Risk of Ruptured Spleen in Contact Sports
Linking Infectious Mononucleosis to Spleen Injury
Infectious mononucleosis is a fairly common viral infection affecting young people. The symptoms of the disease include headache, fatigue, loss of appetite, and muscle soreness. These symptoms are soon followed by sore throat, swollen lymph nodes, and mild to moderate fever.
The danger in athletes is that the spleen may become enlarged in some patients placing the patient at risk for a ruptured spleen in the event of a contact injury. According to Dr. Bryan W. Smith, M.D., Ph.D., “fifty percent of persons who contract mono develop an enlarged spleen or splenomegaly between day 6 to day 21 of the illness” (Sports Sciences Feature: Infectious Mononucleosis, February 1, 2005).
Purpose of the Spleen
The spleen is located in the upper left quadrant of the abdomen. The purpose of the spleen is to filter and store blood. In the event of a rupture, the contents of the spleen are released into the abdominal cavity causing severe blood loss. If not recognized and treated immediately, the injury can be life-threatening.
Determining whether the spleen is enlarged can be done with an abdominal ultrasound. However, unless a baseline ultrasound is on record, there is no way for the physician to determine if the size of the spleen is abnormally large or if the spleen is naturally large for athlete. Second, the ultrasound provides only a picture of the spleen at the time the ultrasound was taken. The size of the spleen can change within hours and days of the original ultrasound during the course of the disease.
Spleen Can Mask Injury
A unique physiological fact about a ruptured spleen is that the organ has the ability to splint itself. This means that the spleen can be ruptured, begin to bleed out, than splint itself to reduce the bleeding. This can mask the original injury.
This is a potentially dangerous scenario because an athlete will present himself with signs of internal bleeding and shock and then the symptoms may dissipate leading the athlete to believe that there is nothing seriously wrong. If the athlete continues to participate in sport activity, a small collision may be enough to restart the internal bleeding sending the athlete into a life-threatening emergency.
The key to reducing the incidents of ruptured spleen in sports is to ensure that athletes diagnosed with infectious mononucleosis do not participate until they are cleared by their physician. Because athletes may develop an enlarged spleen between 6 and 21 days from the start of the illness, Dr. Bryan Smith recommends that athletes not be allowed to participate in contact sports during this time frame (Sports Sciences Feature: Infectious Mononucleosis, February 1, 2005).
Defining a "Contact" Sport
Defining what a “contact sport” is can also be a grey area. Contact does not only mean between two athletes as seen in football and soccer. Contact injuries can also occur in sports in which the athlete is at risk for contact as in the sport of baseball (collision between a base runner and a catcher), but in which contact is not the main focus of the sport.
Contact injuries can also occur in volleyball as the result of contact between the athlete and the floor during a diving technique. All aspects of the sport need to be carefully analyzed to determine if the athlete may be at risk to compete.
Once the athlete has been cleared by her/her physician to participate, the athlete should be gradually reintroduced to sport activity. The athlete’s stamina and endurance may determine the extent to which the athlete can progress.
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