Sports Medicine Book

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Pre-participation Special Circumstances

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  1. Body fat analysis Indications
    1. Weight class sports
      1. Wrestling
      2. Rowing
      3. Martial arts
    2. Appearance sports
      1. Gymnastics
      2. Figure skate
      3. Diving
    3. Lean sports
      1. Distance Running
  2. Lab testing
    1. No general screening lab tests indicated
    2. May obtain Hemoglobin for girls in endurance sports
  3. Special Concerns: Exertional Syncope
    1. Risk for sudden death
    2. Evaluation
      1. Electrocardiogram
      2. Echocardiogram
      3. Graded maximal Exercise Stress Test
      4. Event Monitor or Holter Monitor
      5. Tilt table testing
      6. Electrophysiologic testing
  4. Special Concerns: Tall Athletes
    1. Tall Patient Definition (Marfan's Syndrome Risk)
      1. Male over 6 feet
      2. Female over 5 foot 10 inches
    2. Findings suggestive of Marfan's Syndrome (need 2)
      1. Family History Marfan's
      2. Cardiac murmur or mid-systolic click
      3. Kyphoscoliosis
      4. Anterior thoracic deformity
      5. Arm Span greater than height
      6. Upper to lower body ratio > 1 SD under mean
      7. Myopia
      8. Ectopic lens
    3. Further evaluation studies (for 2 criteria above)
      1. Echocardiogram
      2. Slit Lamp Exam
  5. Special Concerns: Illness
    1. Blood borne pathogens (e.g. HIV)
    2. Infectious Mononucleosis (Splenomegaly)
      1. Risk of splenic rupture
    3. Febrile or Viral illness (Myocarditis risk)
  6. Special Concerns: Closed Head Injury
    1. Repeated Concussion
    2. Strict criteria for return to contact sports
  7. Special Concerns: Altitude
    1. History of Acute Mountain Sickness
    2. Acclimatization issues
    3. Prophylaxis (Acetazolamide)
  8. Special Concerns: Female Athlete Triad
    1. Amenorrhea
      1. Primary Amenorrhea (No Menses by age 16 years)
      2. Secondary Amenorrhea (Missing 3 consecutive cycles)
    2. Bone Mineral Density
      1. Cortical Bone affected by inadequate Estrogen
      2. Stress Fractures
      3. Bone density significantly impacted by Amenorrhea
        1. Amenorrheic age 25 athlete with age 50 bone density
      4. Consider Bone Mineral Density testing with DEXA Scan
    3. Nutrition
      1. Lowest common denominator in Amenorrhea, Overtraining
      2. Adolescent female athletes often eat too few calories
      3. Consider screening with nutritional questionnaire
  9. Special Concerns: Disability and Special Olympics
    1. Down's Syndrome needs Cervical Spine XRay
      1. Rule-out Atlantoaxial Instability
      2. Risk of C1 and C2 dislocation

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