ROP Sports Medicine:

Common Injuries of the

Abdomen and Thorax

ABDOMINAL & THORACIC INJURIES

Injuries are rare Solid organs most often injured Life threatening

LIVER CONTUSION Liver injuries are the 2nd

most common organ injuries resulting from blunt trauma, but are relatively infrequent in sports.

A hard blow to the right side of the rib cage can tear or seriously contuse the liver.

LIVER CONTUSION Damage is even more likely if

the liver has been enlarged because of a disease, such as hepatitis (inflammation of the liver caused by a viral infection or alcohol consumption).

If not corrected, hepatitis can lead to cirrhosis of the liver, which causes the liver cells die and be replaced by scar tissue.

LIVER CONTUSION Signs/Sx:

Liver injuries can cause hemorrhage and shock.

Liver injury commonly produces a referred pain (pain is felt just below the right scapula, right shoulder, and behind the sternum).

Tx: A liver contusion requires immediate

referral to a physician for diagnosis and treatment.

PANCREATITIS Cause:

May be acute or chronic. Acute inflammation leads to necrosis,

gangrene, and hemorrhage. Chronic inflammation results in scar tissue

formation (Inflammation may also occur gradually from chronic alcoholism).

Often related to obstruction of the pancreatic duct.

PANCREATITIS

PANCREATITIS Signs/Sx:

Acute epigastric pain causes vomiting, belching, constipation, and potentially, shock.

Possible tenderness and rigidity with palpation.

Chronic pancreatitis causes jaundice, diarrhea, and mild to moderate pain that radiates to the back.

PANCREATITISTx:

- Acute pancreatitis requires rehydration, pain reduction, treatment of shock, and prevention of secondary infection. - Surgery is indicated only if the pancreatic duct is blocked.

APPENDICITIS Cause:

Inflammation can be chronic or acute.

Causes include fecal obstruction, lymph swelling, or even a carcinoid tumor.

Most common in males age 15-25. In early stages, the appendix is red and

swollen; in later stages, it may become gangrenous, and rupture into the bowels and peritoneal cavity (Bacterial infection is a complication of rupture of the inflamed appendix).

APPENDICITIS Signs/Sx:

Mild-to-severe pain in the lower abdomen

Nausea and vomiting Low-grade fever ranging

from 99 to 100 degrees Later, the cramps may

localize into a pain in the right side.

Palpation may reveal abdominal rigidity and tenderness at a point between the ASIS and the umbilicus, known as McBurney’s Point.

APPENDICITISTx:

- Surgical removal is often necessary. - If the bowel is not obstructed, there is no need to rush surgery. - However, an obstructed bowel with an acute rupture is a life-threatening condition.

APPENDICITIS

APPENDICITIS

Inflamed appendix perforated appendix

ABDOMINAL WALL CONTUSION

Cause: Not common in sports. Most likely to occur in collision sports

such as football or ice hockey. Contusion may occur superficially in

the subcutaneous tissue or much deeper to the musculature.

The extent of the injury depends on whether the force is blunt or penetrating.

ABDOMINAL WALL CONTUSION

Signs/Sx: A contusion of the rectus abdominis

muscle can be very disabling. A severe blow may cause a hematoma

to develop under the fascial tissue surrounding the muscle, resulting in pain and tightness in the area of the injury.

ABDOMINAL WALL CONTUSION

Tx: Apply a cold pack and compression

wrap immediately after the injury. Also, look for signs of possible

internal injury.

HERNIA The term hernia means a protrusion of

abdominal viscera through a portion of the abdominal wall.

Structurally, a hernia has a mouth, a neck, and a body.

Hernias may be congenital or acquired.

HERNIA

HERNIA Cause:

In sports, hernias most often occur in the groin area.

Inguinal hernias, which occur in men, and femoral hernias, which occur in women, are the most prevalent types. Inguinal hernias result from an abnormal

enlargement of the opening of the inguinal canal, through which the vessels and nerves of the male reproductive system pass.

Femoral hernias occur in the canal that transports the vessels and nerves for the thigh and lower limb.

