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A 22-year-old female volleyball player presented with increasing left lower quadrant abdominal pain, swelling, and numbness. Symptoms emerged gradually during volleyball activities, particularly spiking drills, worsening with certain treatments like scraping and cupping. Despite initial relief with ice and ibuprofen, traditional treatments failed, and she experienced pain hindering her ability to perform sit-ups. Physical examination indicated tenderness and a positive Carnett's sign. Point of care ultrasound suggested a rectus sheath hematoma, later confirmed as a grade II tear of the left rectus abdominis muscle.<br /><br />Rectus sheath hematoma is a rare condition where bleeding occurs into the sheath covering the rectus muscle. This injury often requires careful differential diagnosis from other conditions like abdominal strains or hernias. Common symptoms include non-radiating abdominal pain and swelling. A positive Carnett’s test can help distinguish it from visceral pain.<br /><br />Risk factors for developing such a hematoma include factors like coagulopathy, high blood pressure, direct trauma, or increased abdominal pressure, but it can also occur in athletes performing strenuous activities, as seen in this case.<br /><br />Management is generally conservative, emphasizing rest and avoidance of manual therapies. Rarely, surgical intervention may be necessary if conservative methods fail or if the patient shows signs of instability due to severe bleeding. In this patient's case, conservative measures resolved the symptoms within three weeks, allowing a full return to sport.<br /><br />Prompt ultrasound evaluation is crucial in diagnosis, reducing the risk of delays in treatment and facilitating a swift return to activity. The case underscores the importance of accurate diagnosis and appropriate management in athletic settings to prevent prolonged recovery and facilitate safe return to play.

Keywords

volleyball player

abdominal pain

rectus sheath hematoma

Carnett's sign

ultrasound diagnosis

conservative management

athletic injury

muscle tear

risk factors

return to sport