Transcript Document
Valerie Robinson D.O. The Goals The goal of the preparticipation sports physical is to maximize safety of participants. Identify life-threatening medical problems. Identify and treat other medical problems that may interfere with participation. (e.g. asthma, HTN) Identify previous injuries and try to prevent subsequent injuries It does not substitute for a well child check. The Exam Most schools require annual physicals Exam 4-6 weeks before sports season starts May be done by the PCP May be done in a station approach at locations set up by the school or local health department Targeted medical hx Targeted family hx Target physical Emphasis on musculoskeletal and cardiovascular Labwork is not necessary Given that 30-78% of adolescents have a sports physical in lieu of a well child check, it may be appropriate to take the time to perform a complete check-up as well. If performed in a private office, the physician may ask about drug use, sexual activity, violence, and mental health (e.g. depression or bullying) as part of a comprehensive check-up The History Medical history Seizure, excess fatigue, shob Injury history Where, when, lingering effects?, LOC Pain, paresthesia, decreased ROM Cardiovascular history HTN, murmur, dyslipidemia, myocarditis, endocarditis, rheumatic fever, syncope, near-syncope, angina, palpitations Family history Especially cardiac or sudden death, Marfan’s, syncope, SIDS Surgical history Medications Immunization history Menstrual history History of weight changes The Physical Vitals, BMI Low BMI, bradycardia, hypotension, hypothermia are symptoms of an eating disorder HEENT – need acuity test If corrected acuity <20/40, need protective eyewear Lungs - auscultate Abdomen - splenomegaly Genitals – testes, discuss cup Skin – anything contagious? (herpes, varicella, scabies, tinea corpora, molluscum contagiosum) Lymphatic – lymphadenopathy, splenomegaly Neuro – cranial nerves, focal defecits The Physical The Cardiac Exam Pulse and BP, right arm while sitting Auscultation done supine and standing Innocent murmur – systolic, decreases when standing Hypertrophic cardiomyopathy – may have no murmur. Systolic, increases when standing and with Valsalva, decreases with squatting Aortic stenosis – ejection murmur, split S2, murmur may radiate to carotids Mitral prolapse – midsystolic click, poss late systolic murmur Locate PMI Asymptomatic bradycardia (40-50 bpm)may be present in fit athletes - does not preclude activity EKG is not recommended for screening purposes The Physical Musculoskeletal If hx of injury, pay special attention to area involved Look for asymmetry Look for swelling, bruising, deformities Watch for and ask about pain during exam Test for weakness Look for atrophy and watch for fasciculations Shoulder The Physical Musculoskeletal 2 Full abduction, flexion, external rotation Resisted flexion and abduction, apprehension test Elbow Flexion, extension, supination, pronation Hands Flexion and extension of fingers, grip strength Neck Flexion, extension, rotation, sidebending Back The Physical Musculoskeletal 3 Look for scoliosis, spondylolysis Flexion, extension, rotation Hip Flexion, extension, walk “Duck walk” tests the hip and knee Knee Flexion, extension, walk, “duck walk” Check for Osgood-Schlatter Ankle Hop several times on each foot Tx Before Participating HTN DM 1 or 2 Asthma Exercise-Induced Bronchospasm Dx by H&P. Spirometry or exercise challenge as indicated Eating disorders Treat psych. Cut exercise in half, esp. if 85% of IBW Musculoskeletal injuries Physical rehabilitation Plan for return to activities. “Start low. Go slow.” Relative Contraindications Mitral prolapse – May participate UNLESS Hx of syncope Fam hx of sudden death d/t prolapse Arrhythmias Moderate or greater mitral regurg Hx of emboli Uncontrolled HTN Fever Sudden Death Sudden death in the young athlete occurs with a prevalence between 1:100,000 and 1:300,000. 90% of deaths are in males, median age 17 Causes: Hypertrophic cardiomyopathy Wolff-Parkinson-White – delta waves, SVT Long QT syndrome Aortic stenosis – more common in Marfan’s Commotio cordis – precordial blow disrupts heart rhythm Coronary artery anomalies Right ventricular hypertrophy Myocarditis Aortic rupture Refs Albert C Hergenroeder, MD et al. “The preparticipation sports examination in children and adolescents.” UpToDate. Updated July 11, 2012. www.uptodate.com Stephen G. Rice, MD, PhD, MPH et al. “Medical Conditions Affecting Sports Participation.” Pediatrics Vol. 121 No. 4 April 1, 2008 , pp. 841 -848. Retrieved from http://pediatrics.aappublications.org Form: “Preparticipation Physical Evaluation Forms.” American Academy of Pediatrics. http://www.aap.org/en-us/professionalresources/practice-support/Pages/PreparticipationPhysical-Evaluation-Forms.aspx