Pre-participation Sports Exam

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Pre-participation Sports Exam

• Andy Ashbaugh DO MPH
• UNM primary care Sports Fellow

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Disclosures

• I have a lot of student loans, and no commercial
  company is giving me money
• I have adapted slides from Dr. Daniel Day D.O.
  from Virginia Tech

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Objectives

• Understand why Pre-participation exams are done
• How to find the APS pre-participation form
• Understand the importance of the history
• Learn how to do the approved AHA/ACC
  cardiovascular exam
• Learn the 2 minute MSK exam (plus some added
  tests)

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Why do we Do pre-participation exams?

• Detect conditions that may predispose athletes to
  injury or worse.
• Untreated illness or injuries
• Congenital or Developmental issues
• Cardiac issues
• Detect conditions that may limit safe
  participation
• Medications/Supplements
• Illicit drug use
• Eating habits/Menstrual disorders
• Hearing/Vision Problems

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Why do we Do pre-participation exams?
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Why do we Do pre-participation exams?

• Secondary Objectives
• General Health Screen For a lot of athletes,
  this is the only exam they get (some studies
  showing up to 80)
• Offers a good opportunity for a general health
  exam or well child check

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Evidence for pre-participation exams
No Evidence that PPEs reduce death rates.
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Practical Issues

• Patient comes in for a sports physical and does
  not have the form

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www.aps.edu
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History

• A good history can identify over 75 of problems

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It is prudent to ask if the athlete filled out
the form or their parents. There is only a 39
correlation between the athletes answers and the
parents.
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What are the Cardiac causes of Sudden death in
young athletes.

• HOCM
• Arrhythmogenic Right Ventricular Cardiomyopathy
• Pre-excitation/Conduction diseases (WPW)
• Ion channel diseases (brugada)
• Annual Incidence is about 1-2 per 200,000 athletes

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Concussions

• About 2 million TBIs per year, of which 21
  occur in high school athletes
• Account for about 13 of all high school athletic
  injuries
• Most commonly occur in football and womens soccer

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Concussion Hx

• Important to find out how many they have had
  (there is no that will disqualify them)
• Find out how long they were out and what there
  return to play protocol was and how long it took
• Important to know that there is no equipment that
  will prevent concussions.

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Female athletic Triad

• Disordered Eating/Energy Deficiency
• Menstrual Irregularities
• Bone Loss/Osteoporosis (stress Fxs)

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Questions Thus Far?
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Physical Exam
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Physical Exam vitals
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Physical Exam Blood pressure
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Physical Exam Visual Acuity

• Anything under 20/50 is acceptable
• If 20/50 or greater in either eye or both, need
  to make sure their vision is correctable
• If vision not correctable, athlete needs to wear
  protective eyewear

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Physical Exam Appearance

• Looking for Marfanoid appearance

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Physical Exam HEENT

• Consists of visual acuity, PERRL, oropharynx,
  hearing, throat, lymph nodes

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Physical Exam Respiratory

• Normal examination, can adjust based on athletes
  history

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Physical Exam Cardiac
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Physical Exam Cardiac

• Murmurs
• Laying supine Increases preload innocent
  still/flow murmur will increase
• Standing/Valsalva decreases preload pathologic
  murmur (HOCM) will increase
• Pulses
• Check Radial and Femoral at same time
• If femoral pulse weaker than radial, concern for
  coarctation

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Physical Exam Cardiac

• What about getting an ECG
• They are greater than 90 for specificity and
  sensitivity for pathologic heart findings if read
  by physicians trained in reading ecgs for
  athletes
• Large study ongoing in Seattle
• These diseases have a very low incidence, have to
  weigh cost of test vs burden of disease
• Has to be a system in place to handle abnormal
  tests. How many of your pediatric patients can be
  seen quickly by a pediatric cardiologist?

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Physical Exam GI

• Evaluating for Hepatomegaly or Splenomegaly

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Physical Exam Skin

• Looking for anything contagious (Fungal,
  Molluscum)

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Physical exam Neuromuscular

• 2 minute MSK exam
• I incorporate Neuro exam with MSK exam

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2 minute MSK exam 97 spec, 51 Sens
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Physical exam Neuro

• DTRs, Sensation, Balance

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Physical Exam

• My neuromuscular exam
• I need a volunteer

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Questions?