When a player sustains a chest injury, palpate the ribs for grating or displacement that would suggest a rib fracture. Referred pain to the shoulder tip can suggest an injury to the spleen, liver, or inferior lung. Most instances of traumatic hemoptysis involve trace amounts of blood, but be certain of where the blood came from before returning a player to the game. One time we had a football player with hemoptysis, and we thought it was from trauma during the game, but with some investigating, we found that it was a lung tumor. Patients who have nondisplaced rib fractures require a period of watchful waiting, and those who have displaced rib fractures with hemoptysis or other symptoms should be hospitalized for observation.
Some tears require surgical repair, and pneumothoraces require lung reexpansion.
If hemoptysis doesn't recur, the athlete can probably be cleared for play. Pain is a limiting factor with rib fractures. Players are pretty uncomfortable with twisting and turning. Patients who have pulmonary surgery are typically out for at least several weeks. Sometimes fitting the flak jacket under the jersey is a problem.