Recommendations from others
Clinical Sports Medicine recommends athletes refrain from sporting activities until all acute symptoms resolve and contact sports avoided while the spleen is enlarged. No recommendation is given on determining spleen size.7
Team Physician Handbook recommends athletes do no cardiovascular work, lifting, strength training, or contact sports for 2 weeks because of the risk of splenic rupture. Activity is then gradually increased as the athlete improves. Athletes are to avoid contact or weight-lifting for 4 weeks unless they feel well and ultrasound reveals a normal-sized spleen.8
Sports Medicine Secrets advises ultrasound or CT of the spleen to be obtained if there is any suspicion of splenomegaly or if return to play before 4 weeks is contemplated. Light athletic activity may be resumed approximately 3 weeks after symptom onset if the spleen is not tender or enlarged on examination, the patient is afebrile, liver enzymes are normal, and all other complications are resolved. Contact sports may be resumed 4 weeks after symptom onset if there is no documentation of splenomegaly, the athlete feels ready, and all other complications have resolved.9
CLINICAL COMMENTARY
Mononucleosis patients should restrict strenuous activity for 4 weeks from onset
Drew E. Malloy, MD
University of Arizona Campus Health Center, Tucson
At the University of Arizona student health center, we see over 120 new cases of mononucleosis each year. No clinicians in our group can recall a single splenic rupture in 18 years. The quoted rupture rate of 0.1% based on a study of 8116 patients may be a high estimate and it is likely that most physicians go through their entire career without seeing a single case.
For our group, the value of this review was to point out the lack of correlation with illness severity, lab abnormalities, or a palpable spleen in predicting this rare event. Based on this review, we amended our patient handout to make more specific our advice about restricting strenuous physical activity for 4 weeks from the onset of symptoms.