While emergent chest trauma in athletes is concerning, it is relatively uncommon (1). As extreme sports become more mainstream, the incidence of life-threatening chest trauma requiring immediate clinical care will likely rise. Non-life-threatening chest trauma, a much more common occurrence, significantly influences the return to play (RTP) (~42% of athletes return to sport within 1 wk) (2).
The predominant risk factors for chest trauma remain rapid deceleration and direct impact to the chest wall, usually due to impact with another competitor, fixated sporting equipment (goal post, etc.), or projectile (baseball, lacrosse ball, etc.). Frequently, athletes that experience chest injuries lack sufficient external protection. Injuries ranging from runner’s nipples to pericardial effusion can, in some cases, be prevented by better protection.
More than other musculoskeletal injuries suffered during sport, traumatic chest injuries represent a significant mortality risk. All of the injuries discussed in this article, with the exception of commotio cordis, respond well to principles discussed in Advanced Cardiac Life Support (ACLS). If a traumatic chest injury is suspected on the field of play, these ACLS principles should be employed immediately along with the application of an automated external defibrillator (AED). Prompt transfer to an advanced center of care should ensue. With advancement in technology and transportability, ultrasound is emerging as a reliable diagnostic tool that can aid in the rapid diagnosis of serious sideline conditions, like pneumothorax and pericardial effusions, along with less urgent injuries, like rib and clavicular fractures (3). Most conditions have the ability to be monitored and, if needed, addressed with surgical correction.
Return to Play
The overall goal for managing athletes with chest trauma is to return them to play. Once treatment is completed, RTP decisions are heavily dependent on the severity and stability of each athlete (see Tables 1 and 2).
Chest trauma suffered during athletic play provides the full spectrum of consequences because they may vary from minor to emergent to fatal injuries. It is imperative that the team physician be able to provide appropriate evaluation and treatment. The management of each athlete’s condition must be driven by his/her stability.
The authors declare no conflict of interest and do not have any financial disclosures.
1. Nathens AB, Fantus RJ. National Trauma Data Bank: annual report
. Chicago, IL; American College of Surgeons; 2009.
2. Johnson BK, Comstock RD. Epidemiology of chest, rib, thoracic spine, and abdomen injuries among United States high school athletes, 2005/06 to 2013/14. Clin. J. Sport Med
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3. Feden JP. Closed lung trauma. Clin. Sports Med
. 2013; 32:255–65.