Back & Abdomen

Back Musculature

• splenius capitus

• sternocleidomastoid

• Trapezius

• deltoid

• spine of scapula

• teres major

• infraspinatus

• rhomboids

• lattissimus dorsi

• thoracolumbar fascia

• external oblique

• lumbar triangle

Deep Back Musculature

• scapula inferior angle

• serratus anterior

• right longissimus thoracis

• serratus posterior inferior

• external oblique

• internal oblique

• iliocostalis lumborum

• iliac crest

Thorax & Abdomen

Anatomy

Thorax

• Also known as the chest - between neck and diaphragm

• Thoracic vertebrae

  • 12 ribs, costal cartilage, and sternum

    • True rubs = upper 7 that are joined to the sternum

    • False ribs = 8-10

    • Floating ribs - 11-12

    • Sternum = manubrium - body - xiphoid process

• Protects lungs and heart

• Thoracic cage = lungs, heart, and thymus

• Muscles

  • External intercostals - elevate diaphragm during inspiration

  • Internal intercostals - depress rib cage assisting with expiration

  • Phrenic nerve

• Lungs

  • Trachea - right and left primary bronchi - secondary bronchi - alveoli

    • Right lung = 3 lobes

    • Left lung = 2 lobes

  • Diaphragm

    • Contraction = inspiration

    • Relaxation = expiration

  • Blood supply

    • Pulmonary arteries - alveoli turn it into oxygenated blood and return to heart via the pulmonary veins

    • Bronchi get their oxygenated blood from the bronchial arteries (which come off the aorta)

• Heart

  • Under sternum, to the left between ribs 1-5/6

  • Blood supply - right and left coronary arteries that come off the aorta

    • Deoxygenated blood

    • Right atrium

    • Tricuspid valve

    • Right ventricle

    • Pulmonary valve

    • Pulmonary artery and lungs - turned to oxygenated blood

    • Pulmonary vein

    • Left atrium

    • Mitral valve

    • Left ventricle

    • Aortic valve

    • Aorta --> supplies rest of body with blood

• Thymus

  • Anterior and superior to the heart

  • Produces lymphocytes

Abdomen

• Between diaphragm and pelvic bones

• Muscles

  • Rectus abdominis - flexes trunk

  • External oblique - flexes trunk, rotation, lateral flexion, and compression

  • Internal oblique - flexes trunk, lateral flexion, and rotation

  • Transverse abdominis - compression of the abdominopelvic cavity

  • Quadratus lumborum - pulls thoracic cage to the pelvis, abduction of the vertebral column

• Organs

  • Kidneys

  • Ureters and bladder

  • Liver

  • Gallbladder

  • Pancreas

  • Stomach

  • Small intestine

  • Large intestine

  • Spleen

  • Female reproductive organs (uterus, vagina, uterine tubes, ovaries)

  • Male reproductive organs (prostate, urethra, ejaculatory ducts, seminal vesicles, testes, epididymis, vas deferens)

Evaluation and Injuries

• Wear protective equipment

• Strengthening of abdomen muscles

• Empty hollow organs prior to competitions (stomach and bladder)
   

• Abdomen quadrants

  • Upper Right (UR) - liver, pancreas, kidney, lung

  • Upper Left (UL) - heart, spleen, kidney, stomach, lung

  • Lower Right (LR) - appendix, ureter, bladder, colon, gonads

  • Lower Left (LL) - ureter, bladder, colon, gonads

• Referred pain

  • Cardiac, lung, splenic pain = left shoulder

  • Diaphragmatic pain = shoulders

  • Liver, gallbladder pain = right shoulder, UL quadrant

  • Appendix - McBurney's point

• Auscultation

  • Heart sounds

    • "lubb-dupp" - abnormal - murmur

      • S1 --> S2 - systole (blood to body/lungs); S2 --> S1 diastole (filling of heart)

      • S1 = closing of the atrioventricular valves - mitral and tricuspid

      • S2 =closing of semilunar valves - aortic and tricuspid

    • Breath sounds

      • Normal breathing = even and consistent

      • Cheyne-Stokes = rate speeds up and slows down over 1-3 minutes

      • Biot's (Cluster breathing) = series of breaths at the normal rate that is followed by cessation of breathing. Similar to Cheyne-Stokes

      • Apneustic = pauses of the respiratory cycle at full inspiration

      • Thoracic = without diaphragmatic breathing

      • Wheezes (rhonchi) = music like sounds with high pitch

      • Rales = crackling sounds

    • Bowel sounds

      • Normal = liquid gurgling sounds

      • Absent or diminished sounds = swelling

      • High-pitched tinkling sounds = obstruction

• Percussion

  • Solid organs = dull sound

  • Hollow organs = tympanic sound
     

• Injuries (thoracic)

  • Rib contusion

  • Rib fractures

  • Costochondral separation/dislocation

  • Sternum fracture

  • Muscular injuries

  • Breast injury

  • Breast cancer

  • Lung injuries

  • Hyperventilation

  • Contusion

  • Sudden death syndrome

  • Commotio Cordis

• Injuries (abdomen)

  • Kidney contusion

  • Kidney stones

  • Ureter, bladder, urethra contusions

  • Cystitis

  • UTI

  • Urethritis

  • GI bleeding

  • Liver contusion

  • Pancreatitis

  • Indigestion (dyspepsia)

  • Vomiting

  • Gastroenteritis (food poisoning)

  • Peptic ulcer

  • Gastroesophageal reflux

  • Diarrhea

  • Constipation

  • Irritable bowel syndrome

  • Appendicitis

  • Hemorrhoids

  • Scrotal contusion

  • Spermatic cord torsion

  • Traumatic hydrocele of the tunica vaginalis

  • Vaginitis

  • Female genitalia contusion

  • Spleen injury

  • Abdominal muscle strain

  • Abdominal wall contusion

  • Hernia

  • Blow to solar plexus ("wind knocked out")

  • Exercise-related transient abdominal pain ("Side stitch")