HERNIA Cause (continued):

Normally, when intraabdominal tension is applied, these canals are protected by muscles that prevent abnormal opening.

If the muscles fail to react, or if they do not react strongly enough, the abdominal contents may be pushed through the opening.

HERNIA A danger of hernias is that they may

become irritated by falls or blows, which is why most physicians believe that athletes with hernias should not engage in hard physical activity until surgical repair has been made.

Another concern is the development of a strangulated hernia, in which the inguinal ring constricts the protruding sac and occludes normal blood circulation. If this is not surgic- ally repaired immediately, gangrene and death may ensue.

HERNIA Signs/Sx:

An acquired hernia occurs when a natural weakness is further aggravated by a strain or direct blow.

An acquired hernia may be recognized by the following signs:

Previous history of a blow or strain to the groin area that produces pain and prolonged discomfort

Superficial protrusion in the groin area that is increased by coughing

Reported feeling of weakness and pulling sensation in the groin area

HERNIATx:

- The preferred treatment is surgery. - Mechanical supports are for the most part unsuitable in sports because of the friction and irritation they produce. - Exercise was once thought to be beneficial for a mild hernia, but this is not the case.

HERNIAS

HERNIAS

HERNIAS

HERNIAS

BLOW TO THE SOLAR PLEXUS (“WIND KNOCKED OUT”) Cause:

A blow to the sympathetic celiac plexus (solar plexus) produces a temporary paralysis of the diaphragm, which is often referred to as getting the “wind knocked out.”

BLOW TO THE SOLAR PLEXUS (“WIND KNOCKED OUT”) Signs/Sx:

Paralysis of the diaphragm prevents breathing, and leads to anoxia (lack of oxygen).

Hysteria because of fear may result. Symptoms are usually temporary,

so it is important to alleviate these fears and instill confidence in the athlete.

BLOW TO THE SOLAR PLEXUS (“WIND KNOCKED OUT”) Tx: Symptoms are usually

temporary, so the following procedure should be followed:

Speak confidently to help the athlete overcome their fear.

Loosen the athlete’s belt and the clothing around the abdomen.

Have the athlete bend his/her knees. Encourage the athlete to relax by

performing short inspirations and long expirations.

BLOW TO THE SOLAR PLEXUS (“WIND KNOCKED OUT”)

Be aware…Because of the fear of not being able to

breathe, the athlete may hyperventilate which may result in dizziness, or fainting.

A blow hard enough to knock out the wind may also cause internal organ injury.

STITCH IN THE SIDE Cause:

A “stitch” is an idiopathic condition (a condition with no known cause) that occurs in some athletes.

Several hypotheses have been advanced: Constipation Intestinal gas Overeating Diaphragmatic spasm from poor conditioning, Lack of visceral support (i.e. weak abdominal

muscles) Distended spleen Improper breathing causing decreased oxygen in

the diaphragm Ischemia of the diaphragm or intercostals muscles

STITCH IN THE SIDE Signs/Sx:

A cramp-like pain developing on either the left or right costal angle during hard physical activity.

Sports that involve running apparently produce this condition.

STITCH IN THE SIDE Tx:

Immediate care demands relaxation of the spasm.

There are two methods for relaxation: 1. First, the athlete is instructed to stretch the

arm on the affected side as high as possible.

2. If this does not work, flexing the trunk forward on the thighs while tightening the abdominal muscles may help.

*Athletes who have a chronic problem with this condition may require special studies and/or

further evaluation by a physician.

