ROP Sports Medicine : Common Injuries of the Abdomen

 Liver injuries are the 2 nd 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.

 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.

 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.

 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.

 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.

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.

 Cause:  Inflammation can be chronic or acute.  Causes include fecal obstruction, lymph swelling, or even a carcinoid tumor.  Most common in males age  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).

 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.

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.

 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.

 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.

 Tx :  Apply a cold pack and compression wrap immediately after the injury.  Also, look for signs of possible internal injury.

 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.

 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.

 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.

 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.

 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

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.

 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.”

 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.

 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.

 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.

 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

 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.

 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.