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Abdominal and Genitourinary Injuries in Sports
Dennis Colon
May 24, 2024
Incidence and Sports at Risk:
Abdominal and genitourinary injuries in sports constitute a significant portion of acute traumas encountered by sports physical therapists. These injuries often present unique challenges due to their potential to rapidly escalate from benign to life-threatening. Sports-related abdominal and genitourinary injuries are prevalent in high-impact and high-speed sports and constitute about 10% of all sports-related abdominal injuries. Despite their frequency, the management of such injuries on the field or in the clinic requires careful differentiation between non-urgent and critical conditions. According to NCAA data, these injuries occur at a rate of 0.16 per 1000 athlete exposure hours. High-speed sports such as cycling and skiing are commonly associated, but these injuries are not limited to what might typically be expected. Sports such as basketball and soccer, which involve sudden changes in speed and direction, can also result in significant internal injuries due to collisions or falls.
Mechanisms of Injury:
The nature of the mechanism—whether acceleration or deceleration—can be a critical determinant in the type of injury sustained. Acceleration injuries might occur during collisions in sports like football, where athletes experience rapid forward motion. Deceleration injuries are common in sports where athletes may fall and abruptly stop, causing internal organs to jolt within the body cavity. These mechanisms can lead to deep organ damage that might not be immediately apparent. Additionally, direct trauma can cause local injury to the muscle wall, such as a rectus abdominis hematoma, or deeper tissue injuries to organs like the liver and kidneys.
Evaluation Strategies:
A systematic evaluation is paramount in managing these injuries effectively. Initial assessment should focus on the ABCs (Airway, Breathing, Circulation) to ensure stability:
Airway: Ensure that the airway is clear. For example, in cases of facial injuries or unconsciousness, check for obstructions or the need for airway support.
Breathing: Assess breathing patterns and look for any signs of respiratory distress or compromise. This might include observing for asymmetric chest movement, listening for wheezing or other abnormal sounds, and measuring oxygen saturation.
Circulation: Evaluate the circulatory status by checking heart rate, blood pressure, capillary refill, and the appearance of peripheral perfusion to identify signs of internal bleeding or shock.
Tachycardia and hypotension (low blood pressure) are indicators of potentially severe abdominal injuries. The presence of both tachycardia and hypotension necessitates the transfer of an athlete with such injuries to a healthcare facility that can provide more sophisticated treatment options.
Further examination of the abdomen should include palpation for tenderness, rebound tenderness, guarding, and peritoneal signs, along with assessing bowel and respiratory sounds and noting any organ enlargement. Assessing for shock through signs like tachycardia, hypotension, shortness of breath, diaphoresis, anxiety, and confusion is crucial.
Athlete Management Strategies:
If the athlete exhibits signs of shock, immediate transportation with the athlete in a modified Trendelenburg position (feet elevated above the heart) is recommended. For cases without shock signs, close monitoring in a controlled environment such as a training room is suitable, with frequent vital checks.
If an athlete displays symptoms of shock, such as rapid heartbeat or low blood pressure, despite appearing stable during a basic physical examination, it is crucial to take them seriously, especially if they have sustained a significant injury. The athlete should be transported to an emergency department for a more thorough assessment and monitoring, as the facilities and resources available there are more extensive than what can be provided on the sports field or sidelines. This is important because some severe internal injuries may not be immediately obvious but still require urgent medical attention.
Persistent concerns should prompt referral for higher-level evaluation. Physical therapists should be adept at identifying the type of pain—whether immediate, delayed, local, diffuse, stationary, or radiating. Observing guarding, rigidity, rebound tenderness, and other peritoneal signs can provide clues to the underlying severity. Notable diagnostic signs include:
Kehr's sign: Pain radiating to the left shoulder, indicative of diaphragmatic irritation.
Cullen's sign: Bluish discoloration at the umbilicus, suggesting hemoperitoneum.
Grey Turner's sign: Bluish discoloration of the flank, also indicative of hemoperitoneum.
Effective management of abdominal and genitourinary injuries in sports requires a thorough understanding of the typical mechanisms of injury, careful and systematic evaluation, and appropriate management strategies. Early and accurate diagnosis followed by prompt intervention can significantly impact the prognosis and recovery of the athlete, underscoring the critical role of sports physical therapists in acute sports injury management.
Even though athletes may have normal vital signs in the presence of an abdominal injury, they could still experience abdominal tenderness that needs careful monitoring. Repeating vital sign checks is crucial and can be done on the sidelines.
