Return to Play After Liver and Spleen Trauma

Abstract

Context:Sport-related spleen and liver injuries pose a challenge for the physician. Although rare, these injuries can have serious and even life-threatening outcomes if not accurately diagnosed and managed in a timely fashion. Currently, there are no evidence-based guidelines on duration and intensity of restricted activity and return to play after spleen and liver injury. In addition, there is controversy on follow-up imaging after injury.Evidence Acquisition:PubMed was searched using the terms splenic or spleen and trauma and hepatic or liver and trauma from 1980 to 2013. The citations from sentinel papers were also reviewed.Study Design:Clinical review.Level of Evidence:Level 3.Results:Ultrasound is ideal in the unstable athlete. Nonoperative management of blunt splenic and hepatic injuries is recommended for hemodynamically stable patients regardless of injury grade, patient age, or presence of associated injuries. Follow-up imaging is not routinely recommended unless clinically indicated. Athletes may engage in light activity for the first 3 months after injury and then gradual return to unrestricted activity as tolerated. High-level athletes may choose splenectomy or serial imaging for faster return to play.Conclusion:Intravenous contrast-enhanced computed tomography is the diagnostic imaging modality of choice in stable athletes with blunt abdominal trauma.Strength-of-Recommendation Taxonomy:C.

Management of blunt hepatic and splenic trauma in Austria: a national questionnaire study

“…Clancy et al reported that patients with higher-grade injuries were more likely to receive follow-up imaging during their period of in-hospital stay. Although CT-based documentation of complete organ healing was once standard of care, follow-up CT is no longer recommended unless clinically indicated [20]. Lynch et al [21] prospectively showed that the average time to sonographic healing in AAST grade I, II, III, and IV injuries was 3, 8, 12, and 21 weeks, respectively.…”

Non-operative management of blunt hepatic and splenic injuries–practical aspects and value of radiological scoring systems

“…Restitution of a simple liver laceration and sub-capsular hematoma occurs within 2 to 4 months, whereas complex injuries require up to 6 months [47]. Some experts recommend return to unrestricted activity only after a normalised CT, usually 3 to 6 months after injury [48]. Most authors relate

The recommended period of reduced activity is related to the severity of injury

the recommendation of reduced activity to the severity of injury.…”

Musculoskeletal and Sports Medicine Physical Medicine and Rehabilitation Curriculum Guidelines

“…Provide a guideline of return‐to‐play guidelines after splenectomy [21]. Describe the common presentation for blunt bladder trauma, including inability or difficulty voiding, gross hematuria, suprapubic or abdominal pain [22]. •Return to play [21]. Be familiar with the literature and controversy that there is no consensus on return to play, including duration and intensity, after splenic and liver injury.…”

“…Describe the most common location of pain after a liver injury due to blunt abdominal trauma and the associated referral pain pattern. Provide a guideline for return to play [21]. Describe the Kehr sign and the common presentation after a splenic injury.…”

“…Provide postsplenectomy precautions. Provide a guideline of return-to-play guidelines after splenectomy [21]. Describe the common presentation for blunt bladder trauma, including inability or difficulty voiding, gross hematuria, suprapubic or abdominal pain [22].…”