SPLEEN INJURY Mxn:

Direct blow to upper left quadrant Falling on UL quadrant Infectious mononucleosis causes enlarged

spleen putting athlete at risk If spleen is enlarged due to mono, may

resume activity after 3 weeks if the spleen is no longer enlarged or painful and there is no fever

SPLEEN INJURY S/S:

History of injurySigns of shock-dizziness, thirst, pale,

sweating, rapid pulse/respirationsAbdominal rigidityNauseaVomitingKehr’s sign

Reflex (referred) pain that comes on about 30 minutes after injury where pain radiates to the left shoulder and 1/3 the way down the left armReferred pain—pain felt in one part of the body

other than its actual origin

SPLEEN INJURY Can hemorrhage profusely into abdominal

cavity causing athlete to die of internal bleeding days or weeks after injury

Tx: Call 911, monitor athlete, conservative, non-

operative treatment with about 1 week of hospitalization

At 3 weeks can engage in light conditioningReturn to full activity at 4 weeks If surgical repair is needed athlete will return to

activity at 3 months If surgical removal is necessary, return to

activity at 6 months

SPLEEN INJURY

KIDNEY CONTUSION Mxn: blow to the back S/S:

signs of shock nausea vomiting rigidity of muscles of back hematuria (blood in urine) referred pain radiates forward around the

trunk into the lower abdominal region

KIDNEY CONTUSION Tx:

Have athlete urinate 2-3 times to determine if there is blood in urine

Call 911 if necessaryTreat for shock Immediate physician referral there is

hematuria24 hour hospitalization for observationGradual increase in fluid intake If hemorrhage fails to stop, surgical

interventionUsually takes 2 weeks bed rest prior to

return to activity

KIDNEY CONTUSION Kidney contusion

Kidney Laceration

INJURIES TO BLADDERMxn:

blunt force to lower abdominal region if the bladder is distended by urine

Hematuria associated with contusion of bladder during running

Known as runner’s bladder S/S:

blood in urine Referred pain to lower trunk, upper thigh

anteriorly With rupture, athlete will be unable to

urinate

BLADDER INJURIES Tx:

Monitor athletePhysician referral if necessary

TESTICULAR/SCROTAL CONTUSION Due to considerable sensitivity &

vulnerability, contusions to the scrotum & testicles cause extreme pain, nausea and disability

Important for males to wear proper protection to prevent incidence of contusions

Mxn: direct blow to the genitalia

TESTICULAR/SCROTAL CONTUSION S/S:

hemorrhagefluid effusion muscle spasmVomiting is severe

Tx: place athlete on his side flex thighs to chest ice to scrotum as pain diminishes Immediate medical referral for increasing or

unresolved pain after 15-20 minutes

RIB CONTUSION Mxn:

blow to rib cage S/S:

sharp pain with breathing POT over contused area pain with compression of rib cage

Tx: RICE NSAIDS cessation of activity until pain subsides self limiting

RIB FRACTURES Most common in collision sports Ribs 5-9 most commonly fractured Possibility of cause damage to or

puncturing a lung

Mxn: direct impact compression of rib cage

RIB FRACTURES S/S:

severe pain during inspiration POT over fracture site Crepitus Pain with movement of trunk

RIB FRACTURES Tx:

Refer for x-ray iceSupportRestHeal within 3-4 weeksRib brace may offer some stabilization and

comfort

RIB FRACTURES

ABDOMINAL STRAINS Rectus abdominus most often injured Potentially can be incapacitating Mxn:

sudden twisting of trunk or reaching overhead

S/S: pain with movements of the trunk, POT over

affected muscle, tightness of muscles TX:

ice, compression, gentle stretching, no exercise until ROM is pain free

INTERCOSTAL MUSCLES

INTERCOSTALS

COSTAL CARTILAGE INJURY More common than rib fractures Mxn:

direct blow to thorax Indirectly from sudden twist of fall on a

ball compressing the rib cage

COSTAL CARTILAGE INJURY S/S:

similar to rib fracture except pain is localized in the junction of the rib cartilage and the rib

Sharp pain during sudden movements Difficulty in breathing deeply POT with swellingRib deformityRibs make crackling noise (crepitus) as it

moves in and out of place

COSTAL CARTILAGE INJURY Tx:

IceRest Immobilization with rib brace1-2 months healing time

COSTAL CARTILAGE INJURY

INTERCOSTAL MUSCLE STRAIN Mxn:

Direct blow Sudden torsion of trunk

S/S: Pain w/ active motion Pain w/ inspiration/expiration, laughing,

coughing, sneezing Tx:

Ice Compression Immobilization for comfort