Pre-Participation Physical

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Topic updated on 11/09/12 7:09pm
Introduction
  • AAOS, AOSSM, AFP, and AAP have collaborated to form the "Preparticipation Physical Examination Task Force"
  • Goal is to identify conditions that may predispose an athlete to injury or illness.
    • often is the only medical encounter for adolescent athletes that don't have routine physician check-ups
  • Should be performed in all athletes
  • Legal necessity for high school and collegiate participation
  • Orthopaedic history and questionnaire most useful tool for identifying musculoskeletal problems
    • identifies 75% of problems
    • family history and past symptoms are paramount for identifying potentially lethal conditions
  • EKG's, urinalysis, CBC, ferritin, or chest radiographs presently not indicated for routine screening in the USA
 
Examination Red flags
  • Exertional dizziness
  • Diastolic murmurs, systolic murmurs (grade 3 or greater)
  • History of transient quadaplegia
  • Illegal supplement use
  • Heat-related illness
  • Hypertension (> 140/90)
  • Female athleteic triad in females
    • may manifest as stress fracture, amenorrhea, or anorexia
Cardiac Screening
  • History
    • hypertrophic cardiomyopathy, sudden death, murmurs, marfan syndrome, long QT syndrome
    • athletes who suffer a sudden cardiac death most commonly have no history of prodromal symptoms
  • Physical exam
    • exertional symptoms with activity
      • may include dyspnea, angina, dizziness, palpitations
    • cardiac murmur that increases with valsalva indicates hypertrophic cardiomyopathy
      • participation contraindicated with outflow obstruction
Neurologic Screening
  • History
    • concussions, loss of consciousness, seizures, transient quadriplegia
  • Physical exam
    • neuropsychiatric testing at baseline is encouraged to serve as comparative data post-head injury

 


 

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