Examination of Orthopedic and Athletic Injuries 3 rd

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Copyright © 2010.

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Respiratory tract Trachea

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Cardiovascular Fibrous pericardium

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Cardiovascular Right and

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Copyright © 2010. F. A.

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy – Digestive Tract

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Anterior View of the Liver

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Lymphatic organ Spleen

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Urinary tract Kidneys

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Reproductive tract Testes

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Examination of Thoracic, Abdominal,

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Abdominal Quadrant Reference System The

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Mc. Burney’s Point, Located Approximately

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Pathologies of the Thorax and

Examination of Orthopedic and Athletic Injuries, 3 rd Edition A Superior-Inferior View of the

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Pathology of the Reproductive Organs

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Cardiopulmonary Pathologies Commotion cordis “Cardiac

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Cardiopulmonary Pathologies Syncope Cause Cardiac

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Cardiopulmonary Pathologies Hypertrophic cardiomyopathy Myocardial

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Cardiopulmonary Pathologies Respiratory pathologies Asthma

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Examination of Thoracic, Abdominal,

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Management of Thoracic, Abdominal,

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Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Sternum Manubrium Xiphoid process True ribs False ribs Floating ribs Cervical rib Thoracic outlet syndrome Costal cartilages Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Respiratory tract Trachea Bronchi Segmental bronchi Bronchioles Parietal pleura Visceral pleura Pleural cavity Alveoli Pulmonary arteries Pulmonary veins Mucosal cells Ciliary cells Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Cardiovascular Fibrous pericardium Serous pericardium Parietal layer Chordinae tendinae Papillary muscles Right atrium Superior vena cava Inferior vena cava Copyright © 2010. F. A. Davis Company Valves controlling blood entering and exiting the heart.

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Cardiovascular Right and left atrium Right and left ventricle Superior and inferior vena cava Tricuspid valve Mitral valve Semilunar valves Pulmonary arteries and veins Aorta Aortic arch Brachiocephalic trunk Right and left common carotid Abdominal aorta Coronary arteries Copyright © 2010. F. A. Davis Company Anterior view of the heart. Blood supply to the body is delivered through the aorta. The left atrium is hidden in this view.

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Anterior View of the Liver This structure is supported by ligaments arising from the inferior surface of the diaphragm. Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Lymphatic organ Spleen (left side of the body, level of 9 – 11 th ribs) Solid, fragile organ Produces and destroys blood cells during infection Mononucleosis — spleen becomes engorged with blood Trauma may result in the removal of the spleen Copyright © 2010. F. A. Davis Company Spleen. During illness the spleen may become enlarged, causing it to become vulnerable to injury.

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Urinary tract Kidneys (bilaterally at the level of T 12 – L 3; right kidney is slightly lower) Regulate body’s electrolyte levels; filtrate urine Ureters Urinary bladder Urethra Trauma: blow to the low back Copyright © 2010. F. A. Davis Company Relative location of the kidneys.

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Anatomy Reproductive tract Testes Epididymis Ovaries Fallopian tubes Male reproductive system. Female reproductive system. Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies Past medical history General medical history Family medial history Medication and drugs General medical health Cystic fibrosis Crohn’s disease Copyright © 2010. F. A. Davis Company History of present condition Location of pain MOI Onset of symptoms Dysmenorrhea Arrhythmias Complaints Syncope Palpations Respiratory Chest pain

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies Inspection Sweating Throat Profuse sweating is a sign of cardiac arrest Deviations can indicate a pneumothorax Muscle tone Observe contour of abdominal muscles Distended area may indicate bleeding Skin features Note contusion, wounds, or abrasions Possible injury to underlying organs Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies Palpation Sternum Sternal body Xiphoid process Costal cartilage and rib 5. Spleen 6. Kidneys 7. Mc. Burney’s point 1. 2. 3. 4. Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Abdominal Quadrant Reference System The sagittal quadrants are relative to the patient. Therefore, the right kidney is on the person’s right-hand side. Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Mc. Burney’s Point, Located Approximately One-Third of the Way Between the ASIS and the Umbilicus This point becomes tender in the presence of appendicitis. Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies Palpation of the abdomen Rigidity Areas of pain Rebound tenderness Tissue density Quadrant analysis Copyright © 2010. F. A. Davis Company Positioning of the patient during palpation of the abdomen.

