ROP Sports Medicine : Common Injuries of the Abdomen and Thorax

1. ROP Sports Medicine: Common Injuries of the Abdomen and Thorax

2. Abdominal & Thoracic Injuries • Injuries are rare • Solid organs most often injured • Life threatening

3. 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.

4. 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.

5. Liver Contusion • Signs/Sx: • Liver injuries can cause hemorrhage and shock. • Liver injury commonly produces a referredpain (pain is felt just below the right scapula, right shoulder, and behind the sternum). • Tx: • A liver contusion requires immediatereferral to a physician for diagnosis and treatment.

6. 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.

7. Pancreatitis

8. 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.

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

10. 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).

11. 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’sPoint.

12. Appendicitis Tx: - 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.

13. Appendicitis

14. Appendicitis • Inflamed appendix perforated appendix

15. 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.

16. 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.

17. Abdominal Wall Contusion • Tx: • Apply a cold pack and compression wrap immediately after the injury. • Also, look for signs of possible internal injury.

18. 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.

19. Hernia

20. 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.

21. 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.

22. 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 strangulatedhernia, 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.

23. 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

24. Hernia Tx: - 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.

25. Hernias

26. Hernias

27. Hernias

28. Hernias

29. 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.”

30. 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.

31. 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.

32. 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.

33. 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

34. 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.

35. Stitch in the Side • Tx: • Immediate care demands relaxation of the spasm. • There are two methods for relaxation: • First, the athlete is instructed to stretch the arm on the affected side as high as possible. • 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.

36. 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

37. Spleen injury • S/S: • History of injury • Signs of shock-dizziness, thirst, pale, sweating, rapid pulse/respirations • Abdominal rigidity • Nausea • Vomiting • Kehr’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 arm • Referred pain—pain felt in one part of the body other than its actual origin

38. 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 conditioning • Return 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

39. Spleen injury

40. 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

41. Kidney Contusion • Tx: • Have athlete urinate 2-3 times to determine if there is blood in urine • Call 911 if necessary • Treat for shock • Immediate physician referral there is hematuria • 24 hour hospitalization for observation • Gradual increase in fluid intake • If hemorrhage fails to stop, surgical intervention • Usually takes 2 weeks bed rest prior to return to activity

42. Kidney contusion • Kidney contusion Kidney Laceration

43. Injuries to Bladder Mxn: • 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

44. Bladder injuries • Tx: • Monitor athlete • Physician referral if necessary

45. 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

46. Testicular/Scrotal contusion • S/S: • hemorrhage • fluid effusion • muscle spasm • Vomiting 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

47. 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

48. 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

49. Rib Fractures • S/S: • severe pain during inspiration • POT over fracture site • Crepitus • Pain with movement of trunk

50. Rib Fractures • Tx: • Refer for x-ray • ice • Support • Rest • Heal within 3-4 weeks • Rib brace may offer some stabilization and comfort