Revista de Medicina Desportiva (English) May 2018 - Page 21

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
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 limi- tations, 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 patho- logical 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 palpa- tion, 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 radiologist (Figure 4). In a comple- mentary way, he performed a MSK ultrasound exam (ultrasound GE Healthcare LOGIQ E7 with multifre- quency linear probe 6-15MHz – ML6- 15), which showed discontinuity and deviation of the cortical bone of the second rib, with associated hema- toma, in relation to the area of pain, whose findings were compatible with fracture (figures 5 and 6). The ultr ͽչمՅѥ݅́)ѕݥѠɕȁՑ)Ё፱Ցѥ́ѡ)Չ٥م͍ձȁ)QɕѵЁ݅́ͥ)Ѽѡɕ٥͔́ɕɹѼ)ѥѥЁѡͅѥѥٔ)ٕȁ̸)͍ͥ)Qɥ́Ʌɕ́ɔѡЁɔ)Օѱ䁕չѕɕɥ̀Ԕ()́ɕձЁѡɅɅյ)ɔͼѡЁ)䁥ѡɥ̀ܔQ͔Դ)ɥ́䁽ȁѡЁ)ѡѥ́Ѐѽ)Ʌչѥѽѕɹչѥ)ȁѡ䁽ѡѥѡ)хɌаԁQ͔ɥ́ɔٕ)չщذā%U)є ՈMՑIЀؼܰ)ѡɥ́ѡͅɕ)ѕɹմɥ́ɕ)ѼĸȔѡѽхā%ѡ́а)ɕЁѡɅɅյȁ)յȁ̰݅Ս́ѡ)䁥ѡɽѼ她)؃Lѡʹ)Ё͍ɥѡ̸͔͕Q͔)ɥ́ѕ͔Ёѡ)ͥєѡаݥѠѡ)ȁͥх)ݥѡɅ݅ɽѡэ)ЁѕɅɥ一؁%ѡ)ɽЁ́хЁѼ)مՅєѡ)䁽ѡѡєɑȁѼ)ɔԃLUɅͽɽѡ́)Ʌ䁽ѡȁɥѼ፱Ցͥ)ѥ̸ذ 䰁ɥɅ)ɕ͔́Ёѡͥє)ɅյɅمѕ䁥Ʉ)ѥ՝ѥ؀)́Ё͍݅́ɥѡ͔)̸͕)=ɥ)ɔЃL`Ʌ䁽ѡЁɔ؃LUɅͽɅѥѡЁᅴ)Ʌ䁽ѡȁɥѼəɵ́ѡ`Ʌ)ɥ)ѡѕхɥа԰Ȱ)!ݕٕȰѡ́ᅴ́ЁɅѥ)䁅مѡд)ЁՉ́́܁͕ͥѥش)䁥ѡѕѥѡ͔ɥ̰)Ё䁙Ѽ͔)͕̰䁥Ʌɕ́ݥѠ)Ё٥ѥɅɕ́ѡ)хѥа԰Ȱ́ѕȁѡ)ЁمՅѥݥѠ)ѡɅɔѡ)əɵ`Ʌ䁽ѡѕ)хɥQ͔ᅵ́ݕɔ)镐䁅ɥɅ)ѡѕѽȁݡ)ѕЁ䁍̸)Mѡɔ݅́ɕѡ)́ݥѠ)ȁɥɅɔЁ݅)ѼəɴձɅͽչ)ᅴݡ͡ݕ)ѥݥѠѡ͍ɥ)Ʌɕ̸%ѡ͔ѡɅɔ)ѡ͕ٕѠхѥѡ)ͥ́݅́ɵ P%)аѡձɅͽչ́)͕ͥѥ٥ѡѡٕѥ)ɅɅ䁥ѡͥ́ɥ)Ʌɕ̀а԰ȴЀ́ɕѕ)ѡՑ́ɥѠЁ)I٥ф5ѥلɵ ܀