The abdomen is the large cavity in the middle of
the body that contains the stomach, liver, spleen,
colon and small intestines. The abdominal wall,
which surrounds this area, is made of tendons and
muscles designed to support and stabilize the pelvis
and rib cage while also assisting in their motion.
An abdominal wall strain occurs when one of its
muscles or tendons is either stretched, torn, or
ruptured, causing a tear the may be large enough
to allow a section of bowel to protrude into the
abdominal wall. There are three types of abdominal
wall strains:
Grade
1 – Slightly pulled muscle with no loss of
strength in the area.
Grade
2 – Some tearing of fibers in a muscle or
tendon.
Grade 3 – Ruptured
muscle or tendon; severe cases, in which a portion
of the bowel may be protruding into the abdominal
wall, require surgery to repair.
Causes
Abdominal wall strain is usually caused by overuse
or by an incident that results in injury. Repetitive
actions or motions can lead to overuse, which can
lead to pulls or tears. Abdominal strains are common
injuries to hockey and basketball players as well
as track and field athletes who participate in hurdling
and high jumping, for example. These sports require
the athlete to twist and turn frequently. Other
causes include movements that require large muscle
forces while intra-abdominal pressures are generated,
such as those required of weightlifters and football
players. A sudden force or repetitive stress to
the abdominal muscles can cause them to separate
from the pelvic bones. Again, these types of forces
are most commonly seen in sports like hockey and
soccer.
Your physician likely will ask about your activities,
which may have led to your abdominal wall strain.
You may be asked when the soreness or pain began.
If you have had any prior rib fractures, your physician
will ask about the treatments you have tried in
the past. Physicians also typically ask about other
conditions, such as diabetes and allergies, and
medications currently being taken.
PHYSICAL
EXAM
While you lie on an exam table, your physician will
visually inspect the painful area for swelling,
bulging for bruising. If the injury occurred close
to the pelvic bones or the ribs, the bony structures
will be examined. It is helpful to the physician
to localize the tender area while you are lying
relaxed. While pushing on the tender area, the doctor
should ask you to sit up or twist. If this increases
the tenderness and pain, an abdominal wall injury
is very likely. However, if the pain decreases,
the implies a possible intra-abdominal problem.
Your physician may also have you stand cough to
check for hernias, as well as to test the tender
areas under different muscle stresses.
The simplest test your physician may request is
an X-ray to make sure there are no fractures in
the surrounding area if an abdominal wall strain
is suspected. If an intra-abdominal injury, with
or without a strain, is suspected, CT scans for
ultrasound may be necessary.
