Pre-Participation Physical Exam in Athlete - Knee & Sports

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
  - should include complete list of current and past illnesses and injuries along with prior treatments
  - all current OTC and prescription medications and supplements should be listed
  - family history and past symptoms are paramount for identifying potentially lethal conditions
  - document instances of only a solitary remaining organ in a paired-organ system (e.g., single kidney, single enucleation).
- Physical examination
  - height, weight, and body mass index (BMI) , vital signs
  - visual acuity
  - lung exam
  - musculoskeletal exam with focus on regions of prior injury or surgery
  - male genital examination for inguinal hernia, testicular mass, and undescended testis
  - scoliotic curve
- EKG's, urinalysis, CBC, ferritin, or chest radiographs presently not indicated for routine screening in the USA
- athletes are then assigned one of the following:
  - clearance without restriction
  - cleared with further evaluation recommended
  - cleared with restrictions
  - not cleared for participation

Examination Red flags
- Exertional dizziness
- Diastolic murmurs, systolic murmurs (grade 3 or greater)
- Cardiac murmur worse with valsalva (may indicate HOCM)
- 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

Action	Numeric Key	Letter Key	Function Key
Show Bullets		S	Enter (frontside only)
20%	1	N
40%	2	H
60%	3	F	Enter (backside only)
80%	4	E
100%	5	M
Toss	0	T