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Care and Prevention Chapters 25 and 26

The Spine, Thorax, and Abdomen

CHAPTER 25 - THE SPINE

Bones: Vertebral bodies (33)  May be considered 26 in adults
Cervical- convex (7)
          C1-Atlas- hold skull
          C2- Axis- has processes that atlas rotates on
Thoracic- concave (12)
Lumbar- convex (5)
Sacrum- concave (5) fused (some consider this 1 bone)
Coccyx- tailbone- concave (4) fused (some consider 1 bone)

Ligaments:
anterior and posterior longitudinal ligaments run length of back
Infraspinatus and supraspinatus-hold vertebra together
Vertebra disc- (jelly doughnut) hard on outside and gelatinous center, shock absorption

Muscles: Erector Spinea (paraspinous)- ridged muscles along spine-extension

Motions of Spine-
Flexion- bend over toes (sagittal plane)
Extension- bend over backwards (sagittal plane)
Left and Right Lateral Flexion (coronal plane)
Rotation- twisting

Normal Curvatures-
Lordosis- convex describes lumbar curve, may be hyper or hypo
Kyphosis- thoracic curvature hyper or hypo

Irregular Curvature-
Scoliosis- lateral curve of thoracic and lumbar spine

Factors of Low Back Pain:
Muscle strength and flexibility, stabilization of low back, overweight and poor hamstring flexibility

Sciatica: inflammation of sciatica nerve that runs down back with pain in low back that runs down leg
MOI: muscular spasm, strain or poor mechanics
S&S: tingling, numbness, burning sensation, deep aching, radiating in buttock down posterior leg, weakness
Treatment: treat the cause that creates problem, ice, heat, stretch, NSAID

*Herniated lumbar disk:
MOI:  flexion with rotation or repetitive trauma that places an abnormal strain affected vertebral region 
S&S:  There is usually a centrally located pain that radiates unilaterally in a dermatomal pattern to the buttocks and down the back of the leg, or pain that spreads across the back.  Forward bending and sitting increases the pain.  Straight Leg Raises to 30 degrees increases pain.  A Valsalva maneuver increases the pain.  Side bending toward the side of pain is limited and increases pain.
Treatment:  Initial treatment is pain-reducing modalities such as ice or electrical stimulation.  Manual traction combined with passive backward bending or extension makes the athlete more confortable.  The goal is to reduce the protrusion and restore normal posture.  As pain and posture return to normal, back extensor and abdominal strengthening should be used.  If there is signs of nerve damage, surgery may be required to eliminate pain and dysfunction.
 

CHAPTER 26 - THORAX AND ABDOMEN

CHEST
Bones:
Sternum
Ribs
Clavicle

Cartilage: Costal cartilage

Rib Contusion:
MOI: blunt trauma
S&S: pt tender, pain with inhalation, negative X-ray
Treatment: rest and ice

Rib Fracture and Rib and Costal Separation:
MOI: blunt trauma
S&S: pt tender, X-ray positive-fracture, negative-separation
Treatment: ice and pad

ABDOMEN
Muscles: Rectus Abdominis- Flexion
Internal Oblique- Rotation
External Oblique- Rotation
Transverse Abdominis- sucking in your gut
Viscera- guts
Kidneys- Filter blood and produce urine
Spleen- Fights infection
Liver- Involved in blood production

*Hernia:  protusion of abdominal viscera through a portion of the abdominal wall 
MOI: acquired or congenital
S&S: superficial protrusion- increase with coughing, pain or discomfort
Valsalva Maneuver: simulate bowl movement, feeling of weakness in groin area
Treatment: surgery perferred by most physicians.  Exercise will not affect the stretched inguinal or femoral canals positively. 

*Hyperventilation: breathing too fast or too much
MOI:  too much oxygen and not enough carbon dioxide in the blood stream
S&S: rapid breathing pattern, light headed, pale
Treatment: take control, paper bag, do not let them fall if they pass out

*Solar Plexus Injury: getting the wind knocked out of you
MOI: blow to the sympathetic celiac plexus (solar plexus) produces a transitory paralysis of the diaphragm
Treatment: calm them down, speak confidently, have the athlete bend the knees; loosen the athletes clothing around the abdomen; encourage the athlete to relax by initiating short inspirations and long expirations.

*Spleen Injury: spleen in upper left quadrant, spleen fights infection, contusion of spleen - fear of rupture
Infectious mononucleosis is the most likely cause of enlarged spleen.  Athletes with "mono" should not engage in ant activity for three weeks because approximately 50 percent of sufferers exhibit splenomegaly, which is difficult to diagnose clinically.
MOI: blunt trauma, infection causes spleen to swell, increasing chance of contusion to spleen 
S&S: history of blow to upper left quadrant, signs of shock (syncope)-pale, light headed, blood pressure low, heart rate up, nausea, abdominal rigidity, pt tender in upper left quadrant but less tender if muscles are tense, KEHR's sign-pain in left shoulder
Treatment: monitor even if just had wind knocked out, see MD if symptoms persist, conservative, nonoperative treatment is recommended with a week of hospitalization.  No activity for three weeks.  Can resume light activity at three weeks to full recovery at four weeks.  If surgical repair is needed, then will require 3 months to recover, whereas spleen removal will require six months before the athlete can return to activity

Kidney Injury: 2 kidneys per person, they filter blood and make urine; contusion of kidney, either blunt trauma or repetitive pounding such as running
S&S: signs of shock, rigidity of back muscles, hematuria-blood in urine
Treatment: ice, monitor urine 2 or 3 times

Liver Injury: right upper quadrant, due to contusion or laceration
S&S: history of blow, shock, abdominal rigidity, pain in right shoulder
Treatment: monitor, refer

*Testicular or Scrotal Contusion:
MOI: blunt trauma
S&S: pain, swelling, ecchymosis, spasm of testicles, nausea
Treatment: rest, ice, continue to rest and evaluate, refer to doctor or urologist; bringing both knees to the chest helps relieve spasm

Spermatical Torsion: spermatcord twisted and stops circulation
S&S: deep pain and aching, nausea, veins swollen
Treatment: refer to doctor or urologist, surgery

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