Please enable JavaScript.
Coggle requires JavaScript to display documents.
Preparticipation Sports Evaluation (Preparticipation History (Marfan…
Preparticipation Sports Evaluation
Pre-participation Physical Evaluation (PPE)
Goal: Promote health & safety of athletes
Primary Objectives:
Screen for life threatening or disabling conditions
Screen for conditions that may predispose to injury or illness
Secondary Objectives
Establish medical home
determine the general health of the individual
assess fitness for specific sports
counseling on injury prevention & health-related issues
Schedule the exam 6-8 weeks before training starts. This allows time to evaluate, treat, or rehabilitate any identified problems
Preparticipation History
Most Important!!!
IDs 3/4 of medical & MS conditions
Standardized PPE form, endorsed by six medical societies is available
CV Hx
Sudden cardiac arrest is the leading cause of death in young athletes, accounting for 75% of all sudden deaths
Most commonly causes of death are hypertrophic cardiomyopathy (HCM) & congenital coronary artery anomalies
AHA currently recommends against routine EKG usage in asymptomatic athletes
low sens, high FP rate, limited resources, lack of trained clinicians, poor cost effect due to low dz prevalence
12-point screen
Chest pain or discomfort with exercise?
Syncope or near syncope associated with exercise?
Excessive shortness of breath or fatigue associated with exertion?
Hx of heart murmur?
Hx of elevated blood pressure?
Premature death before age 50 yo due to heart dz
Disability from heart dz in a close relative younger that 50 yo
Knowledge of specific cardiac conditions: hypertrophic or dilated cardiomyopathy, long QT syndrome, other ion channelopathies, Marfan syndrome, arrhythmias.
Auscultation of heart murmur in supine and standing position
Palpation of radial & femoral pulses
Physical stigmata of Marfan syndrome
Brachial blood pressure taken in seated position
Marfan Syndrome
Tall, lean, lanky build w/ disproportionately long arms & legs, slender fingers & toes
Loose & flexible joints
Myopia, etc
Long, thin face. Deep set eyes. Small bottom jaw. High arched roof of the mouth & crowded teeth.
May have an abnormal curve to their spine or a different shape to their chest.
Central Nervous System
These affect clearance: Frequent, exertional headaches. Seizure disorders. Concussion. Recurrent stingers/burners. Cervical cord neuropraxia.
Preseason concussion screen (Standardized Assessment for Concussion)
Chronic Diseases
Notes hx of chronic disease & elicit pertinent follow-up info
Reactive airway dz.
Exercise-induced asthma.
Diabetes.
Renal dz.
Liver dz.
Chronic infx.
Hematologic dz.
Surgical Hx
Possible dehiscence of wounds.
Remove from game if bleeding
Nutritional Issues
Inquire abt methods used to maintain, gain or lose weight.
Eating disorders or inadequate nutritional intake lead to persistent or recurrent injury, including stress fractures
Vit D deficiency has become more common in female athletes due to inadequate dietary intake &/or decreased sunlight exposure
Medication Hx
Rx, OTC medications & supplements
May reveal problems omitted in the hx, like side effects
Discuss the drawbacks of performance enhancing compounds such as anabolic steroids, creatine, stimulants & narcotics
Menstrual Hx in Females
Female athlete triad
Disordered eating
Amenorrhea
Osteoporosis
MS limitations and prior injuries
limited ROM, muscle weakness & prior injuries
Pain/soreness after activity may reflect overuse syndromes/tendonitis
Infectious Dz
Infectious mononucleosis in the last month
Risk for splenic rupture increases the first 3 weeks of illness
W/ or w/o trauma
D/c physical activity during the first month after onset
Serial abdominal u/s to assess spleen size for return to play decisions. No normal data for size, etc...
Physical Examination
General
Pt stands in front of examiner
evaluate both front & back along with posture
General body habitus
Observe for asymmetry in muslce bulk, scars, or unsusual postures
Neck
Evaluate ROM
Flex/Extend (chin to chest, look at ceiling)
Rotate from side to side & lateral bend (ear to shoulder)
Observe for asymmetry, lack of motion, pain w/ movement
Shoulder & Upper Extremity
Observe clavicles, fingers, position of shoulders, scapula, elbow
ROM screening
Fully abduct arms with palms supinated
Internally & externally rotate shoulder
Flex & extend wrist,
pronate & supinate wrist,
flex & extend fingers
Manual muscle testing
Shrug shoulders (testing trapezius)
Abduct to 90 degrees (testing deltoid)
Flex elbow (testing biceps)
Extend elbow over head (testing triceps)
Test wrist flexion & extension
Have pt grasp fingers
Back
General inspection
ROM
Gait & Lower Extremity
Gait
Toe-walk & heel-walk for short distance
Check tandem walking
Skin
Vision
Abdomen
Hepatosplenomegaly
Genitourinary System
Testicular abnormalities or hernias
Self-check testicular exam
Neurologic System
Coordination, gait & mental processing
Sexual Maturity
Tanner Screening
After medical evaluation, make recommendations
Cleared for all sports
Without restrictions
With restrictions: recommendations for further evaluation or treatment
Not cleared: pending further evaluation, for any sports, or for certain sports