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Abdominal Wall Injury - Causes, Diagnosis, and Management

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The abdominal wall injury is caused by trauma to the abdomen. Athletes' injuries are usually uncommon and treated with rehabilitation and sports guidance

Medically reviewed by

Dr. Jagdish Singh

Published At March 13, 2023
Reviewed AtMarch 20, 2023

Introduction:

Abdominal wall injuries are less common in nonpenetrating sports trauma. Direct hits to the abdomen or repetitive trunk movements, such as rotation or flexion/extension, can affect the abdominal wall muscles. The severity of the injuries might range from mild to severe, like a contusion or abdominal wall rupture. But since these injuries are closely related to potentially severe cardiac and systemic injuries, such as aortic damage, delay in diagnosis can lead to consequences such as intestinal hernias with the potential for blockage or the misdiagnosis of an abdominal wall tumor.

What Is the Abdominal Wall?

The abdominal wall is relatively deficient in skeletal support; however, pelvic bones and the thoracic cage are connected to the skeletal system. Because of this relative bone deficit, the trunk can stretch and adapt to changes in the volume of the abdominal contents while moving (jumping, gliding, boxing, and running). In addition, the abdominal wall comprises enormous layers like skin, subcutaneous tissue, muscles, fascia, and peritoneum to protect the internal organs.

What Is the Function of an Abdominal Wall?

The abdominal muscles assist in flexion, extension, and trunk rotation. In addition, the abdominal muscles contract simultaneously and can help provide the intraabdominal and intrathoracic pressure necessary for sneezing, coughing, vomiting, and defecating. Eventually, stabilize the trunk while weight lifting and aids in respiration by lowering the ribs to produce active expiration.

What Are the Causes of Abdominal Wall Injuries?

The common cause of abdominal wall injuries include

  • Direct trauma by a contact sport or an object.

  • The sudden and unexpected movement of the trunk or repeated physical activity, such as occurs in golf, throwing, and racquet sports.

  • Running or jumping is susceptible to injury because of the pelvic stabilizer function of the abdominal muscles.

  • Extreme or intense workout.

  • Accidents, self-falls, or car crashes.

  • Weight lifting

  • Improper technique while playing a sport.

What Are the Type of Abdominal Injury?

The most common type of abdominal injury is

  • Rectus Sheath Hematomas: The rectus sheath is a connective tissue that supports abdominal muscles. Any bleeding from epigastric arteries that extends into the abdomen might result in a rectus sheath hematoma. A bluish discoloration may occur in the periumbilical region after 72 hours of an injury. This is called Cullen's sign. Pain worsens by resisted hip flexion, trunk flexion, and back extension. The majority of rectus sheath hematomas resolve on their own without medical intervention. It is characterized by abdominal pain with localized swelling and is often relieved by flexing the trunk. It is often misdiagnosed intra-abdominal injuries; hence appropriate examination is necessary.

  • Abdominal Muscle Injuries: The injury to the abdominal muscles results in contusions. These injuries are treated symptomatically and with rehabilitation. Ice therapy and abdominal strengthening treat contusions in the initial stage. Sports involving activities with trunk rotation, such as volleyball, tennis, golf, baseball, softball, gymnastics, diving, and the throwing and jumping events in track and field, are likely to cause recurrent strains that manifest more gradually. Therefore, the treatment is only based on the severity of the injury.

What Are the Symptoms of an Abdominal Wall Injury?

The predominant symptoms of an abdominal wall injury are stomach or abdominal pain, aggravated by touching the affected area, sneezing, coughing, or laughing, exercise, and prolonged immobilization. The other symptoms include

  • Muscle stiffness.

  • Swelling or bruising.

  • Muscle cramps.

  • Fever.

  • Tenderness.

  • Black poop.

  • Nausea and vomiting.

  • Swollen stomach.

How to Diagnose an Abdominal Wall Injury?

The diagnosis is based on the severity of the symptoms, the history of the illness, and the physical examination. On the other hand, an x-ray is indicated to confirm ribcage injuries, spinal fractures, or other broken bones. Since these injuries are closely related to potentially severe cardiac and systemic injuries, such as aortic damage, delay in diagnosis can lead to consequences such as intestinal hernias with the potential for blockage or the misdiagnosis of an abdominal wall tumor.

How to Manage an Abdominal Wall Injury?

Most abdominal wall muscle injuries are treated nonoperatively, with the uncommon rectus sheath hematoma needing artery ligation or hematoma evacuation being the exception.

The management of abdominal wall injury based on three factors are

  • Plenty of physical rest.

  • Ice pack therapy.

  • Strengthening of the abdomen by stretching and strengthening exercises.

Palliative care is carried out with the help of nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve symptoms like pain and inflammation. Eventually, abdominal braces were advised to minimize swelling. As a result, most athletes return to sports activity once the injury has healed up.

What Is the Rehabilitation Treatment for Abdominal Wall Injuries?

Generally, a muscle injury results in muscle weakness and alters the function of the affected area. Functional rehabilitation is employed to regain strength and function. Although restoring the affected muscle groups is crucial, it starts only after symptomatic relief. Recovery-focused rehabilitation and potential reinjury prevention strategies become the cornerstones of therapy for a speedy and successful return to training and competition. The standard rehabilitation exercises are

  • Partial sit-ups.

  • Partial sit-up with rotation to either side.

  • Flat back with one leg raised.

  • Flat lower back and bringing both legs up higher than heart level.

  • Straight plank.

  • Side plank.

How to Prevent Abdominal Wall Injury?

The abdominal wall injury is avoided by strengthening the abdominal muscles. Abdominal strength can be achieved through Pilates, yoga, or other exercises that stretch the abdominal muscles. The majority of the injury was prevented by avoiding unbearable weightlifting. Before engaging in strenuous physical activity, warm up muscles, and cool down afterward.

Conclusion:

Injuries to the abdominal wall are often observed in athletes. Collision sports, using bats and racquets, and sports involving thrown or batted items increase the risk of injury by exposing a vulnerable abdomen. However, the constant requirement of healthy abdominal wall muscles for the athlete in running, leaping, throwing, and batting sports implies the possibility of damage and the consequent necessity of injury therapy. After a precise diagnosis, recovery-focused rehabilitation and potential reinjury prevention strategies become the cornerstones of treatment for a speedy and successful return to training and competition.

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Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology

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abdominal wall injury
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