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Updated: Dec 24 2022

Pre-Participation Physical Exam in Athlete


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  • 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
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