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Clinical Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies Review of systems Cardiovascular Heart rate Blood pressure (BP) Heart auscultation Vomiting Auscultation of the abdomen Genitourinary Capillary refill Respiratory Breath sounds Respiratory rate and pattern Respiratory flow Copyright © 2010. F. A. Davis Company Gastrointestinal Urinalysis Neurologic

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Pathologies of the Thorax and Abdomen and Related Special Tests Injuries to the thorax Rib fractures Costochondral injury Pneumothorax Hemothorax Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Pathologies of the Thorax and Abdomen and Related Special Tests Pathologies of the abdominal and urinary organs Splenic injury MOI: blunt trauma to the abdomen Causes: contusion or laceration Inflamed due to infectious disease Kehr’s sign — telltale sign of a ruptured spleen; pain in the ULQ and left shoulder Vital sign are indicators of hemodynamic (process of blood circulating through the body) changes MRI and CT scans identify splenic trauma Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Pathologies of the Thorax and Abdomen and Related Special Tests Kidney pathologies Area over kidneys may become TTP or reveal crepitus Rib fracture Kidney stones Urinary tract infection Palpation of the right kidney. Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition A Superior-Inferior View of the Thorax Demonstrating a Stone Located Within the Left Kidney (arrow) The stone is approximately 14 mm (0. 55 in. ) long. Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Pathologies of the Thorax and Abdomen and Related Special Tests Appendicitis and appendix rupture Common in 15 – 25 year olds (men > women) Signs and symptoms Lower abdominal tenderness Fever Nausea Vomiting Prefer lying supine with right leg flexed at hip Immediate referral, and no eating or drinking! Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Pathologies of the Thorax and Abdomen and Related Special Tests Hollow organ rupture MOI: blow to the abdomen Signs and symptoms Pain Nausea Muscle guarding/rigidity Tenderness Absent bowel sounds Bloody stool Immediate referral, and no eating or drinking! Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Pathology of the Reproductive Organs Male reproductive system pathologies Female reproductive system pathologies Testicular contusion Testicular torsion Testicular dysfunction Testicular cancer Copyright © 2010. F. A. Davis Company Menstrual irregularities Associated with physical activity Female athlete triad Pelvic inflammatory disease

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Cardiopulmonary Pathologies Commotion cordis “Cardiac concussion” Instantaneous cardiac arrest caused by a nonpenetrating blow to the chest Cardiac contusions MOI: Direct blow or compression to sternum Contusion to pericardial lining, ventricular contusion, or aortic rupture Copyright © 2010. F. A. Davis Company Electrocardiogram demonstrating ventricular fibrillation caused by a blunt impact to the chest wall during vulnerable zone of repolarization (10 — 30 ms prior to the T wave peak).

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Cardiopulmonary Pathologies Syncope Cause Cardiac abnormality Symptom of heat illness Benign Always warrants further exam Especially exertional syncope (after exercise) Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition Cardiopulmonary Pathologies Hypertrophic cardiomyopathy Myocardial infarction Arrhythmias Tachycardia Athlete’s heart Mitral valve prolapse Hypertension Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies Examination of the unconscious athlete Cervical stabilization Airway Look, listen, and feel Breathing Bradypnea (< 10 breaths per minute) Tachypnea (> 30 breaths per minute) Dyspnea (labored quick breathing pattern) Circulation Carotid pulse Copyright © 2010. F. A. Davis Company Management of sudden cardiac arrest.

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies Inspection and palpation of the conscious athlete Position of the athlete Skin color Airway Breathing Circulation Sweating Responsiveness Nausea and vomiting Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies Rib fractures Rule out pneumothorax or hemothorax Stabilize injury Rib belt Wrap arm to side of athlete Transport athlete for further medical evaluation Copyright © 2010. F. A. Davis Company Immobilization of the rib cage through the use of a swath.

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies Pneumothorax and hemothorax Monitor vital signs Treat for shock Place athlete on affected side in semi-reclined position Give oxygen if available Activate EMS Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies Open pneumothorax Activate EMS Do not remove object Cover opening with a sterile dressing Seal opening with nonporous material Transport athlete to emergency room Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies Hollow organ injuries Activate EMS Treat for shock Monitor vital signs Record and give to medical transport team Don’t give anything by mouth Transport athlete to emergency room Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies Solar plexus injury MOI: direct blow to abdomen or falls on an object Transitory paralysis of diaphragm “Have the wind knocked out of you” Management Loosen clothing Calm athlete Instructions for long inspirations, short expirations€ Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies Asthma Have athlete’s medication on hand marked Move athlete to sideline If no inhaler is available Pulmonary emergency Sit athlete down with hands on knees Assist in slow controlled diaphragmatic breathing Hard part is to breath out Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies Hyperventilation Control the rate at which CO 2 is lost from the body Breathe into paper bag Breathe through only one nostril Controlling hyperventilation. Copyright © 2010. F. A. Davis Company

Examination of Orthopedic and Athletic Injuries, 3 rd Edition On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies Sudden cardiac arrest Activate EMS Early defibrillation For every minute that defibrillation is delayed, chance of survival decreases by 10% Copyright © 2010. F. A. Davis Company