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Pre-Participation Physical

Topic updated on 09/23/14 10:52pm
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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