Lateral one-third of the clavicle,

acromion process and spine of the scapula.

Action Upper Fibers – Bilaterally – Extend the

head and neck. Upper Fibers - Unilaterally – Laterally

flex the head and neck to the same side, rotate the head and neck to the opposite side, elevate the scapula and upwardly rotate the scapula.

Middle Fibers – Adduct the scapula and stabilize the scapula.

Lower Fibers – Depress the scapula and upwardly rotate the scapula.

Muscles of the Abdomen & Thorax Serratus Posterior

Superior Origin

Spinous processes of C7 through T3.

Insertion Posterior surface of the

second through fifth ribs. Action

Elevate the ribs during inhalation.

Muscles of the Abdomen & Thorax

Serratus Posterior Inferior Origin

Spinous processes of t12 through L3.

Insertion Posterior surface of ninth

through twelfth ribs. Action

Depress the ribs during exhalation.

Muscles of the Abdomen & Thorax Erector Spinae Group

Origin Common tendon (thoracolumbar

aponeurosis) that attaches to the posterior surface of the sacrum, iliac crest, spinous processes of the lumbar and last two thoracic vertebrae.

Insertion Various attachments at the

posterior ribs, spinous and transverse processes of the lumbar and last two thoracic vertebrae.

Action Unilaterally – Laterally flex the

vertebral column to the same side.

Bilaterally – Extend the vertebral column.

Referred Pain

Pressure upon palpation of the abdominal organs may elicit referred pain in predictable patterns away from the source.

Common Thoracic & Abdominal Injuries

Rib contusion Rib fracture Costochondral

Separation/Dislocation Sternum Fracture Pneumothorax Hemothorax Flail Chest Hyperventilation Heart contusion Sudden Death

Syndrome in Athletes

Kidney Contusion Liver Contusion Pancreatitis Appendicitis Scrotal Contusion Injury to the Spleen Abdominal

Contusion Hernia Solar Plexus Injury Side Stitch

Rib Contusion

Etiology

Signs & Symptoms

Treatment

Rib Fracture

Etiology

Signs & Symptoms

Treatment

Costochondral Separation/Dislocation

Etiology

Signs & Symptoms

Treatment

Sternum Fracture

Etiology

Signs & Symptoms

Treatment

Gymnast video

Pneumothorax

Etiology

Signs & Symptoms

Treatment

Video

Hemothorax

Etiology

Signs & Symptoms

Treatment

Flail Chest

Etiology

Signs & Symptoms

Treatment

Video

Hyperventilation

Etiology

Signs & Symptoms

Treatment

Heart Contusion

Etiology

Signs & Symptoms

Treatment

Video

Sudden Death Syndrome in Athletes

Etiology Hypertrophic

Cardiomyopathy (HCM)

Anomalous Origin of the Carotid Artery

Marfan’s Syndrome

Signs & Symptoms

Prevention

Treatment

Kidney Contusion

Etiology

Signs & Symptoms

Treatment

Liver Contusion

Etiology

Signs & Symptoms

Treatment

Pancreatitis

Etiology

Signs & Symptoms

Treatment

Appendicitis

Etiology

Signs & Symptoms

Treatment

Scrotal Contusion

Etiology Video

Signs & Symptoms

Treatment

Injury to the Spleen

Etiology

Signs & Symptoms

Complications

Treatment

Abdominal Contusion

Etiology

Signs & Symptoms

Treatment

Hernia

Etiology

Signs & Symptoms

Treatment

Solar Plexus Injury

Etiology

Signs & Symptoms

Treatment

Side Stitch

Etiology

Signs & Symptoms

Treatment

For Your Quiz

Students should be able to: Identify the abdominal quadrants and regions

and the particular organs that lie in each. Identify the musculature of the thorax and

abdomen. Identify/explain the different injuries that

occur to the abdomen and thorax.