The rectus abdominis is a vertical muscle that extends the length of the abdomen from the inferior costal margin to the symphysis pubis. One type of abdominal wall contusion is a rectus abdominis hematoma. A Grey Turner sign demonstrates a similar bluish discoloration of the flank also suggestive of hemoperitoneum. The Cullen sign demonstrates a bluish periumbilical discoloration suggestive of hemoperitoneum. A Kehr sign demonstrates pain radiating to the left shoulder which suggests diaphragmatic irritation secondary to free fluid. Certain physical examination findings may signal characteristic pathologic conditions. Other characteristics include the presence or absence of guarding, rigidity, rebound tenderness, and peritoneal signs. Considerations include immediate versus worsening pain, local versus diffuse pain, and stationary versus radiating pain. Pending the arrival of transportation, patients should remain lying supine in a modified Trendelenburg position.įinally, the type of abdominal pain can lead to insights concerning the underlying condition and severity of injury. If these signs are present, transport should be arranged to the nearest medical facility. Signs of shock include tachycardia, hypotension, dyspnea, diaphoresis, anxiety, and confusion. Second, patients should be assessed for any signs of shock which may indicate a need for immediate intervention. This type of injury may cause complete disruption of deep organs and very few superficial signs. In contrast, an acceleration/deceleration-type injury occurs when a moving athlete is abruptly brought to a stop, i.e. The depth of the injury is related to the force of the blow. This mechanism will result in local injury and damage to the overlying skin and subcutaneous blood vessels. Direct trauma often results from a blow to the abdomen. One consideration is the mechanism of injury. Should the injured player return to play, be removed from competition, or be transported for further evaluation? 4įirst, the sideline physician should differentiate benign from potentially life-threatening abdominal injuries and determine the disposition of the player. Indirect sport-related trauma has also been reported in baseball and lacrosse from a ball striking the abdomen. These types of injuries tend to be more common in contact or collision sports, such as hockey, football, and soccer, but have also been reported in noncontact sports, such as cycling, skiing, snowboarding, and surfing. The sports medicine physician needs to be familiar with the signs and symptoms of abdominal injury when evaluating players on the sideline. Abdominal wall injuries: rectus abdominis strains, oblique strains, rectus sheath hematoma. Percentage of abdominal wall injuries from the 2004–2005 NCAA’s injury surveillance systemĭata from Johnson R.
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