This episode features the sports medicine department. We discuss a systematic review of the treatment of musculoskeletal pain, and a meta-analysis of the timing of splenic rupture.

Presenters: Rebecca King, MD and Laura Shaffer, MD, Wellspan Health Sports Medicine Fellows.
Hosts: Giselle Aerni, MD and Sonya Del Tredici, MD
Producer: Robert Stuntz, MD

Dr. King presented the article What does best practice care for musculoskeletal painlook like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review.Lin I, Wiles L, Waller R, et al. Br J Sports Med 2020;54:79–86.

This article collects several Clinical Practice Guidelines from around the world addressing different MSK complaints to create a set of common recommendations that can be applied broadly to all MSK conditions. The authors find 11 consistent recommendations, based off of high-quality evidence, to aid in the treatment of MSK conditions in general. Essentially, the recommendations emphasize the importance of a thorough history and physical exam, discourages the use of unnecessary imaging studies, and highlights the importance of excellent patient education and communication with an early return to activity and exercise.

AGREE II tool link: https://www.agreetrust.org/agree-ii/

Dr. Shaffer presented the article Association of Splenic Rupture and Infectious Mononucleosis: A Retrospective Analysis and Review of Return-to-Play Recommendations Sylvester JE, Buchanan, BK, Paradise SL, Yauger JJ, Beutler AI. Sports Health, Nov-Dec 2019. v. 11 no. 6, pp 543-549.

Why is this study important?

Something that can be managed across medical disciplines. Splenic rupture (although rare) is a very serious medical emergency. Current guidelines for RTP are 21 days from symptom onset. Based off case reports.

What are the results?

Of the 42 cases meeting inclusion criteria, the overall mean to splenic rupture was 15.4 days with SD of 13.5 days. 73.8% of splenic ruptures occurred by 21 days (current standard), leaving over 25% of cases yet to occur. 90.5% occurred by 31 days. 80.5 cases were reported as atraumatic.

When assessing just the traumatic rupture cases, the mean time to rupture was 22.9 days and included things like running, fall, or abdominal blow. Most cases of IM were laboratory confirmed after their traumatic splenic rupture.

35 of the 42 cases also had documented information regarding their return to sport/activity post-illness. 71.4% returned to pre-activity/sport level. Of those, nearly half did so within 90 days and nearly 3/4ths did so within 180 days.

How will this study help us in patient care?

This study shows that 1 in 4 splenic ruptures are occurring after the current return to play recommendation of 21 days after symptom onset. This challenges the current guidelines.