Sam Darnold of the New York Jets was out of action for some time due to mononucleosis. Actually, he wasn’t sidelined because of mono, he was kept off the field because there isa risk of a ruptured spleen after mono.
Mononucleosis is fairly common in teenagers and young adults. I’d like to present today some quick facts about mono, what happens to the spleen aftermono, the risks from a ruptured spleen, and general guidelines for return to sports.
What is mononucleosis, or ‘mono’?
Mononucleosis is a viral illness, usually caused by the Epstein-Barr virus. The classic appearance includes fever, throat inflammation, and enlarged lymph nodes in the neck. You’ll generallyfeel crummy with fatigue, lack of energy, and headaches. These symptoms usually last around 3 weeks but can stretch out to 8 weeks.
Mono is transmitted through saliva, or even a cough orsneeze. An experienced physician can usually make the diagnosis based on a physical exam. Confirmation can be made through a blood test called a
Treatment for monoinvolves rest, hydration, proper nutrition, and over the counter pain medication such as Tylenol, Advil or Aleve.
The problem for contact and collisionsports: risk of a ruptured spleen
The spleen is an internal organ located on the left side of the body toward the back, just above the lower margin of the rib cage.It’s a vital organ that’s part of the immune system. It serves as a filtration source for blood cells and a storage site for infection-fighting white blood cells.
In mono, thespleen becomes enlarged, typically by 4x or 5x. When the spleen is enlarged it extends below the protection of the rib cage and is vulnerable to injury. A hit to the left lower back is the classicmechanism to injure the spleen, but interestingly more than 85% of spleen ruptures occur without contact.
If the spleen is injured it can split apart (rupture), which can be a life threateningemergency. It’s estimated that the death rate from a ruptured spleen could be as high as 9%, although with proper emergency care the death rate is substantially lower, closer to 0.1% to 0.5%.Regardless of what that actual percentage is, if you’re the one with mono you simply don’t want to take a risk that you’ll rupture the spleen.
Lower the complication rate by withholding collision and contact sports for 3-4 weeks, minimum
Because the vast majority of spleen ruptures aftermono occur without contact, there’s some controversy about the best way to determine return to play in a contact sport athlete.
There is no universally accepted method to determine appropriate return to play timelines for athletes in contact and collisionsports. The athlete will need to feel back to their normal baseline, blood tests will need to normalize, and for elite athletes we will want to see their spleen imaging (CAT scan or ultrasound) show areturn to normal size.
The decision requires input from a physician skilled in medical return to play issues in athletes. If you’re an athlete with mono, be sure to follow closely thecounsel from your regular physician, and seek specialty input if there are questions about appropriate return to play.
Key Points
• For athletes, the key issue with mononucleosis is the risk of a ruptured spleen if the athlete returns to sports activity too soon.
• Return to sport requires a minimumof 3 to 4 weeks after the start of the illness.
(Dr. Dev K. Mishra, a Clinical Assistant Professor of orthopedic surgery at Stanford University, is the creator of the
I had mono during soccer season when I was a senior in HS. I was tired, but thought it was just overwork. I didn’t miss a day. I also got knocked out in a game, then came back and scored the winning goal (this, after repeatedly asking my brother what the score was while I was on the sideline). It was the first game my soccer-hating father (old school football jock) came to see. He was a doctor, and cleared me to go back in the game. After that, he no longer called it a “sissy sport” and ended up coming to most games. Best game in my HS career. Times were different then.