Sports Medicine Book

http://www.fpnotebook.com/

Pre-participation Special Circumstances

Aka: Pre-participation Special Circumstances, Sports Physical Special Circumstances
  1. See Also
    1. Pre-participation History
    2. Pre-participation Exam
    3. Station Divided Sports Physical
    4. Sports Participation Disqualifiers
    5. Sports Contact Levels (Contact Sport or Collision Sport)
    6. Sports Intensity Levels (Dynamic Sports, Static Sports)
    7. Athletic Heart Syndrome
    8. Arrhythmias in Athletes
    9. Sudden Death in Athletes
  2. Evaluation: 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
  3. Labs
    1. No general screening lab tests indicated
    2. May obtain Hemoglobin For girls in endurance sports
  4. Evaluation: 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
  5. Evaluation: 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
  6. Evaluation: Illness
    1. Blood borne pathogens (e.g. HIV)
    2. Infectious Mononucleosis (Splenomegaly)
      1. Risk of Splenic Rupture
    3. Febrile or Viral illness (Myocarditis risk)
  7. Evaluation: Closed Head Injury
    1. Repeated Concussion
    2. Strict criteria for return to Contact Sports
  8. Evaluation: Altitude
    1. History of Acute Mountain Sickness
    2. Acclimatization issues
    3. Prophylaxis (Acetazolamide)
  9. Evaluation: 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
  10. Evaluation: Disability and Special Olympics
    1. Down's Syndrome needs Cervical Spine XRay
      1. Rule-out Atlantoaxial Instability
      2. Risk of C1 and C2 dislocation
  11. References
    1. Kurowski (2000) Am Fam Physician 61(9): 2683-90 [PubMed]
    2. Mirabelli (2015) Am Fam Physician 92(5): 371-6 [PubMed]

You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree