Ranger's Injury Leaves Him Down but Not Out

There are a few basic organs that define a top-flight pro hockey player.

Good lungs. Sharp eyes. A healthy heart that can pump hard through a demanding shift.

But an intact spleen?

Such might have been the question that the New York Rangers' Sean Avery asked himself after doctors at St. Vincent's Medical Center in Manhattan diagnosed him with a lacerated spleen early Wednesday morning.

Avery, 28, injured during Tuesday night's game, will not play for the rest of the hockey season. Doctors say that even though his injury is rare for an athlete, he is likely to make a full recovery -- with his spleen intact.

"I think it was probably an unfortunate event -- a fluke," said Mark Hutchinson, a professor of orthopaedics and sports medicine at the University of Illinois at Chicago.

While he did not treat Avery, Hutchinson said he believes "he has a very good chance of coming back into play."

Out for the Count

While athletes, especially ice hockey players, are prone and even expected to take a beating as part of their game, any sport that involves blows to the abdomen or playing with sticks puts players at risk for spleen injuries.

The organ's main functions are filtering blood, breaking down old red blood cells and producing some of the body's infection-fighting white blood cells.

"People do OK without this [organ]. It's not like without it you are a shut in," said Dr. Stephen Rice, director of the Jersey Shore Sports Medicine Center. "But if you lose the spleen … in general, the immune system is going to get a heavy hit."

Although lacking a spleen is not deadly, doctors maintain that it is very important for the role it plays in keeping the body robust and free from infections.

A tear such as the one Avery may have sustained would cause swelling, discomfort and pain.

But Avery is known for being verbally aggressive on the ice, a calculated strategy to invite blows from opponents and draw penalties. His injury may lead Avery to rethink his strategy in the future.

The spleen, located behind the lower left portion of the rib cage, is protected by the abdominal wall, the rib cage and a tough membrane. The membrane might remain intact even if the spleen tears, which experts say is likely the type of injury Avery had.

Because Avery finished the game and was not diagnosed until several hours later, experts believe his injury was probably a tear in the spleen rather than a tear in both the spleen and the membrane.

"He would have been symptomatic immediately" if it was the latter, Rice said.

And treating a serious tear can be a problem. Because the spleen is such a soft structure, it cannot be stitched up easily. A ruptured spleen would have resulted in significant bleeding into the abdominal cavity, causing the body to go into shock within minutes. In this case, the spleen is removed.

Torn Up

But a torn spleen, swollen from blood seeping into the space between the organ and the covering, will still take several weeks to months to scar and become safe. This situation is particularly dangerous for an athlete because swelling causes the spleen to poke out from under the rib cage, leaving it unprotected by anything except the abdominal wall.

"When it really stretches, then it extends below [the] rib cage and is exposed to trauma from the abdomen," Rice said.

Pressure on the stomach or excessive tightening of the abdominal muscles, from activities such as holding your breath or being constipated, have a similar effect, squeezing the spleen so that it is exposed and more likely to tear.

But spleen injuries are rare in athletes because they are better equipped to absorb potentially damaging injuries than the average person.

"[Avery's] tough," said Dr. Joe Shurman, chairman of the pain committee at Scripps Hospital in La Jolla, Calif. "Athletes just do better because they are in better physical condition."

Avery is out of commission for the remainder of the season to allow his injury to heal, but many expect him to be back on the ice and to his usual self soon.

"For some people, a significant injury might make them cautious," Hutchinson said. "But he's not going to back down from anybody. … This shouldn't probably change his style of play in the future."