Pneumothorax
A pneumothorax (PTX) is defined as air that has leaked into the pleural space, either spontaneously or as a result of traumatic tears in the pleura following a chest injury. Chest trauma sustained in sporting occurs infrequently. It has been found that only 2% of adult thoracic injuries requiring medical treatment are sports related. Although uncommon in athletics, when they occur they can be life-threatening, requiring immediate diagnosis and treatment.
What Are the Different Types? And Which Type is Most Common in Athletics?
Pneumothorax can be divided into spontaneous, traumatic, or iatrogenic (result of medical procedures). In the realm of athletics, you a traumatic or spontaneous PTX are the types most likely to occur (although still very rare). Traumatic PTX can be further subdivided into penetrating or non-penetrating trauma. While rare, traumatic PTX have been reported in sports such as ice hockey, football, rugby, and soccer. For the most part, sports-related PTX are due to blunt chest trauma. Additionally, individuals who have Marfans Syndrome are also at an increased risk of spontaneous PTX.
How Do You Prevent a Pneumothorax?
The only way of preventing a PTX is to reduce the risk by not smoking.
What Puts an Individual at Risk for a Pneumothorax?
Individuals who are young and tall are most susceptible to the development of a primary spontaneous pneumothorax. Individuals in high blunt chest trauma risk sports, are also at increased risk when compared to non-contact sports.
How Do I Know if an Athlete Has a Pneumothorax?
The classic presentation of a PTX is shortness of breath and sharp pain in the chest while breathing. The chest pain is usually present on one side, but can radiate to the shoulder, neck and into the back. 10% of the individuals who have a PTX can present with no symptoms. The symptoms of a pneumothorax may also present atypically. For example, it is possible that athletes may present with chest pain attributed to injury and deconditioned status.
| Clinical signs and symptoms of pulmonary injury | |||
| Pneumothorax | Hemothroax | Pneumomediastinum | Pulmonary Contusion |
| Shortness of breath | Shortness of breath | Shortness of breath | Shortness of breath |
| Sharp pain in chest while breathing | Chest pain | Pain behind the sternum while breathingNeck painDifficulty speaking
Difficulty swallowing Cough |
Chest painCoughing blood |
| Rapid breathing | Rapid breathing | Air under the skin | Rapid breathing |
| Rapid heart rate | Rapid heart rate | Crunching sound in chest typically with heart beat | Reduction of blood supply to tissues |
| Anxiety | Anxiety | Fever | Wheezing |
| Tension pneumothorax:High blood pressureTracheal deviation
Distended neck veins |
Massive hemothorax:High Blood pressure | ||
What Else Could This Be?
- Sternal, rib, or scapula fracture
- Injury to the diaphragm
- Asthma
- Cardiac event
- Aortic rupture
How Do I Treat a Pneumothorax?
First, activate emergency medical services (EMS). Treatment incudes assessing vital signs (blood pressure, pulse, and breathing rate), listening for quality of breaths, and removing air from the pleural space, re-expanding the underlying lung, and preventing recurrence. Ensure that there is an adequate airway present. X-rays may help determine a diagnosis.
When Can the Athlete Return to Activity?
There are no specific guidelines for returning to sports after traumatic pneumothorax. General timelines are based on case reports and expert opinions and range from 2-10 weeks. Pain has been shown to be the most likely factor in determining return to play. Additionally, return to play should not be allowed before radiographic resolution of the PTX. A physician must clear the athlete before re-introducing activity, and return should include a gradual progression back into activity with appropriate medical monitoring.
Where Can I Get More Information?
References
Curtain SM, Tucker AM, Gens DR. Pneumothorax in sports: issues in recognition and follow-up care. Phys Sportsmed. 2000;28(8):23-32.
Feden JP. Closed Lung Trauma. Clin Sports Med 2013; 32:255-265.
Hull JH, Ansley L, Robson-Ansley P, Parsons JP. Managing respiratory problems in athletes. Clinical Medicine 2012; 12:351-356.
Karnik AK Management of Pneumothorax and Barotrauma: Current Concepts. Comp Ther. 2001; 27(4): 311-321.Marnejon T, Sarac S, Cropp AJ. Spontaneous pneumothorax in weightlifters. J Sports Med Phys Fitness. 1995;35(2):124-126.
Partridge RA, Coley A, Bowie R, Woolard RH. Sports-related pneumothorax. Ann Emerg Md 1996; 30:539-541.
Putukian M. Pneumothorax and pneumomediastinum. Clin Spors Med 2004; 23:443-454.