Grade III Splenic Laceration After a Ground-Level Fall in a Pediatric Patient: The Need for Return-to-Play/Activities Protocols for Individuals With Splenic Injury or Splenomegaly

Splenic injury is a potentially fatal injury if left undetected or untreated. Although most splenic injuries result from a traumatic event, it is important to consider if one's history (past or present) increases their risk for splenic injury (i.e., splenomegaly). We present a case regarding a school-age child who presented to the Emergency Department (ED) with abdominal pain following a ground-level fall onto a carpeted stair step. Prior to this injury, the patient had cold-like symptoms for 3 months that were treated solely with supportive care by their pediatrician(s). A transferring hospital's abdominal CT imaging revealed a grade III splenic laceration. The patient was monitored in the pediatric intensive care unit (PICU) by way of serial abdominal examinations, vitals, and labs. When the patient was cleared for discharge, it was recommended to refrain from strenuous activity for 1-2 months due to the risk of repeat splenic injury. Post-discharge, the patient's Epstein-Barr virus (EBV) serology returned and was consistent with a past infection which was an inconclusive finding. Although trauma is most commonly the culprit of splenic injuries, it is important to keep differentials broad when considering causes of splenomegaly as this may allow healthcare providers to potentially prevent injury/provide appropriate management post-injury and guide return-to-play recommendations.

Functional Rehabilitation and Return to Play After Arthroscopic Surgical Stabilization for Anterior Shoulder Instability

BACKGROUND

There exists limited objective functional return-to-play criteria after surgical stabilization for anterior shoulder instability in the competitive athlete.

HYPOTHESIS

The proposed functional rehabilitation program and psychological evaluation after arthroscopic Bankart repair will help athletes return to sport with a decreased redislocation rate on return.

STUDY DESIGN

Case series.

LEVEL OF EVIDENCE

Level 4.

METHODS

Participants were contact or overhead athletes at the high school or collegiate level. Each underwent arthroscopic Bankart repair after a single dislocation event, with less than 10% glenoid bone loss. Western Ontario Shoulder Instability Index (WOSI) scores, Single Assessment Numeric Evaluation (SANE) scores, and American Shoulder and Elbow Surgeons (ASES) scores were evaluated pre- and postoperatively. Athletes were only allowed to return to competition after completing the proposed functional and psychological rehabilitation protocol.

RESULTS

A total of 62 participants were enrolled (52 male, 10 female; average age, 18.7 years (range 16-24 years); mean Instability Severity Index Score, 5.63 ± 0.55). All returned to sport for 1 full season and completed a minimum of 2 years of follow-up. The average time to pass functional testing was 6.2 ± 0.7 months, psychological testing was 5.2 ± 0.5 months, and return to sport was 6.5 ± 0.7 months. SANE scores improved from 44.3 to 90.0, ASES from 45.5 to 89.3, and WOSI from 1578.0 to 178.9 (all P < 0.001). Redislocation rate was 6.5% (4 of 62).

CONCLUSION

The proposed functional rehabilitation and psychological assessment protocol is safe and effective in returning athletes to sport after arthroscopic surgical intervention for anterior shoulder instability. This demonstrated a low redislocation rate after 2-year follow-up.

CLINICAL RELEVANCE

Most return-to-play protocols after arthroscopic Bankart repair are centered on recovery time alone, with limited focus on functional rehabilitation, psychological assessment, and return-to-play testing parameters. To our knowledge, this is the first study to propose a dedicated rehabilitation program incorporating functional testing, psychological readiness, and return-to-play criteria for competitive athletes recovering from arthroscopic shoulder stabilization.