aerobic training , strength and agility . On the 10 th day after the injury he integrated a conditioned training with the team , with avoidance of contact exercises . On the 17 th day he was allowed to train without limitations , with tapping protection at the site of the injury . The return to the competition happened 22 days after the initial injury , at the same competitive level . The progression in the rehabilitation plan took place without worsening the pain and without complications .
Clinical Case 2
Male athlete , 21 years of age , 1.68m tall and 68kg , professional football player ( middle center ). No pathological history of relief . There was an episode of blunt trauma to the anterior left thoracic region by the impact of a colleague ’ s elbow while he was trying to get the ball in the air , during a soccer practice . On the first evaluation , on the pitch , he referred pain located in the area of the trauma , increasing with palpation , thoracic compression , deep inhalation and cough . Due to the functional disability , it was removed from training for further evaluation .
In the locker room , he didn ’ t show any signs of respiratory distress , pulmonary auscultation was normal and the peripheral saturation of O 2 it was 99 %. Due to the suspicion of a rib fracture , it was transported to the private imaging clinic , where he performed an X-ray of the left costal grid ( face and oblique incidences ), which showed no acute injuries in the analysis by an experienced
Figure 4 – X-ray of the left ribs
Figure 5 – Ultrasonopgraphy of the 2 nd rib
Figure 6 – Ultrasonopgraphy of the 2 nd rib
radiologist ( Figure 4 ). In a complementary way , he performed a MSK ultrasound exam ( ultrasound GE Healthcare LOGIQ E7 with multifrequency linear probe 6-15MHz – ML6- 15 ), which showed discontinuity and deviation of the cortical bone of the second rib , with associated hematoma , in relation to the area of pain , whose findings were compatible with fracture ( figures 5 and 6 ). The ultrasound evaluation was complemented with colored Doppler study , and it excluded complications of the subclavian vascular beam .
The treatment plan was similar to the previous case , returning to competition at the same competitive level in 32 days .
Discussion
The ribs fractures are the most frequently encountered injuries ( 25 %) 8-
10 as a result of thoracic trauma and are also the most common type of injury in the ribs ( 67 %). 8 These injuries may occur in the bone part or in the cartilaginous part ( costochondral junction , costosternal junction or in the body of the cartilage ) of the costal arc . 4 , 5 These injuries are very uncommon in football . 6 , 11 In UEFA Elite Club injury Study Report 2016 / 17 , the injuries of the dorsal region , sternum and ribs correspond only to 1.2 % of the total . 11 In this sport , direct thoracic trauma can occur in a number of ways , such as the elbow injury in the approach to a flying ball 6 – the mechanism of injury just described in these cases . These injuries often cause big pain at the site of the impact , with the need for medical assistance and withdrawal from the pitch , at least temporarily . 6 In the clinical approach it is important to evaluate the pain and incapacity of the athlete , in order to control the complaints and to exclude possible complications . 6 , 8 Clinically , rib fractures cause pain at the site of trauma , aggravated by inspiration , cough and on palpation 6 , as it was described in these cases .
On suspicion of rib injury , traditionally the first exam to be performed is the X-ray
4 , 5 , 8 , 12 , 13
of the affected coastal grid . However , this exam is not traditionally available in the medical department of clubs and has low sensitivity in the detection of these injuries , it may fail to diagnose in 50 % of cases , especially in fractures without deviation and fractures of the costal cartilage . 4 , 5 , 9 , 10 , 12 , 13 After the first medical evaluation and with the suspicion of fracture , the players performed an X-ray of the affected coastal grid . These exams were analyzed by an experienced radiologist and by the team doctor who did not detect any changes .
Since there was no relief of the complaints and with a high index of suspicion for rib fracture , it was decided to perform an ultrasound exam , which showed changes compatible with the described fractures . In the case of the fracture of the seventh costal cartilage , this diagnosis was confirmed by CT . In fact , the ultrasound has a higher sensitivity than the conventional radiography in the diagnosis of rib fractures 4 , 5 , 8-10 , 12-14 , as reported in the studies of Griffith et al ( 90 % and
Revista de Medicina Desportiva informa may 2018 · 19