function of preparticipation sports physical
maximize safe participation
identify medical problems with risks to the athlete or another participant during participation
identify conditions requiring treatment before participation
remove unnecessary restrictions on participation
should the PPE serve as a sub for comprehensive health maintenance?
no
ugh
when to do a PPE
best within 6 weeks of a season
not at a station exam ideally
neurocognitive testing in athletes
impact or immediate post-concussive assessment and cognitive testing is the most common
computer based - takes 30 min
get a baseline test for athletes 12 and older before season begins
problems with neurocognitive testing system
athletes can “game” the test to get a low score so can return to play
should not replace clinical signs and symptoms
bleeding problems in athletes
important in patients who want to play contact sports
mononucleosis - spleen size peaks at one month
recent infections that are important to be aware of in athletes
mono hep B HIV -5-7 mil cases worldwide -first stage is asymptomatic -recurrent infections?
important PMH components to be aware of in athletes
sickle cell trait history
-extreme heat and exertion may be a risk
congenital or acquired absence of a kidney
-contraindications for contact sports questionable
congenital or acquired absence of a testicle
-mandatory protective cup use
history of a seizure disorder
-water sports athletes need full evaluation
female athlete triad
amenorrhea
anorexia (disordered eating)
osteoporosis
primary amenorrhea
no menses by 16
secondary amenorrhea
no menses for >6 months after onset
heat illness in athletes
feeling faint or dizzy in heat, can cause heat exhaustion
athletes tend to have recurring problems
water > sports drinks»_space;> energy drinks
symptoms with exercise requiring further evaluation
syncope (cardiac, neuro, endocrine)
coughing, wheezing (pulm causes, asthma, EIB)
important family history in athletes
cardiac death before age 50 (hold from participation until cleared)
asthma
diabetes
bleeding problems (contact sports)
2 main parts of PPE
MSK exam
-stress fracture history
general physical exam
components of general physical exam on PPE
mental status neuro growth parameters CV status lung exam
derm conditions in athletes
tattooing/piercings
common in athletes
-Hep C most common cause of liver transplant
-3.9 mil americans have hep C
marfans syndrome
autosomal dominant
tall, thin, arm span exceeds height
refer to cardiologist for EKG and echo
sexual maturity
determine rating
based on stage of sexual maturity, not age or size
if advancement is suspected, think anabolic steroid use (8-9% of high school seniors)
cardio exam in PPE
95% of all sports related fatalities are cardiac in nature
more than 50% of those are hypertrophic cardiomyopathy (auto dom)
patient and fam history are important
hypertrophic cardiomyopathy
disproportionate hypertrophy of the ventricular septum
most cases are previously asymptomatic
exercise induced bronchospasm
90-100% of asthmatics have EIB difficulty breathing during and/or immediately after exercise loss of FeV1 of at least 15% worse in summer and fall pollution can exacerbate
important points of an orthopedic exam in the PPE
recognizing any preexisting injuries
define injury patterns
identify areas of injury susceptibility
develop rehab strategies to prevent injuries from occurring
stance / symmetry instructions
stand with arms at sides
stance/ symmetry abnormalities
enlarged AC joint
enlarged sternoclavicular joint
asymmetrical waist
asymmetrical shoulder height
neck exam instructions
look at ceiling (c spine extension)
look at floor (c spine flexion)
touch R & L ears to shoulder (lateral flexion)
turn head R & L (rotation
neck exam abnormalities
limited flexion, extension or rotation
components of back exam
inspection (scoliosis)
flexion (pain = disc prob)
extension (pain = posterior element problem)
rotation (pain = paraspinous muscle problem)
reflexes
spondylosis
back pain with extension
worsens with activity
common in extension sports: ballet, gymnastics, skating, line man of football, volleyball
scoliosis screen and lower extremity assessment abnormalities (standing)
shoulder asymmetry
prominent rib cage
waist curve asymmetry
wasting thigh or calf muscles
back extension exam instructions
lean back as far as possible
observe back flexibility
scoliosis screen and lower extremity assessment abnormalities (bending at waist)
rib asymmetry
spinal curvature
wasting calf or thigh muscles
pain
shoulder strength exam instructions
shrug shoulders while examiner holds them down
expect symmetrical muscle bulk and strength
shoulder exam abnormalities
indicators of neck and shoulder concerns:
loss of strength
loss of muscle bulk
arm / shoulder strength exam instructions
hold out arms and lift up while examiner hold them down
expect equal muscle bulk and strength in both arms
arm / shoulder strength exam instructions abnormalities
loss of strength
wasting of deltoid muscles
shoulder external rotation exam instructions
hold arms out from sides with elbows bent 90 deg
raise hands back as far as they can go
shoulder external rotation exam abnormalities
may indicate shoulder problem or old dislocations
-loss of external rotation
shoulder internal rotation exam instructions
hold arms to side, elbows bent 90 deg
pull hands downward, palms facing backward
shoulder internal rotation exam abnormalities
limited rotation
elbow range of motion exam instructions
hold arms out from sides, palms up
straighten elbows completely, bend completely
elbow range of motion exam abnormalities
may indicate old elbow injury
loss of extension or flexion
elbow/forearm/wrist assessment instructions
hold arms down at sides with elbows bent 90 deg
supinate palms
pronate palms
hand/finger assessment instructions
make a fist
open hand and spread fingers
hand/finger assessment abnormalities
protruding knuckles
swollen or crooked fingers
calf strength and Achilles tendon assessment
stand on heels, then on toes
calf strength and Achilles tendon assessment abnormalities
calf asymmetry - muscle wasting
limited ankle flexion
knee flexion / extension assessment instructions
squat on heels ; duck walk 4 steps, stand up
expect painless movement, equal heel to butt distance, equal knee flexion, rises straight up
knee flexion / extension assessment abnormalities
inability to flex knees
inability to stand up without twisting or bending to one side