Abdominal & Pelvic Assessment

The assessment of the abdomen needs to consider the position of the organs including the bowel. The abdomen should be assessed taking into consideration the main organs that have been found to be traumatised in contact collision sports. A system of asking the player the site of pain, thorough examination including palpation is advised.

Liver/Hepatic/ injury: pain is usually localised to the right upper quadrant of the abdomen. Players may also indicate they perceive pain in the region of the right shoulder. Injury to the liver is often a result of lower rib fracture(s) but can also be due to direct blunt trauma. There may be evidence of shock clinically and possibly guarding found on abdominal palpation from blood irritating the peritoneum.

Spleen/Splenic injury: pain is usually localised to the left upper quadrant of the abdomen. Players may also indicate they perceive pain in the region of the left shoulder. This can either be due to blood irritating the diaphragm or due to diaphragmatic rupture. Injury to the spleen is often as a result of rib fracture(s) but also be due to direct blunt trauma. There may be evidence of shock clinically and possibly guarding found on abdominal palpation, from blood irritating the peritoneum. The spleen is encased by a thick capsule occiasionally resulting in delayed rupture up to 10 days after an injury. Practitioners need to be aware of this and observe players for at least 4-6 hours, give appropriate advice and to seek advanced medical care if there is any suggestion of splenic rupture.

Kidney/Renal trauma: Care must be taken when examining the abdomen to also examine the retroperitineum by balloting the kidneys. In cases of significant renal trauma the abdomen may be found to be soft and nontender. Palpation of tenderness or complaints of pain in the renal angle after trauma, should lead to hospital review/investigations for possible renal trauma. The presence of frank haematuria is  an additional sign to check for and to warn the player about reporting.

Pelvic trauma: in rugby, pelvic fractures are relatively uncommon, but cases have been reported, presenting with pain at the site of the fracture or in the groin. There may be shortening of one leg in comparison to the other and the presence of crepitus.

There may be bleeding from the urethra or rectum. If a player is shocked and presents with pain in the region of the pelvis following trauma, it should be assumed there is pelvic trauma and no palpation of the pelvis should take place. If this is not evident examination should be by gentle compression only, If pelvic trauma with haemorrhage is suspected the pelvis should be bound with a commercial pelvic binder. If these are not available a sheet or blanket can be used to tie around the pelvis. In the application of any of these binders, it is essential that the pressure applied to the pelvis is across the inter-trochanteric line and not above or below this, to ensure the pelvic volume is being reduced and not opened up. Pelvic binders must be applied directly to skin with clothing cut away over the greater trochanter/hips but left in situ over the groin area to maintain dignity. Tying the player’s feet together may also help reduce the pelvic volume if there is a displaced pelvic fracture. Distal neurovascular checks must be undertaken post-application of a pelvic binder and recorded.

Pelvic SAM sling