PMC6329028_01
Athlete 1 being struck accidentally by an opponent's elbow in a marking contest.
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Athlete 1, a 29-year-old male, sustained a direct blow from an opponent's elbow (Figure 1).
Athlete 1 showing ecchymosis on the left anterolateral abdominal wall on day 3 postinjury.
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He was assessed at the injury clinic 48 hours after the injury; on examination, he continued to be troubled by significant pain and had obvious ecchymosis over the area of injury (Figure 2).
Day 4 ultrasonography results for athlete 1. EO, external oblique; H, hematoma; IO, torn internal oblique.
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Ultrasonography was then performed, which revealed a 6-cm, anterior-to-posterior disruptive injury or hematoma deep to the internal oblique muscle insertion (Figure 3); 10 mL of blood was aspirated, followed by injection of 1 ampoule of betamethasone and 2 mL of 0.5% bupivacaine.
Match day ultrasound-guided aspiration and local anesthetic injection for athlete 1.
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Seven days after the initial injury, a radiologist performed a pregame ultrasound-guided aspiration of 10 mL of blood and a subsequent injection of 15 mL of 0.75% ropivacaine along the middle one-third of the left iliac crest (Figure 4).
Day 9 coronal magnetic resonance image for athlete 1. Arrow points to internal oblique. EO, external oblique; H, hematoma; IO, internal oblique; TA, transversus abdominis.
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Nine days after the injury, the medical team decided to investigate the injury with a magnetic resonance imaging (MRI) examination of the left iliac crest and lower anterolateral wall (Figure 5).
Follow-up magnetic resonance image of athlete 1 at 18 months postinjury.
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The MRI revealed no anatomic reattachment of the internal oblique muscle to the iliac crest but rather an area of fibrosis (Figure 6).
Day 3 magnetic resonance image of athlete 2 with arrow indicating area of muscle retraction and hematoma.
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Given the high index of suspicion for a disruptive injury of the anterolateral abdominal wall, similar to athlete 1, he was investigated promptly with an MRI 3 days after the injury (Figure 7).
Follow-up magnetic resonance image of athlete 2 at 6 months postinjury.
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Athlete 2 had a follow-up MRI (sagittal imaging only) 6 months after injury, and this demonstrated findings identical to those of athlete 1 (Figure 8).