Pneumothorax in a High School Football Player

Abstract

UNIQUENESS OF CASE BACKGROUND • Pneumothorax is the presence of air between the visceral and the parietal pleura of the pleural cavity 1 • A traumatic pneumothorax is caused by a penetrating wound to the chest, such as a fractured rib that violates the visceral pleura 1 • Research concerning pneumothorax in football is non-existent • Literature about pneumothorax in athletics in general is also non-existent PATIENT CHARACTERISTICS AND HISTORY • Male • 18 year old • African – American • High school football running back/linebacker • History of heat-related muscle cramping DIFFERENTIAL DIAGNOSIS • Heat-related illness • Rib Contusion • Lung Contusion • Part of athlete's signs and symptoms were attributed to: o 2 hours of playing both offense and defense o High heat and humidity o Dehydration due to playing both ways with little chance to adequately rehydrate o Treated earlier in scrimmage for muscle cramps • The athlete's pain level did not match with the seriousness of the injury EVIDENCE-BASED CLINICAL RECOMMENDATIONS • Check for lung sounds, even when you believe the injury may be benign • Use extra padding (hard, soft, or both) when recovering CLINICAL PRESENTATION • Athlete tackled while running the ball and fell onto his back • Speared on the left anterolateral aspect of his thorax • Signs & symptoms: SOB, point tenderness on ribs 5-10, no visible defects • Normal inspiration/expiration observed during breathing cycle • Auscultation was not performed initially TREATMENT • 10 days post-injury unresolved pneumothorax • Patient admitted to the hospital for a thoracostomy • Released 2 days later with instructions to rest and to wear a sling on the effected side • 24 days post-injury , patient was cleared to resume activity • 4 days later released for full, unrestricted play • Played in a game 28 days post-injury • Protection offered by an inner, soft, padded shirt and an outer, hard, shelled rib protector DIAGNOSTIC TESTING • X-ray and CT scan findings o Trace pneumothorax o Non-displaced incomplete fractures to the lateral L 4 th , 5 th , and 6 th ribs (Figures 1 & 2) o Non-displaced incomplete fractures to the posterior L 5 th , and 6 th ribs (Figures 1 & 2) REFERENCES 1. Cvengros RD, Lazor J. Pneumothorax – a medical emergency. J Athl Train. 1996; 31: 167-168 Outline of soft inner, soft padded shirt Fig. 1 -Day after injury x-rays Fig. 2 -Return to play x-rays

Full text

printed by
www.postersession.com
Pneumothorax in a High School Football Player
Sara Henley, BS, University of Tennessee at Chattanooga,
Scott L. Bruce, MS, ATC, University of Tennessee at Chattanooga,
Casey Riley, ATC, Signal Mountain High School
UNIQUENESS OF CASE
BACKGROUND
•Pneumothorax is the presence of air between the visceral and the parietal
pleura of the pleural cavity1
•A traumatic pneumothorax is caused by a penetrating wound to the chest, such
as a fractured rib that violates the visceral pleura1
•Research concerning pneumothorax in football is non-existent
•Literature about pneumothorax in athletics in general is also non-existent
PATIENT CHARACTERISTICS AND HISTORY
•Male
•18 year old
•African – American
•High school football running back/linebacker
•History of heat-related muscle cramping
DIFFERENTIAL DIAGNOSIS
•Heat-related illness
•Rib Contusion
•Lung Contusion
•Part of athlete’s signs and symptoms were attributed to:
o2 hours of playing both offense and defense
oHigh heat and humidity
oDehydration due to playing both ways with little chance to adequately rehydrate
oTreated earlier in scrimmage for muscle cramps
•The athlete’s pain level did not match with the seriousness of the injury
EVIDENCE-BASED CLINICAL RECOMMENDATIONS
•Check for lung sounds, even when you believe the injury may be benign
•Use extra padding (hard, soft, or both) when recovering
CLINICAL PRESENTATION
•Athlete tackled while running the ball and fell onto his back
•Speared on the left anterolateral aspect of his thorax
•Signs & symptoms: SOB, point tenderness on ribs 5-10, no visible defects
•Normal inspiration/expiration observed during breathing cycle
•Auscultation was not performed initially
TREATMENT
•10 days post-injury unresolved pneumothorax
•Patient admitted to the hospital for a thoracostomy
•Released 2 days later with instructions to rest and to wear a sling on the effected side
•24 days post-injury , patient was cleared to resume activity
•4 days later released for full, unrestricted play
•Played in a game 28 days post-injury
•Protection offered by an inner, soft, padded shirt and an outer, hard, shelled rib protector
DIAGNOSTIC TESTING
•X-ray and CT scan findings
oTrace pneumothorax
oNon-displaced incomplete fractures to the lateral L 4th, 5th, and 6th ribs (Figures 1 & 2)
oNon-displaced incomplete fractures to the posterior L 5th, and 6th ribs (Figures 1 & 2)
REFERENCES
1. Cvengros RD, Lazor J. Pneumothorax – a medical emergency. J Athl Train. 1996; 31: 167-168
Outline of soft inner, soft padded shirt
Fig. 1 - Day after injury x-rays Fig. 2 - Return to play x-rays