Question

1. A football player comes to you complaining of pain on his left side after falling on it while diving for a ball. He complains of some soreness over the lower thoracic ribs but most of the pain is just below that. He also noticed some pain in the left shoulder. After evaluating the athlete, you determine that his tenderness is centralized over the left flank (upper abdomen and back).

1. What structures can be involved and in what region and quadrant are they located?
2. What pathologies would you rule out?
3. Does this athlete demonstrate any referred pain patterns? If so, explain.
4. What do you think is wrong with this football player?
5. What are some red flags that this individual can experience?

Answer 1

A) Patient is complaining about left flank pain

Important organs in the left flank are

SPLEEN ( LEFT HYPOCHONDRIUM )

KIDNEY(LEFT UPPER QUADRANT)

TAIL OF PANCREAS(LEFT HYPOCHONDRIUM)

2)Pathologies that should be ruled out are

a) Pyelonephritis - It is infection of kidney due to Urinary tract infection . it can be ruled out by asking the symptoms like dysuria, fever, cloudy urine

b)Nephrolitiasis - Kidney stone . it can also be ruled out by asking dysuria, abdominal pain or by doing a ultra sound scan of Abdomen

3)Yes , the athelete demonstrate Left shoulder pain , it is a referred pain

This sign is called kehr sign.

Irriattion to the diaphragm , splenic injury, kidney stone, injury to the tail o pancreas can cause referred pain to the left shoulder , Because the same cranial root supplying this viscera have dermatome over the left shoulder region.

4) most probable diagnosis in this football player is spleen injury(splenic trauma ) . Spleen can be easily ruptured when a person got injury to the left side of the abdomen

A proper Ultrasound scan should be done as early as possible.

5) Intra abdominal Hemorrhage - Splenic injury can result in severe bkeeding in to the peritoneal cavity . This is a emergency situation . it can be confirmed by taking a ultrasound scan . Immediate splenectomy should be done if the injury is severe ( stage 4,5)

If the splenic injury is kept untreated it can lead to persons death due to hypovolemic shock