Jessica M. Intravia, BS, MHA^a∗ and Thomas M. DeBerardino, MD^b

^aSchool of Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, MARB4, Farmington, CT 06034-4037, USA. E-mail address: jintravia@gmail.com

^bDepartment of Orthopaedic Surgery, University of Connecticut Health Center, 263 Farmington Avenue, MARB4, Farmington, CT 06034-4037, USA

^∗Corresponding author.

In 1981, Bergqvist and colleagues¹ estimated that 10% of all abdominal injuries resulted from sport-related trauma. Since then, athletic pursuits have continued to become a popular American pastime. From 1988 to 2004, female participation in National Collegiate Athletic Association (NCAA) championship sports has increased 80% and male participation has increased 20%.² Table 1 reports the percentage of abdominal wall injuries from the 2004–2005 NCAA’s injury surveillance system.³

The sports medicine physician needs to be familiar with the signs and symptoms of abdominal injury when evaluating players on the sideline. 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. Indirect sport-related trauma has also been reported in baseball and lacrosse from a ball striking the abdomen.⁴

First, the sideline physician should differentiate benign from potentially life-threatening abdominal injuries and determine the disposition of the player. Should the injured player return to play, be removed from competition, or be transported for further evaluation?

One consideration is the mechanism of injury. Direct trauma often results from a blow to the abdomen. This mechanism will result in local injury and damage to the overlying skin and subcutaneous blood vessels. The depth of the injury is related to the force of the blow. In contrast, an acceleration/deceleration-type injury occurs when a moving athlete is abruptly brought to a stop, i.e. when a skier hits a barricade. This type of injury may cause complete disruption of deep organs and very few superficial signs.

Second, patients should be assessed for any signs of shock which may indicate a need for immediate intervention. Signs of shock include tachycardia, hypotension, dyspnea, diaphoresis, anxiety, and confusion. If these signs are present, transport should be arranged to the nearest medical facility. Pending the arrival of transportation, patients should remain lying supine in a modified Trendelenburg position.

Finally, the type of abdominal pain can lead to insights concerning the underlying condition and severity of injury. Considerations include immediate versus worsening pain, local versus diffuse pain, and stationary versus radiating pain. Other characteristics include the presence or absence of guarding, rigidity, rebound tenderness, and peritoneal signs. Certain physical examination findings may signal characteristic pathologic conditions. A Kehr sign demonstrates pain radiating to the left shoulder which suggests diaphragmatic irritation secondary to free fluid. The Cullen sign demonstrates a bluish periumbilical discoloration suggestive of hemoperitoneum. A Grey Turner sign demonstrates a similar bluish discoloration of the flank also suggestive of hemoperitoneum.⁴